Burn injury

PREPARED BY: SAMBAD
JAGDISH
M.SC NURSING –M.S.N
BURN INJURY

INTRODUCTION
 Burn injuries occurs when energy from heat source is
transferred to the tissues of the body.
Heat may be transferred through conduction or
radiation.
A scald is burn injury caused by contact with hot liquid
or steam but the term ‘burn’ is often used to include
scald.
Most burns only affects skin. Disruption of skin can
lead to increased fluid loss, infection, hypothermia,
scarring, changes in appearance and body image.

DEFINITION
Injuries that results from direct contact with or
exposure to any thermal, chemical, electrical, or
radiation sources are termed as BURNS.
Damage to skin or tissues caused by heat, flame, or
steam.

TYPES:
TYPE
S
PRIMARY
INJURY
SECONDA
RY INJURY

CAUSES:
CAUSES
INHALATION
INJURY
THERMAL
CHEMICAL
RADIATION
BURN
ELECTRIC
AL BURN

CLASSIFICATION:
ACCORDING TO BURN DEPTH:

•FIRST DEGREE BURNS:
o It involves only
epidermis.
o Tissue will blanch with
pressure.
o It produces pink to
reddish colour on
burned skin.
o Involves minimal tissue
damage.
o S&S: redness, pain,
swelling

•SECOND DEGREE BURNS:
o It involves epidermis and
portion of dermis.
o Often involves other structures
such as sweat glands, hair
follicles.
o bright red and Blisters are
produced.
o Oedema, decreased blood
flow to tissue can lead to third
degree burn
o S&S: severe pain, swelling,
blisters
o Healing time: depend on

•THIRD DEGREE BURNS:
o It involves epidermis, dermis
and hypo-dermis.
o Both dermis and epidermis are
destroyed.
o They produce deep scars.
o Sometimes nerves ending also
may destroyed.
o S&S: charred skin or translucent
white skin with coagulated
vessels, pain may or may not
present.
o Healing time: depend on
severity. It needed to be treated

•FOURTH DEGREE BURNS:
o It involves deep injuries to
muscle, bone, tendons.
o These may occur with deep
flame, electrical or chemical
injuries.
o S&S: wound may become
blackened, depressed and
sensation is absent.
o If extremity is involved,
amputation is required.

ACCORDING TO BURN SEVERITY:

ACCORDING TO EXTENT OF BODY
SURFACE AREA:
THE RULE OF NINE:

Thermal Burn Injury
Inflammation
Histamine release
Vasoconstriction Increased Capillary
Permeability
Increased Blood Pressure Fluid Loss From
Injury Site
Increased Blood Flow To Injury Decreased
intravascular fluid

 DIAGNOSTIC STUDIES IN BURN:
DIAGNOSTIC
STUDIES
-CBC
-ABGs
-CO Hb
S.ELECTR
OL-YTES
S.GLUCOS
E
S.ALBUMIN
-ECG
-ALKALINE
PHOSPHATE
PHOTOGRP
HS OF
BURNS
-CHEST X-
RAY
-
FIBEROPTIC
BRONCHOS
COPY
-LUNG
SCAN
-BUN/Cr
-URINE
-RANDOM
URINE
SODIUM

MANAGEMENT OF BURN:
MANAGEMEN
T
IMMEDIAT
E PHASE
INTERMED
-
IATE
PHASE
LONG
TERM
PHASE

SUBSEQUENT MANAGEMENT
FIRST AID
PREVENTION OF SHOCK AND RESPIRATORY
DISTRESS
WOUND ASSESSMENT AND WOUND CARE
PREVENTION OF COMPLICATIONS AND
INFECTION
NUTRITIONAL SUPPORT
REHABLITATION
FUNCTIONAL AND COSMETIC
RECONSTRUCTIONS

FIRST AID FOR BURN INJURY:
 If the skin is not broken, run cool water over the burned
area or soak it in a cool water bath.
 Reassure the victim and keep calm.
 Cover the burn with sterile non-adhesive Bandage.
 Protect burn from friction and pressure.
 Over the counter pain medications may be used to help
relieve pain , that also help to reduce inflammation and
swelling.
 Make sure that victim is breathing. If the breathing has
stopped or the victims airway is blocked then open airway
and if necessary begin CPR.
 Do not use blanket and towel.
 Avoid breaking blisters.

DO NOT:
 Do not apply ointment, butter,
medications, fluffy cotton dressings, ice,
adhesive bandages, cream, oil, or any
household remedy to burns.
 Do not allow the burn to become
contaminated. Avoid breathing and
coughing on burned area.
 Do not disturb blisters or dead skin.

AIRWAY MANAGEMENT:
• Persons who are burned on face and neck or those
who inhaled flame, steam or smoke should be
observed closely for laryngeal oedema and airway
obstruction.
• For mild pulmonary injury, inspired air is humidified
patient is encouraged to cough so that secretions
removed by suctioning.
• For severe injury, it is necessary to remove
secretions by bronchial suctioning and to administer
bronchodilators , mucolytic agents.
• Early management may required intubation and
ventilation.
• Elevation of head and chest by 20-30 degree to

HYPERBARIC OXYGEN
THERAPY(HBOT):
 It is non-invasive mode of medical treatment.
 In which the patient is entirely enclosed in a pressure
chamber filled with oxygen at a Pressure greater than
atmosphere.
 Topical hypererobic oxygen therapy techanique
includes delivering 100% oxygen directly to an open,
moist wound at a pressure slightly higher than
atmospheric pressure through special devices.
 It is specially used in also used in the treatment of
smoke inhalation. CO has a high affinity to hemo-
globin and when it is inhaled it will bind to hemo-globin
forming compound called carboxy-hemoglobin, this will
lead to hypoxia and decreases oxygen delivery to

FLUID MANAGEMENT:
 Fluid loss is best immediately replaced through
two large caliber peripheral intravenous
catheters. An indwelling foley catheter is inserted
to monitor urine output accurately.
 Adult with >15% of burns and child with >10% of
burns BSA requires fluid resuscitation.
 *All resuscitation formulae should be delivered
as a goal directed therapy to prevent the
complications of hypovolemic shock and over-
hydration.

WOUND MANAGEMENT:
 The wound is one of cause of morbidity and
mortality of burn injuries. Until the wound is
healed, patient remains at risk of complications.
 GOALS of wound care:
 Cleanse wound & eliminate dead tissues and
debris.
 Prevent further destruction of viable skin.
 Provide for patient comfort.
• Wound dressings.

SURGICAL MANAGEMENT:
SURGERIES
DERMABRASION
SKIN
GRAFTS

DERMABRASION:
 It is the surgical procedure to
improve appearance of scars,
restore function and correct
disfigurement of injury.
 It is used to smooth scars
tissue by shaving or scarring off
the top layers
 Scars are permanent but their
appearance will improve.
 The procedure may be
performed in a dermatological
surgeon’s office or in a out-

SKIN GRAFTS:
 It is a surgical procedure in
which piece of skin from one
area to another area.
 Skin from another person or
animal is used to cover only
large burned areas.
 The skin is taken from donor’s
site, which was healthy skin
implanted at damaged recipient
site.
 That is performed under general
sanesthesia.
 This time may be 3 weeks or few
months.

ROLE OF NURSE IN BURN
MANAGEMENT:
RESTORING NORMAL FLUID BALANCE
PREVENTION OF INFECTION
MAINTAIN ADEQUATE NUTRITION
PROMOTING SKIN INTEGRITY
RELIEVING PAIN AND DISCOMFORT
PROMOTING PHYSICAL MOBILITY
STRENGTHENING COPING STRATEGIES
SUPPORTING PATIENT AND FAMILY

NURSING MANAGEMENT:
 NURSING ASSESSMENT:
 Assess airway, breathing, circulation, disability,
exposure and need for fluid resuscitation.
 Assess severity and conscious level.
 Assess for associated injuries.
 Assess for any pre-existing illness, drug therapy,
allergies.
 Establish patient’s tetanus immunization
 Body surface area burned: rule of nine.
 Depth of burn
 Circumferential extremity burns

 NURSING DIAGNOSIS:
BY LEAFLETS

ROLE OF NURSE IN
REHABILITATION:
Promoting activity intolerance
 Schedule care in a way that each person has a
periods of uninterrupted sleep.
 A good time is planned for rest, after the stress of
dressing changes and exercise.
Improving body image and self concept
 Assess the patient concern about body images
and can refer to support group.
 Help patients practice their responses to people
who may stare or inquire about their injury once
they are discharged from the hospital.

CONTINUE...
Monitoring and managing potential
complications
 Contracture may main complication which may
come after the recovery of burns.
 It may be minimized by doing or applying range
of motion exercises.
 Although there is a procedure escharotomy to
make patient relieve from scars.

PREVENTION OF BURN
INJURY:
 IN GENERAL:
 Keep matches, lighters, chemicals and lit candles out of
kid’s reach.
 Put child’s safety covers on all electrical outlets.
 Make sure especially when using irons and curl irons.
 Prevent house fires by making sure you have smoke
alarm in every level of your home and in each bedroom.
Check these monthly and change it.
 IN BATHROOM:
 Set thermostat in your hot water heater to 120 degree
farenheit, or use low medium setting.
 Always test bathwater with your elbow before use.
 Turn kids away from fixtures so they are less likely to

CONTINUE...
 IN KITCHEN:
 Turn pot handles toward the back of the stove.
 Never let child use walker in kitchen.
 Avoid using tablecloth that can pull hot drink or plate on
them.
 Keep hot drinks and foods out of reach of children.
 Never drink hot beverages when child is sitting in your lap.
 Never hold baby while cooking.
 OUTSIDE/IN THE CAR:
 Use playground with caution. If it’s very hot outside, use
equipment only in morning.
 If you leave your car seat and stroller in sun then when you
are using cover it with blanket or towel.
 Don’t forget to apply sunscreen when going outside. Use
product with SPF 15 or higher.

Burn injury

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