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Republic of the Philippines

Cavite State University
Don Severino de Las Alas Campus Indang, Cavite

S.Y. 2012 - 2013


Submitted to NORMIDIA QUION, RN, MAN Clinical Instructor

October 8, 2012

appearance. The depth of the injury depends on the temperature of the burning agent and the duration of contact with the agent. causing a fullthickness (third-degree) injury. The skin and the mucosa of the upper airways are the sites of tissue destruction. and how much body surface area that it involves. 3.BURNS The skin has an important role to play in the fluid and temperature regulation of the body. or full-thickness injuries. 1 second of contact with hot tap water at 68. CLASSIFICATION OF BURNS Burn injuries are described according to the depth of the injury and the extent of body surface area injured. Burn depth determines whether . or ionization of cellular contents. and body image. Burn Depth Burns are classified according to the depth of tissue destruction as superficial partial-thickness injuries. including the viscera. and changes in function. There are three layers: 1. Hypodermis or subcutaneous tissue. blood vessels.9°C (156°F) may result in a burn that destroys both the epidermis and the dermis. This is the layer of tissue that is most important in temperature regulation. the outer layer of the skin 2. Tissue destruction results from coagulation. Burns are categorized as thermal (which includes electrical burns). where larger blood vessels and nerves are located. If enough skin area is injured. and hair follicles reside. Deep tissues. Fifteen seconds of exposure to hot water at 56. Dermis. scarring. Burns are caused by a transfer of energy from a heat source to the body. infection. radiation. The amount of damage that a burn can cause depends upon its location.1°C (133°F) results in a similar full-thickness injury. Temperatures less than 111°F are tolerated for long periods without injury. made up of collagen and elastic fibers and where nerves. The anatomy of the skin is complex. The skin also acts as a protective barrier against the bacteria and viruses that inhabit the world outside the body. Epidermis. in the case of scald burns in adults. compromised immunity. and there are many structures within the layers of the skin. the ability to maintain that control can be lost. can be damaged by electrical burns or through prolonged contact with a heat source. deep partial-thickness injuries. or chemical. hypothermia. sweat glands. Disruption of the skin can lead to increased fluid loss. its depth. protein denaturation. Heat may be transferred through conduction or electromagnetic radiation. For example.

57-1). in some cases. the epidermis is destroyed or injured and a portion of the dermis may be injured. A full-thickness burn involves total destruction of epidermis and dermis and. or black. inflammation and fluid accumulation in and around the wound occur. The following factors are considered in determining the depth of the burn: • How the injury occurred • Causative agent. Capillary refill follows tissue blanching. underlying tissue as well. Hair follicles remain intact. it should be noted that the skin is the body's first defense against infection by microorganisms. such as flame or scalding liquid • Temperature of the burning agent • Duration of contact with the agent • Thickness of the skin Regardless of the type of burn. The wound is painful. Deep partial-thickness burns take longer to heal and are more likely to result in hypertrophic scars. The burned area is painless because nerve fibers are destroyed. as in sunburn. Moreover. Wound color ranges widely from white to red. A deep partial-thickness burn involves destruction of the epidermis and upper layers of the dermis and injury to deeper portions of the dermis. A burn is also a break in the skin. brown. and the risk of infection exists both at the site of the injury and potentially throughout the body. In a superficial partial-thickness burn.epithelialization will occur. and exudes fluid. hair follicles and sweat glands are destroyed (Fig. The damaged skin may be painful and appear red and dry. The wound appears leathery. or it may blister. Determining burn depth can be difficult even for the experienced burn care provider. . appears red.

Ammonia is a common alkali found in the home. Bases or alkali compounds have a pH greater than 7. minor scars with tissue formation Very painful 14-21 days Black Charred dry scar tissue formation No pain Grafting needed  What about electrical burns? Electrical burns may cause serious injury that is not readily apparent. muscle fibers and chemicals can be released into the bloodstream causing electrolyte disturbances and kidney failure. or sulfuric acid. hydrochloric acid. Chemical burns may be classified by their pH or acidity. brown.  What about chemical burns? Burns can also occur when chemicals are spilled onto the body and generate a reaction that creates heat. Electricity flows more easily through tissues in the body that are designed to deal with electricity.Only the epidermis has the ability to regenerate itself.  Acids are those with pH less than 7 and include common household compounds like acetic acid. flaking or peeling within 2-3 days Mild pain 3-5 days Cherry red. If significant muscle damage occurs.  . blisters. black or marble white Charred dry leathery tissue formation No pain Grafting needed 4TH DEGREE Deep Penetration Including fat. Burns that extend deeper may cause permanent injury and scarring and not allow the skin in that area to return to normal function. Characteristic Depth of Involvement 1st DEGREE Superficial Thickness Epidermis 2ND DEGREE Partial Thickness Epidermis and dermal elements 3RD DEGREE Full Thickness All elements of the skin including subcutaneous layer Tan. muscle. Nerves and muscles are "wired" for this task and often are damaged. or white and mottled Moist. Often the entry and exit points for the electrical shock may not be easily found. and bone Color Skin Surface Pain Healing Period Pink or red/erythema Dry.

 What is the significance of the amount of body area burned? In addition to the depth of the burn. though this measurement is adjusted for infants and children. back = 9%) As an example. and the palm method. The "rule of nines" is often used.EXTENT OF BODY SURFACE AREA INJURED Various methods are used to estimate the TBSA affected by burns. the Lund and Browder method. Burns are measured as a percentage of total body area affected. This calculation is based upon the fact that the surface area of the following parts of an adult body each correspond to approximately 9% of total (and the total body area of 100% is achieved):  Head = 9%        Chest (front) = 9% Abdomen (front) = 9% Upper/mid/low back and buttocks = 18% Each arm = 9% Each palm = 1% Groin = 1% Each leg = 18% total (front = 9%. . this would involve 55% of the body. the total area of the burn is significant. among them are the rule of nines. the groin (1%) and the front chest and abdomen were burned. if both legs (18% x 2 = 36%).

there is a risk that there will be enough inflammation and swelling to obstruct the airway and cause breathing problems. and there is considerable fluid and heat loss. the back of the knee. and metabolism steps up. Burns to areas of the body withflexion creases. clotting may occur. If there are circumferential burns to the chest. or toes. By dividing the body into very small areas and providing an estimate of the proportion of TBSA accounted for by such body parts. muscles. As the burn matures. mouth or neck. If the burn involves the face. The patient may go into burn or hypovolemic shock from fluid leaking into the area tissues. Physiologically the first reaction to a burn is vasoconstriction of capillaries followed by vasodilation and discharge of plasma. especially the head and legs. a method to estimate the percentage of burn is the palm method. one can obtain a reliable estimate of the TBSA burned. PALM METHOD In patients with scattered burns. the skin may scar and shorten. the tissue involved may not allow enough motion of the chest wall to allow adequate breathing to occur. dry scab made of denatured protein develops over the injured area. nerve endings. and bone. Pathophysiology Burns are generally characterized in terms of their thickness. and changes with growth. An eschar or thick. Local sepsis is likely. the face. which can destroy tissue and increase the burn thickness. but they heal because epithelial cells are not actually destroyed. nose. Deeper full thickness burns destroy the epidermis. LUND AND BROWDER METHOD A more precise method of estimating the extent of a burn is the Lund and Browder method. dermis. These burns hurt due to severed and exposed nerve endings and they generally blister. penetrating only the epidermis or deep partial thickness with epidermal and dermal involvement. which become edematous. The initial evaluation is made on the patient’s arrival at the hospital and is revised on the second and third post-burn days because the demarcation usually is not clear until then. . fingers. as the burn progresses. If circumferential burns occur to arms. preventing full range of motion of the body area. The size of the patient’s palm is approximately 1% of TBSA. the same constriction may not allow blood flow and put the survival of the extremity at risk. and the groin may need specialized care. How important is the location of a burn? Burn location is an important consideration. Hemodynamic changes can also cause systemic problems. and sometimes subcutaneous tissue. Partial thickness burns are either superficial. like the palm of the hand. legs. Within a few days cells die. which recognizes that the percentage of TBSA of various anatomic parts.


even if it seems like a minor burn. or any other remedies to the burn. or chemicals. Refer to the dosing guidelines on the label according to your child's age or weight. as these can be a choking hazard). joint surfaces. scalp.  If the area affected is small (the size of a quarter or smaller). or red streaking of the skin near the wound).  Give your child acetaminophen or ibuprofen for pain. or genitals. cold compress on the burn for approximately 3-5 minutes (do not use ice.  Do not apply butter. as these can make the burn deeper and increase the risk of infection. hands.and Third-Degree Burns:  Seek emergency medical care. any cold. pus. cover the area with a clean.or third-degree burn. For Second. The burn looks infected (with swelling. For First-Degree Burns:    Remove the child from the heat source. drinkable fluid can be used) or hold a clean. Remove clothing from the burned area immediately. This may be done a few times during the day.  Apply aloe gel or cream to the affected area.    The burn comes from a fire.  Tetanus immunization should be updated if needed. You can protect it with a sterile gauze pad or bandage for the next 24 hours (but do not use adhesive bandages on very young kids. keep it clean. The burned area is large (2-3 inches in diameter). call for medical assistance. grease. then follow these steps until medical personnel arrive: o Keep your child lying down with the burned area elevated. . For any burn that appears to cover more than 10% of the body.First aid for burns Seek Medical Help Immediately When:   You think your child has a second. soft cloth or towel. The burn may be dressed with a topical antibiotic ointment like Bacitracin or Neosporin. Run cool (not cold) water over the burned area (if water isn't available. Instead. The burn is on the face. And don't use wet compresses or ice because they can cause the child's body temperature to drop. as it may cause more destruction to the injured skin). an electrical wire or socket. powder. increasing redness.

If you're having difficulty removing clothing.  For chemical burns. you may need to cut it off or wait until medical assistance arrives. then follow instructions for second. apply a sterile gauze pad or bandage. Symptoms may vary.  If the burned area from a chemical is small. . buckets of water. depending on the type and severity of the burn and what caused it and may include abdominal pain. flush for another 10-20 minutes. you can then remove clothing from the burned area. and call your doctor. As you continue flushing the burn. flush the area with lots of running water for 5 minutes or more. For Flame Burns:     Extinguish the flames by having your child roll on the ground. Although both chemical and electrical burns might not always be visible. Apply cool water over the area for at least 3-5 minutes. shower. then cover the area with a clean dry cloth or sheet until help arrives. Remove all jewelry and clothing from around the burn (in case there's any swelling after the injury). use a tub. or a garden hose. or you also may get shocked. they can be serious because of potential damage to internal organs. Cover him or her with a blanket or jacket.  Chemical burns to the mouth or eyes require immediate medical evaluation after thorough flushing with water.o o Follow the instructions for first-degree burns. For Electrical and Chemical Burns:  Make sure the child is not in contact with the electrical source before touching him or her. Remove smoldering clothing and any jewelry around the burned area. o o Do not break any blisters.  Do not remove any of your child's clothing before you've begun flushing the burn with water. Call for medical assistance. except for clothing that's stuck to the skin. If the burned area is large.and third-degree burns.

http://kidshealth.html#  Medicine Net .Nursing Diagnoses for Burns • Acute pain related to tissue destruction and exposure of nerves in partially destroyed tissue • Compromised family coping related to prolonged disease or disability • Contamination related to infective agents at place of injury • Disturbed body image related to potential scarring • Imbalanced nutrition: Less than body requirements related to increased metabolic needs of burn healing • Impaired gas exchange related to airway burns and carbon monoxide inhalation • Impaired physical mobility related to movement limitations from scar tissue or burn treatments • Ineffective tissue perfusion (peripheral) related to: – circumferential eschar formation on arms and legs – compartment syndrome – vascular disruption • Powerlessness related to illness • Risk for deficient fluid volume related to active loss through disrupted skin • Risk for imbalanced body temperature related to infection • Risk for impaired skin integrity related to nonadherence of graft and impaired donor site healing • Risk for infection related to: – decreased perfusion – exposure to contamination – impaired immunologic response – loss of protective integument • Risk for injury related to continued exposure to heat or chemicals Reference: Book  CRRN Exam Secrets Study Guide You’re Key to Exam Success  Brunner and Suddarth’s Textbook of Medical – Surgical Nursing Internet  Kid’s Health .