Burn Injuries & Its Management  Chemical

BURNS exposure to acid, alkali or

organic substances
Wounds caused by exposure to:

1. excessive heat

2. Chemicals

3. fire/steam

4. radiation

5. electricity

TYPES OF BURNS

 Thermal  Electrical
exposure to flame or a hot object result from the conversion of
electrical energy into heat. Extent of
injury depends on the type of
current, the pathway of flow, local
tissue resistance, and duration of
contact
  Radiation

result from radiant energy being

transferred to the body resulting in
production of cellular toxins

SUPERFICIAL BURNS
(FIRST DEGREE)

 Epidermal tissue only affected

 Erythema, blanching on
pressure, mild swelling

no vesicles or blister initially

BURN WOUND ASSESSMENT
 Not serious unless large areas
 Classified according to depth of involved
injury and extent of body
surface area involved  i.e. sunburn

 Burn wounds differentiated

depending on the level of 4/1/2011

dermis and subcutaneous

tissue involved

1. superficial (first-degree)
11

2. deep (second-degree)

3. full thickness (third and fourth

degree)
 DEEP (SECOND DEGREE)  Exposure to flames, electricity
or chemicals can cause 3rd
Involves the epidermis and
degree burns
deep layer of the dermis

Fluid-filled vesicles –red, shiny,

wet, severe pain

Hospitalization required if over

25% of body surface involved

i.e. tar burn, flame

Calculation of Burned Body

Surface Area

TOTAL BODY SURFACE AREA (TBSA)

 Superficial burns are not

involved in the calculation

 Lund and Browder Chart is the

most accurate because it
adjusts for age

 Rule of nines divides the body

– adequate for initial
FULL THICKNESS (THIRD/FOURTH assessment for adult burns
DEGREE)

 Destruction of all skin layers

 Requires immediate
hospitalization

 Dry, waxy white, leathery, or

hard skin, no pain
RULES OF NINES area. Palmar surface are can be used
to estimate relatively small burns (<
 Head & Neck = 9% 15% of total surface area) or very
 Each upper extremity (Arms) = large burns (> 85%, when unburnt
9% skin is counted). For medium sized
 Each lower extremity (Legs) = burns, it is inaccurate.
18%
 Anterior trunk= 18% Wallace rule of nines—This is a good,
 Posterior trunk = 18% quick way of estimating medium to
 Genitalia (perineum) = 1% large burns in adults. The body is
divided into areas of 9%, and the total
burn area can be calculated. It is not
accurate in children.
Lund and Browder chart—This chart,
if used correctly, is the most accurate
method. It compensates for the
variation in body shape with age and
therefore can give an accurate
assessment of burns area in children.

Palmar surface—The surface area of a

patient's palm (including fingers) is
roughly 0.8% of total body surface
Lund Browder Chart used for 3. keep the client comfortable with
determining BSA analgesics

4. prevent infection through wound

care

5. maintain body temperature

6. provide emotional support

 Knowledge of circumstances
surrounding the burn injury

 Obtain client’s pre-burn weight

(dry weight) to calculate fluid
rates

 Calculations based on weight

PHASES OF BURN INJURIES obtained after fluid
replacement is started are not
 Emergent (24-48 hrs) accurate because of water-
 Acute induced weight gain

 Rehabilitative  Height is important in

determining body surface area
EMERGENT PHASE (BSA) which is used to calculate
Immediate problem is fluid loss, nutritional needs
edema, reduced blood flow (fluid and  Know client’s health history
electrolyte shifts) because the physiologic stress
 Goals: seen with a burn can make a
latent disease process develop
1. secure airway symptoms
2. support circulation by fluid
replacement
CLINICAL MANIFESTATIONS IN THE common in the trachea and
EMERGENT PHASE mainstem bronchi

 Clients with major burn injuries  Auscultate these areas for

and with inhalation injury are wheezes
at risk for respiratory problems
 If wheezes disappear, this
 Inhalation injuries are present indicates impending airway
in 20% to 50% of the clients obstruction and demands
admitted to burn centers immediate intubation

 Assess the respiratory system

by inspecting the mouth, nose,
and pharynx
SKIN ASSESSMENT
 Burns of the lips, face, ears,
neck, eyelids, eyebrows, and  Assess the skin to determine
eyelashes are strong indicators the size and depth of burn
that an inhalation injury may injury
be present
 The size of the injury is first
 Change in respiratory pattern estimated in comparison to the
may indicate a pulmonary total body surface area (TBSA).
injury. For example, a burn that
involves 40% of the TBSA is a
 The client may: become
40% burn
progressively hoarse, develop a
brassy cough, drool or have  Use the rule of nines for clients
difficulty swallowing, produce whose weights are in normal
expiratory sounds that include proportion to their heights
audible wheezes, crowing, and
stridor

 Upper airway edema and

inhalation injury are most
ACUTE PHASE OF BURN NURSING DIAGOSIS IN
INJURY THE ACUTE PHASE

• Lasts until wound  Impaired skin integrity

closure is complete
 Risk for infection
• Care is directed toward
 Imbalanced nutrition
continued assessment
and maintenance of the  Impaired physical mobility
cardiovascular and
 Disturbed body image
respiratory system
PLANNING AND
• Pneumonia is a concern
IMPLEMENTATION
which can result in
respiratory failure DRESSING THE BURN WOUND
requiring mechanical
 After burn wounds are cleaned
ventilation
and debrided, topical
• Tetanus toxoid antibiotics are reapplied to
prevent infection
• Weight daily without
dressings or splints and  Standard wound dressings are
compare to pre-burn multiple layers of gauze
weight applied over the topical agents
on the burn wound
• A 2% loss of body weight
indicates a mild deficit REHABILITATIVE PHASE OF
BURN INJURY
• A 10% or greater weight
loss requires  Started at the time of
modification of calorie admission
intake
 Technically begins with wound
• Monitor for signs of closure and ends when the
infection client returns to the highest
possible level of functioning
 Provide psychosocial support  No aspirin

 Assess home environment,  Strict surgical asepsis

financial resources, medical
 Turn q2h to prevent
equipment, prosthetic rehab
contractures
 Health teaching should include
 Emotional support
symptoms of infection, drugs
regimens, f/u appointments, DEBRIDEMENT
comfort measures to reduce
 Done with forceps and curved
pruritus
scissor or through
DIET hydrotherapy (application of
water for treatment)
 Initially NPO
SKIN GRAFTS
 Begin oral fluids after bowel
sounds return  Done during the acute phase

 Do not give ice chips or free  Used for full-thickness and

water lead to electrolyte deep partial-thickness wounds
imbalance
POST CARE OF SKIN GRAFTS
 High protein, high calorie
 Maintain dressing
GOALS
 Use aseptic technique
 Prevent complications
 Graft should look pink if it has
(contractures)
taken after 5 days
 Vital signs hourly
 Skeletal traction may be used
 Assess respiratory function to prevent contractures

 Tetanus booster  Elastic bandages may be

applied for 6 mo to 1 year to
 Anti-infective
prevent hypertrophic scarring
 Analgesics