A Case Study on

Superficial Partial Thickness Burn

Submitted by:
Bulan, Maricho
Cuenca, Julian

Submitted to:
Mr. Reynaldo H. Quellar Jr., RN

June 14, 2023

Practical Nursing – RLE 1

Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 1

Definition of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 2

Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3

Drug Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Nursing Care Plan . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . 8
CASE STUDY Page 1 of 8

I. INTRODUCTION

PATIENT CASE:

On 05-27-2023, a 14-year-old girl was admitted to the hospital after sustaining a second-degree
burn on her right hand due to the consequences of incidentally having close contact with hot cooking
oil. In the response given by the mother to the medical interview, the personnel was informed that they
applied petroleum jelly as initial first aid before seeking medical help. The patient's vital signs were
recorded as follows: blood pressure of 120/80 mmHg, heart rate of 100 beats per minute, respiratory
rate of 22 breaths per minute, temperature of 35.7 degrees Celsius, and oxygen saturation of 97%. The
patient has no known allergies but has an occurring illness of anemia.

BACKGROUND:

As stated in a study conducted by Tan et al., burn injuries remain a persistent public global
health concern. In the Philippines, for instance, incidents of burn victims inside homes are a concerning
reality. According to statistics, burns rank as one of the leading causes of accidental injuries within
households. Among these cases, second-degree burns are prevalent, often resulting from various factors
such as scalding liquids, open flames, or faulty electrical equipment. Unfortunately, inadequate safety
precautions and awareness contribute to the occurrence of such incidents.

Skin-degree burns, also known as thermal burns, are a common type of burn injury that
results from exposure to heat sources such as flames, hot liquids, steam, or contact with hot
objects. Understanding the clinical features, management, and outcomes of second-degree burns is
crucial for healthcare professionals, as these injuries can have significant implications on patients' well-
being and quality of life. Additionally, advances in treatment modalities and wound care techniques
have contributed to improved outcomes and reduced complications associated with these burns.
In this case study, we will be focusing on a case of second-degree burn which has been
experienced by our patient. A second-degree burn does not only damage the outer layer of the skin but
damages both the epidermis and the underlying dermis. Compared to first-degree burns, second-degree
burns involve deeper tissue damage, leading to blister formation and a longer healing process.
The symptoms of second-degree burns often present with symptoms such as redness, blistering,
swelling, and pain. The affected area may also be moist, weeping, and tender to any type of touch. On
the other hand, its blisters can vary in size and may be filled with clear fluid or blood while the
surrounding skin may appear red or mottled. Further detail about the degree shall be explained below.

CASE STUDY Page 2 of 8

 II. DEFINITION OF TERMS
BURN CLASSIFICATIONS
Burns can be classified as first, second, third-degree, or fourth-degree, depending on how
deeply and severely they may penetrate the skin's surface.

Source: https://1staidsupplies.com/how-to-treat- first-degree-burns/

First-degree burns, also known as superficial burns, exclusively impact the outermost layer of
the skin, which is called the epidermis. These burns typically manifest as red, painful, and dry areas
without blisters. An instance of mild sunburn serves as a suitable example. It is uncommon for these
burns to cause long-term tissue damage, although occasional changes in skin color, either increased or
decreased, may occur. Second-degree burns, also referred to as partial thickness burns, affect not only
the outer layer of the skin (epidermis) but also extend into the underlying layer called the dermis. These
burns are characterized by a red appearance, the presence of blisters, and possible swelling.
Additionally, they tend to be painful for the individual affected. Third-degree burns, classified as full-
thickness burns, cause damage to both the epidermis and dermis layers of the skin. In some cases, these
burns may extend into the innermost layer of skin, known as the subcutaneous tissue. The affected area
of the burn may exhibit a whitish or blackened appearance, appearing charred. Fourth-degree burns are
even more severe, as they penetrate through the layers of the skin, and underlying tissue, and
potentially reach deeper tissues such as muscles and bones. Due to the extent of damage, nerve endings
in the affected area are destroyed, resulting in a lack of sensation. Debridement is a procedure
performed to eliminate dead or infected skin tissue, facilitating the healing process of a wound. It is
also utilized to remove any foreign material present in the tissue. By removing these non-viable or
contaminated tissues, debridement promotes a healthier environment for the wound to heal effectively.

CASE STUDY Page 3 of 8

 III. LABORATORY

The laboratory test is specifically done to analyze the patient's condition of anemia.

CASE STUDY Page 4 of 8

 IV. DRUG STUDY

DRUG Class Mechanism Indications/ Side Effects Nursing Implications

of Action Contraindications

Generic Name: The exact mechanism It is contraindicated in Back, leg, or Clean the wound part
Silvadene, by which silver near-term pregnancy, stomach pain, thoroughly, change the
Thermazene sulfadiazine exerts its neonates, or infants blistering, peeling, or dressing, and apply
anti-infective activity less than two months loosening of the skin, topical ointment twice a
Brand Name: is unknown. Both free of age, and lactating blue-green to black day for seven straight
Silver silver and the mothers. skin discoloration, days.
Sulfadiazine sulfonamide moiety Intramuscular dark urine, fever
Ointment may exert activity, but injections must be with or without Monitor any new or
the drug does not administered with chills, general body increased skin reactions
Dosage: inhibit folic acid caution as they can swelling, increased at the site of application,
Pea-Sized or until synthesis as other cause bleeding, sensitivity of the skin including rash, burning,
the whole portion sulfonamides do. bruising, and to sunlight, itching, pain, and
of the burn is Silver sulfadiazine hematoma. Silver especially in patients necrosis. Report any
covered. disrupts bacteria by sulfadiazine should be with burns on large suspicious skin reactions
damaging the cell used with caution in areas, intense itching to the physician. Be alert
Route: membrane and the cell patients with glucose of burn wounds, for signs of leukopenia,
Topical wall rather than by 6-phosphate lower back or side including fever, sore
inhibiting folic acid dehydrogenase pain, nausea or throat, and signs of
synthesis. Silver (G6PD) deficiency vomiting, pinpoint infection.
sulfadiazine has a wide because sulfonamides red spots on the skin,
spectrum of can cause hemolytic skin rash, sores,
bactericidal activity anemia in patients ulcers, or painful
against both Gram- with G6PD glands, unusual
positive and Gram- deficiency. bleeding or bruising,
negative organisms. unusual tiredness or
weakness, upper
right abdominal or
stomach pain, yellow
eyes, and skin.

CASE STUDY Page 5 of 8

DRUG Class Mechanism Indications/ Side Effects Nursing Implications
of Action Contraindications

Generic Name: Naproxen blocks It is contraindicated in Chest tightness, If pain persists, take one
Naproxen arachidonate binding first-trimester difficult or labored (1) tablet every six to
to competitively pregnancy and breathing, the feeling eight hours.
Brand Name: inhibit both absolute of indigestion,
Flanax cyclooxygenase contraindication at headache, itching Naproxen is a GI
(COX) isoenzymes, thirty (30) weeks skin, pain in the chest irritant so it must be
Dosage: COX-1 and COX-2, gestation. It also below the breastbone, taken with food.
25mg resulting in analgesic concludes skin eruptions, Monitor any side
and anti-inflammatory hypersensitivity to stomach pain, effects. The patient is at
Route: effects. COX-1 and NSAID medications. swelling, risk for cardiovascular
Oral COX-2 are catalysts For patients with constipation, events and bleeding.
of arachidonic acid kidney disease, taking decrease in urine
conversion to naproxen sodium output or decrease in
prostaglandin G increases the risk of urine-concentrating
(PGG), the first step chronic kidney ability, disturbed
of the synthesis of disease. color perception,
prostaglandins and double vision, fast,
thromboxanes irregular, pounding,
involved in rapid or racing heartbeat or
physiological pulse, halos around
responses. lights, indigestion,
loss of appetite,
nausea or vomiting.

CASE STUDY Page 6 of 8

 V. NURSING CARE PLAN
CRITICAL ANALYSIS

Based on the diagnosis of a burn, the treatment plan for the patient aligns with clinical practice
guidelines. In cases of superficial burns, the use of Silver Sulfadiazine is recommended. This
medication can be applied topically to the affected areas to help prevent infection and promote healing.
By adhering to the prescribed treatment, the patient can receive the appropriate care needed for their
burn injury. It is essential to follow the guidance and recommendations of healthcare professionals to
ensure effective management and recovery.

FDAR

Focus 1 Data, Action, Response

● Center on alleviating the pain caused by
the superficial partial thickness (second-
degree) burn in her right hand.
● Data: A 14-year-old female patient was
admitted to the hospital due to a burn on her
right hand caused by contact with hot cooking
oil. The patient reported experiencing severe
pain, rating it at 10 out of 10 on a pain scale.
Upon physical examination, the second-
degree or superficial partial-thickness burn
was characterized by pain and open blisters.

● Action: To manage the burn, it is essential to

thoroughly wash hands and gather all
necessary sterile materials. The doctor will
use sterile gloves and employ wound
debridement to facilitate the growth of
healthy tissue, minimize scarring, and reduce
the risk of infections. The procedure for
treating the burn involves the following steps:
cleanse the burn area using irrigating
solutions, gently dry the skin using a sterile
gauze, apply betadine to the affected area,
rinse it again with irrigating solutions, gently
dry the skin, remove any blisters, apply
betadine once more, rinse again, gently dry
the skin, and apply Silver Sulfadiazine
ointment around the affected area. Finally, the
burn area is covered with paraffine gauze and
secured with micropore tape on top of the
dressing.

● Response/Results: After the treatment

 management, the subjective view indicated
that the patient’s pain scale lessened to 5/10
as directly reported.

Focus 2 Data, Action, Response

Risk for shock due to burn Injury Data:
● Assess burn severity and extent using
the Rule of Nines or Lund-Browder
chart.
● Determine the percentage of total body
surface area (TBSA) affected by the
burn.
● Monitor vital signs: blood pressure,
heart rate, respiratory rate, and oxygen
saturation.
● Observe clinical signs such as skin
color, temperature, mental status, and
urine output.
Action:
● Remove the patient from the source of
the burn and stop the burning process.
● Initiate immediate cooling of thermal
burns with cool running water.
● Ensure a patent airway and provide
supplemental oxygen if necessary.
● Establish intravenous (IV) access for
fluid resuscitation.
● Administer fluid resuscitation
according to the Parkland formula or
other appropriate guidelines.
● Monitor urine output and adjust fluid
administration as needed.
● Consider transfer to a burn center
based on burn severity and TBSA
involvement.
● Collaborate with burn specialists and
other healthcare professionals for
comprehensive care.
Response:
● Evaluate the patient's response to
interventions and treatment.
● Continuously monitor vital signs, urine
output, and fluid balance.
● Adjust fluid resuscitation based on
 clinical assessment and reassessment.
● Observe for signs of shock resolution
or progression.
● Provide ongoing wound care, infection
prevention, and pain management.
● Update the care plan based on the
patient's evolving condition and
response to treatment.
Focus 3 Data, Action, and Response
Risk for perioperative hypothermia in Data:
burn patients
● Assess the patient's preoperative
temperature.
● Evaluate the extent and severity of the
burn injury.
● Consider the percentage of total body
surface area (TBSA) affected by the
burn.
● Take into account the patient's age,
body mass index (BMI), and medical
history for risk factors associated with
hypothermia.
● Note the duration and type of surgery,
as burn procedures may involve
prolonged exposure and increased risk
of hypothermia.
● Consider environmental factors, such
as operating room temperature and
ambient temperature.
Action:

● Preoperatively warm the patient by

using warming blankets or forced-air
warming devices.
● Adjust the operating room temperature
to maintain thermal comfort.
● Cover exposed burn areas with sterile
dressings or appropriate insulation.
● Utilize warmed intravenous fluids
during the procedure.
● Monitor the patient's temperature
throughout the perioperative period
using appropriate thermometers.
● Consider using a Bair Hugger or other
active warming devices during the
procedure.
● Educate the surgical team on the
importance of preventing hypothermia
in burn patients and implementing
warming strategies.
● Document interventions and actions
taken to prevent hypothermia.
Response:

● Monitor the patient's temperature

closely during the perioperative
CASE STUDY Page 7 of 8

VI. CONCLUSION

The patient's ultimate diagnosis was a superficial partial thickness (second-degree) burn on her
right hand. After receiving appropriate treatment, the patient was discharged on 5-27-2023. The doctor
prescribed the following medications for home use: Silver Sulfadiazine, to be applied on the affected
areas, and Naproxen 275 MG, one tablet to be taken every 6-8 hours as needed for pain relief. With
improved treatment, the patient experienced reduced pain and was able to return home.

Upon discharge, the patient was given essential instructions to promote their recovery. They
were advised to maintain proper nutrition by following a well-balanced diet that includes foods rich in
vitamins, minerals, and protein. Adequate water intake was encouraged to support hydration and
overall healing. The patient was also advised to manage their sleep effectively, ensuring sufficient rest
to aid in the healing process. Additionally, the importance of daily wound care was emphasized,
highlighting the need to follow specific instructions provided by the healthcare team to clean and dress
the burn site properly. These discharge instructions aimed to optimize the patient's healing and overall
well-being as they continued their recovery at home.
Benefits of the study: Studying second-degree burns can provide several benefits in the field of
medicine and healthcare. Studying second-degree burns leads to advancements in treatment,
prevention strategies, rehabilitation, and scar management. These benefits collectively
contribute to improving patient care, enhancing quality of life, and reducing the burden of burn
injuries on individuals and society as a whole. At the end of these case study we would be able
to learn the goals of treatment;
•Control pain, remove dead tissue, prevent infection, reduce scarring risk and regain
function.
•Identify the layers of the epidermis and describe the features of each layer.
•Differentiate between 1st, 2nd, and 3rd degree burns.
•Describe the application and treatment of the use of wound debridement for wound
care.
•Describe tests used to assess the condition of the burn patient to include:
A. Vital signs. Describe how core temperature, blood pressure, pulse, and
respirations are affected in a burn patient.
B. Laboratory tests. CBC: Describe how WBCs, RBCs, and the Hct are affected
with the burn.
•Discuss the nutritional requirements of a burn patient.
CASE STUDY Page 8 of 8

BIBLIOGRAPHY

Brainlaw.com. (n.d.). Stages of Burn Injury. Brain Injury Law Center. Retrieved from
https://brainlaw.com/personal-injury/burn-injury/stages-of-burn-injury/

Healthline. (n.d.). Debridement: Procedure, Types, and Aftercare. Retrieved from

https://www.healthline.com/health/debridement

Mayo Clinic. (n.d.). Silver Sulfadiazine (Topical Route) - Side Effects. Mayo Clinic. Retrieved from
https://www.mayoclinic.org/drugs-supplements/silver-sulfadiazine-topical-route/side-effects/
drg-20068819?p=1

Philippine College of Surgeons. (2022). Profile of patients with burn injuries admitted at the Philippine
General Hospital Burn Center. Philippine Journal of Surgery, 72(2), 1-5. Retrieved from
https://pcs.org.ph/wp-content/uploads/2022/03/PCS-v72-no2-1-profile_patients1.pdf

Stanford Children's Health. (n.d.). Classification of burns. Retrieved from

https://www.stanfordchildrens.org/en/topic/default?id=classification-of-burns-90-P09575