PART I

PRELIMINARY
BURNS
A. BACKGROUND

            Approximately 2.5 million people suffered burns in the United States annually. Of this
group 200 thousand patients requiring outpatient treatment and 100 thousand patients are
hospitalized. About 12 thousand people die each year from burns and inhalation injuries
associated with burns over half of all cases of burns in hospital could have been prevented.
Nurses can play an active role in the prevention of fire and burns to teach the concept of
prevention and promote legislation on fire safety. Comprehensive nursing care is given when
there is a burn is critical for the prevention of death and disability. It is important for nurses to
have a clear understanding of the changes that are interconnected on all systems of the body
after burn injury is also an appreciation of the emotional impact of injury on burn victims and
their families. Only with a comprehensive knowledge base nurses can provide the necessary
therapeutic interventions at all stages of healing.

B. PURPOSE OF WRITING
The purpose of this paper is:
1. Knowing the major pathophysiological associated with burns
2. Knowing burns Classification System
3. Identify Key Clinical Issues in burn injury
4. Knowing the specific management of burns in Phase resuscitative
5. Develop Nursing Care Plans burn patients resuscitative phase
 CHAPTER II
REVIEW OF THEORY

2.1 BASIC CONCEPTS OF MEDICAL

A. DEFINITIONS
            The skin consists of three layers namely epidermis, dermis and subcutaneous tissue. Each
layer becomes more differentiated. The epidermis is the outermost layer, the external layer of
epithelial cells this level consists mainly of keratinocytes. Sub-cutaneous tissue or hypodermis is
the deepest layer of the skin. This layer is principally in adipose tissue that provides a cushion
between the skin layers and internal structures such as muscles and bones.
            The burn is an injury caused by the transfer of energy from a heat source to tubuh.Luka
burn is damage or loss caused tissue in contact with a heat source such as a fire, hot water,
chemicals, electricity, and radiation (Moenajat, 2001) .Luka fuel is tissue damage caused by the
heat of the body surface at high temperatures that cause a reaction on the entire metabolic
system (new edition Diet Guidebook). The burn is an injury caused by heat, electric current,
chemicals, and lightning on the mucosa, and the deeper tissues (Irna Dr.Soetomo Surgical
Hospital, 2001). Burns are injuries caused by eye contact with a high temperature such as fire,
hot water, electricity, chemicals, radiation, also because of contact with renadah temperature
(frost bite). [Capita selekta vol 2].
            Burns adaalah partially lost or damaged body tissues caused by sharp objects or blunt
trauma, changes in temperature, chemicals, explosion, electric shock or animal bites (Science
book Teaching surgery. Syamsuhidayat). The burn is damage directly or indirectly in the skin
tissue that it is possible to internal organs, which caused direct contact denagn heat source of
fire, water / steam heat, chemicals, radiation, electric current, and the temperature was very
cold .
B. Etiology
            Burns can be caused by heat, ultraviolet light, X-rays, nuclear radiation, electrical,
chemical, mechanical abrasion. Burns caused by hot fire, vapors or liquids that can burn is of
lasim encountered from severe burns. At burns the most frequent primary panyebab among
other things because of the fire, hot water, electric current, chemicals, radiation, low
temperature (frost bite), lightning strike, explosion. Complications arising from the burns,
among others, acute renal failure, pulmonary edema, SIRS (Systemic inflammatory Response
Syndrome), infection, and sepsis as well as hypertrophic scarring and kontraktur.Disebabkan by
energy transfer from the heat source to the body melelui elektromagnitik conduction or
radiation.
Burns are categorized according injurinya mechanisms include:

a) Luka Thermal Burn. Burns thermal (heat) caused by the exposure or contact with flame,
hot liquid or other hot objects.
b) Luka Fuel Chemistry. Chemical burns (chemical) caused by the ignition of skin tissue with
acids or strong bases. The concentration of chemicals, length of exposure and the
number of exposed tissue to determine the extent of injury due to this chemical.
Chemical burns may occur for example due to contact with the cleansing agents are
often used for domestic purposes and various chemicals used in industry, agriculture and
the military. More than 25,000 products are known chemical substances can cause
chemical burns.
c) Luka Fuel Electric. Burns electric (electric) caused by heat is moved from the electrical
energy is delivered through the body. Severity of injury influenced by the length of
exposure, high voltage and electrical waves that way until about the body.
d) Burn Radiation. Radiation burns caused by exposure to radioactive sources. This type of
injury is often associated with the use of radiation ion on the industry or from the source
of radiation for therapeutic purposes in the medical world. Burned by the sun for too
long due to exposure is also one type of radiation burns.
F. PROGNOSIS
           Recovery depends on the depth and location of the burn. On the superficial burns (stage I
and stage II superficial), a layer of dead skin will peel and outer layer of skin grows back cover
layers underneath. The new layer of epidermis which can grow rapidly on the basis of a
superficial burns with little or no scarring. Superficial burns do not cause damage to deeper skin
layer (dermis).
  Burns in causing injury to the dermis. The new epidermal layer that was growing
slowly from the edge of the affected area and from the remnants of the epidermis in the
injured area. As a result, recovery is very slow and can form scar tissue. The burned area is also
prone to shrinkage, causing changes in the skin and disrupt its function. Minor burns in the
esophagus, stomach and lungs will usually recover without causing problems. More severe
injuries can lead to scarring and narrowing. Scar tissue can block the way of food in the
esophagus and block the normal transfer of oxygen from the air to the blood in the lungs.

H. DIAGNOSTIC
Checks that can be done to support the diagnosis are:
1. Complete blood count
 Increased initial MHT shows hemokonsentrasi sehubung with displacement or
kehilngan fluid. Further decrease in hemoglobin and hematocrit may occur with
respect to damage by heat on the endothelium of blood vessels.
2. White blood cells
Leukocytes may occur in connection with the loss of cells in the wound and the
inflammatory response to injury.
3. GDA
Important basis for the suspicion of inhalation injury.
4. CO Hbg
An increase of more than 15% indicate poisoning CO inhalation injury.
5. Serum electrolytes
Potassium can be increased in connection with the initial tissue injury / damage HR and
decreased kidney function.
6. Sodium random urine
Greater than 20 MEqL indicate excess fluid resuscitation, less than 10 mEq / L suspect
adekuatan lack of fluid resuscitation.
7. Serum Glucose
 The ratio of albumin / globulin may be reversed with respect to loss of protein in the
edema fluid.
8. Serum Albumin
Increased serum glucose showed the stress response.
9. BUN, creatinine
Increased BUN addressing its slide-function fungai kidney.
10. Urine
 The presence of albumin, hemoglobin and mioglobulin showed tissue damage and loss
of protein.
11. The chest x-ray photos May appear normal at early though pansca burns with
inhalation injury, but the actual inhalation injury will exist at the time of the progressive
without chest film.
12. Bronkopi optical fiber  Useful in comprehensive diagnosis of inhalation injury, the result
may include edema, bleeding and / ulcers of the upper respiratory tract
13. Loop flow volume Provides non-invasive assessment of the effects / breadth of
inhalation injury
14. Lung Scan May be performed to determine the extent of inhalation xidera
15. ECG Signs of ischemia miokardiak dysrhythmias may occur in electrical burns
16. grafi photos burns Leave a note for the healing of burns next.
G. MEDICAL MANAGEMENT
     1. First Aid
a. Patients kept away from sources of trauma and if there is still fire extinguished with
water and closed with a damp cloth, when the chemicals then it is advisable to rinse
with running water, electricity must be made to power outages.
b. Reduce pain by:
 Cool the wound
 analgesic drugs
 Providing the correct position by putting a higher injury
c. Keeping the airway
d. preventing infection
Injuries that occur covered with a clean cloth or sterile.
2. Action in emergency departmentsPatients who are hospitalized are:
a. Grade II burns less than 2%
b. Sores on the face, extremities and perineum
c. Grade III burns more than 2%
d. Burns in children ari grade I over 10%
e. Burns due to high voltage power
f. Burns accompanied airway trauma
g. Burns with other diseases
Penatalaksaan others also include:
1. The first priority in addressing the burn is to stop the process of burns. This includes first
aid intervention on the situation:
a. For thermal burns (fire), "stop, lie down and roll over." Lid individuals with a
blanket and roll in a smaller fire. Give a cold compress to reduce the
temperature of the wound. (Ice or cold water causes further injury to the
affected tissues).
 b. For chemical burns (liquid), rinse with lots of water to remove kinia of the skin.
For chemical burns (powder), chemical powder brush of the skin and then rinse
with water.
c. electrical burns to turn off the power source first before attempting to separate
the victim with danger.

2. The second priority is to create an effective airway, to the client with suspicion of
inhalation injury gave 100% humidified oxygen through a mask 10 l / min. Use of
endotracheal intubation and mechanical ventilation when placed on arterial blood gas
showed severe hypercapnia though with O2 supplementation.
3. The third priority is aggressive fluid resuscitation to correct the loss of plasma volume is
essentially half of the estimated volume of fluid diberikanpada first eight hours after the
burns and the other half was given 16 hours later. The types of fluids used melipuit
crystalloid solution such as Ringer lactate and or as a colloid such as albumin or plasma.
Fluid therapy is indicated in degree burns two to three area> 25% or lien can not drink.
Fluid therapy is stopped when oral input can replace parenteral. Two common ways to
calculate the fluid requirements in patients with burns, namely:
A. how Evans
             To calculate the need on the first day count:
 Berat weight (kg) X X% burns 1cc NaCl
 Berat weight (kg) X X% burns 1cc colloidal solution
 3.2000cc glucose 5%
Half of the amount (1). (2), (3) given in the first 8 hours. The rest is given within 16
hours. On the second day given half the amount cairn first day. On the third day
given half the amount of fluids given second day. As did the counting diuresis
monitoring provision.
B. how Baxter
Is another way that is more simple and widely used. The amount of fluid needs on
the first day is calculated by the formula X =% burns weight (kg) X 4cc. Half of the
 amount of fluid given in the first 8 hours, the rest were given in 16 hours. The first
day especially diberika electrolyte that Ringer's lactate solution for hyponatremia
occurs. For the second day was given half of the first day of administration.
4. The fourth priority is the care of burns:
a. Cleansing and antimicrobial topical cream such as silver sufadiazin (silvadene).
b. The use of various types of dressing synthetic or biological dressings (skin graft),
especially on full thickness burns.
 Nursing in place of Genesis
The first priority is to stop the fire and prevent harm to self. The following
additional emergency procedures:
1. Turn off the fire
2. Cool the burn
3. Removing an obstacle
4. Closing burns
5. mengirigasi chemical burns.