LESSON PLAN FOR SURGERY AND SURGICAL NURSING

NAME OF SUBJECT : SURGERY AND SURGICAL NURSING II

PLACE : ROAN SCHOOL OF NURSING AND MIDWIFERY

VENUE : CLASSROOM

TARGET GROUP : SECOND YEAR STUDENTS

SIZE OF CLASS : 15

NAME OF TOPIC : DISORDERS OF THE SKIN/BURNS

DATE :

TIME :

METHOD OF TEACHING : LECTURE/ DISCUSSSION

TEACHING AIDS : CHALK BLACKBOARD, LCD, LAPTOP

NAME OF SUPERVISOR : MR SICHONE

NAME OF STUDENT : SAKAUMBA MUZALA

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 INTRODUCTION

The skin is the largest organ in the body and has a surface area of about 1.5 to 2m squared in adults. There are two main
layers: epidermis and the dermis. Between the skin and underlying structures is the subcutaneous layer. The skin protects
the underlying structures from injury and from invasion by microbes, contains sensory nerve endings of pain, temperature

and touches, is also involved in the regulation of body temperature. Burns are a second cause of accidental injury and death

in children.

An estimated 2.5 million Americans seek medical care each year for burns. Approximately 100, 000 are hospitalized, and

70,000 require intensive care services. An estimated 12,000 of these people die annually as a direct result of these burns.

About 1 million sustains substantial or permanent disability resulting from their burn injury.

The highest fatality rates occur in children (especially pre-school age children) and older adults. Children are at risk because
they are curious, adventurous, and sometimes unattended to (Lewis, et al., 2004).

General objective

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 By the end of the lecture/discussion, students should acquire knowledge on the burns.

Specific Objectives
 Define a burn
 Describe the types and causes of burns
 Classify burn injury depth and surface area.
 Describe the pathophysiology and clinical manifestations of burns

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 Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation
objective method activity activity visual
aids
2 min SKIN DISORDERS Lecture/ Explaining, Listening, LCD, What is a
Define a BURN discussion asking asking laptop, burn?
burn DEFINITION: questions questions chalk
A burn is an injury to the tissues of and and board
the body caused by either heat, answering taking
chemicals, electrical current or questions notes
radiation (Lewis, et al., 2004).
Causes and Types of Burn injury
 Thermal Burns
Describe the Can be caused by flame, scald, flash, What are the
types and contact with hot objects or cold (cold types and
causes of thermal injury) e.g. frostbite. causes of
burns burns?

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 Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation
objective method activity activity visual
aids
45 Describe the Causes and Types of Burn Lecture/ Listening, LCD, What are the
min types and injury................ discussion Explaining, asking laptop. types and
causes of  Chemical Burns asking questions causes of
burns Caused by acids, alkaline substances questions and burns?
and by-products of burning and taking
substances. E.g. carbon. answering notes
 Electrical Burns questions
Result from coagulation necrosis that
is caused by intense heat generated
from an electrical current. Can also
result from direct damage to nerves
and vessels causing tissue anoxia and
death.
CLASSIFICATION OF BURNS
Different scholars and authors
How do you
classify burns differently for instance,
Classify Classify burns
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 burn injury the American Burn Association (ABA) according to
60 depth and classifies burn injuries into; smeltzer and
min surface area minor, moderate uncomplicated or bare
major (Lewis, et al., 2004),
Classify where as Smeltzer and Bare (2004) Lecture/ Explaining, LCD,
burn injury classify burns according to the depth discussion asking Listening, laptop.
depth and of burns or extent of the burns. questions asking
surface area classification of burns according to and questions
smeltzer and bare answering and
Smeltzer and Bare (2004), describes questions taking
How do you
burn injuries according to the depth notes
Classify burns
of injury and the extent of body
according to
surface area injured and this is the
smeltzer and
approach we shall follow for this
bare
presentation.

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual
aids

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 30 Classify DEPTH OF INJURY Lecture/ Explaining, Listening, LCD, How do you
min burns The following factors are considered discussion asking asking laptop. Classify burns
according to in determining the depth of the questions questions according to
depth burn: - and and smeltzer and
• how the injury occurred answering taking bare
• causative agent such as questions notes
• flame or scalding liquid,
• temperature of the burning
agent,
• duration of contact with the
agent
• and thickness of the skin

CLASSIFICATION OF BURNS ACCORDING

TO THE DEPTH
1.Partial-thickness burn
a) Superficial or 1st degree
• Layers involved-epidermis

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 30 Classify • Causes- Sunburn, low Lecture/ Explaining, Listening, LCD,
min burns intensity discussion asking asking laptop. How do you
according to • Appearance-Redness questions questions Classify burns
the depth (erythema),blanches with and and according to
pressure. answering taking smeltzer and
• Texture-Dry questions notes bare
• Sensation-Painful
• Time to healing-1wk or less
• Complications-Increased risk
to develop skin cancer later in
life

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual
aids
30 Classify • CLASSIFICATION CONT… Lecture/ Explaining, Listening, LCD, How do you
min.. burns b) 2nd degree burns discussion asking asking laptop. Classify burns
according to • Layers involved-Extends questions questions according to
the depth into dermis and and smeltzer and
• Causes - Scalds, flash answering taking
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 flame questions notes bare
• Appearance-Red with
clear blisters. Blanches
with pressure or becomes
less when deeper dermis
involved.
• Texture-Moist
• Sensation-Painful
• Time to healing-2-3wks

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual
aids
2 min Classify • CLASSIFICATION CONT… Lecture/ Explaining, Listening, LCD, How do you
burns • Complications-Local infection discussion asking asking laptop. Classify burns

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 according to (cellulitis),Scarring, contractures questions questions according to
the depth (may require excision and skin and and smeltzer and
grafting) answering taking bare
2. Full- thickness Burns questions notes
c) 3rd degree
• Layers involved-Extends
through entire dermis
• Causes - Fire, prolonged
exposure to hot liquid
• Appearance-Stiff and
white/brown
• Texture-Dry, leathery

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual
aids
30 Classify CLASSIFICATION CONT… Lecture/ Explaining, LCD, How do you
min burns • Sensation-Painless discussion asking Listening, laptop. Classify burns
according to • Time to healing-Requires questions asking according to
the depth excision and questions smeltzer and
• Complications-Scarring, answering and

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 contractures, amputation questions taking bare
notes
d) 4th degree
• Layers involved-Extends
through skin, subcutaneous
tissue and into underlying
muscle and bone
• Appearance- Black; charred
with eschar (a dry scab
formed on skin that has been
burned)
• Texture- Dry
• Sensation-Painless
• Time to healing-Requires
excision
• Complications-Amputation,
significant functional Explaining, Listening,
Classify impairment, Lecture/ asking asking LCD,
How do you
burns possible gangrene, and in discussion questions questions laptop
Classify burns
30 according to some cases death. and and
according to

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 min the extent answering taking smeltzer and
of the questions notes bare
surface area
injured

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual
aids
30 Classify CLASSIFICATION CONT… Lecture/ Explaining, Listening, LCD, How do you
min burns EXTENT OF THE BODY SURFACE AREA discussion asking asking laptop. Classify burns
according to INJURED questions questions according to
the extent Various methods are used to estimate and and smeltzer and
of the the total body surface area (TBSA) answering taking bare
surface area affected by burns; among them are the questions notes
injured • rule of nines,
• Lund and Browder method,
• and the palm method.
An estimation of the TBSA involved in a
burn is simplified by using the rule of

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 nines. It is a quick way to calculate the
extent of burns.

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual
aids
30 Classify CLASSIFICATION CONT… Lecture/ Explaining, Listening, LCD, How do you
min burns a. Rule of nines discussion asking asking laptop. Classify burns
according to • The system assigns percentages questions questions according to
the extent in multiples of nine (9) to major and and smeltzer and
of the body surfaces. answering taking bare
surface area • The percentage of TBSA in adult questions notes
injured is arrived at by sectioning the
body surface into areas with
numerical value related to nine.
I. . head and neck 9%
II. arms each 9%
III. ant. trunk 18%
IV. post. trunk 18%

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

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 objective method activity activity visual
aids
30 Classify CLASSIFICATION CONT… Lecture/ Explaining, Listening, LCD, How do you
min burns V. legs each 18% discussion asking asking laptop Classify burns
according to VI. perineum 1% questions questions using Lund
the extent total 100% and and and Browder
of the Moreover, in burn victims, the total answering taking method?
surface area estimated percentage of TBSA injured is questions notes
injured used to calculate the patient’s fluid
replacement needs.
b. Lund and Browder method
This is the more precise method of
estimating the extent of a burn and
recognizes that the percentage of TBSA
of various anatomical parts, especially
the head and legs, changes with growth.
The body is divided into very small areas
to provide an estimate of the proportion
of total body surface area, accounted for
by such body parts, hence obtain a

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 reliable estimate of the total body
surface area burned. The initial
evaluation is made on the patient’s Explaining,
30 Classify arrival at the hospital and is revised on Lecture/ asking Listening, . LCD, How do you
min burns the second and third post-burned days discussion questions asking and laptop Classify burns
according to because the demarcation usually is not and answering using Lund
the extent clear until then. answering questions and Browder
of the KEY FOR THE CHART questions method?
surface area • HEAD 7%
injured • L. L. ARM 3%
• NECK 2%
• R. HAND 2½%
• ANT. TRUNK 13%
• L. HAND 2½%
• POST. TRUNK 13%

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 Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation
objective method activity activity visual
aids
30 Classify CLASSIFICATION CONT… Lecture/ Explaining, LCD, How do you
min burns • R. THIGH 9½% discussion asking Listening, laptop. Classify burns
according to • R. BUTTOCK 2½% questions asking using Lund
• L. THIGH 9½
the extent and questions and Browder
• LT. BUTTOCK 2½%
of the answering and method?
• R. LEG 7%
surface area questions taking
• GENITALIA 1%
injured notes
• L. LEG 7%
• R. U. ARM 4%
• R. FOOT 3½
• L. U. ARM 4%
• L. FOOT 3½%
• R. L. ARM 3%
• TOTAL 100%
CLASSIFICATION CONT……

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 c. Palm method
• This is used in patients with
scattered burns in order to
estimate their percentage.
30 Classify • The extent of a burn is often Lecture/ Explaining, Listening, LCD, How do you
min burns revised after oedema has discussion asking asking laptop Classify burns
according to subsided and demarcation of questions questions using the
the extent zones of injury has occurred. and and palm
of the • The size of the palm is answering taking method?
surface area approximately 1% of total body questions notes
injured surface area.
•

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 Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation
objective method activity activity visual
aids
30mi Describe the Pathophysiology Lecture/ Explaining, Listening, LCD, What is the
n pathophysiolog May be classified into 3; discussion asking asking laptop. pathophysiolog
y of burns • fluid and electrolyte shifts, questions questions y of burns in
• inflammation and healing and and association with
• and immunological changes. answering taking fluid and
Fluid and electrolyte shifts questions notes electrolyte
Hypovolaemic shock caused by massive shifts?
shift of fluids out of blood vessels as a
result of increased capillary permeability
.Colloidal osmotic pressure decreases
with loss of protein from the vascular
space.Results in fluid accumulation in
the interstitium.Exudate and blister
formation.Signs of intravascular volume
depletion

Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation

objective method activity activity visual

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 aids
30 Describe the Lecture/ Explaining, Listening, LCD, What is the
min pathophysiolog Inflammation and healing. discussion asking asking laptop. pathophysiolog
y of burns The tissue destroyed by the burn questions questions y of burns in
separates from the underlying viable and and association with
tissue by the process of liquefaction answering taking inflammation?
(slough formation), leaving a large open questions notes
wound that is commonly caused by the
normal flora. Infection will then manifest
through local tenderness, fever and
tachycardia.
Neutrophills and monocytes accumulate
at the site of injury.
Fibroblasts and newly formed collagen
fibrils appear and begin wound repair
within the 1st 6 to 12 hours after injury.

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 Time Specific Content Teaching Teacher’s Student’s Audio/ Evaluation
objective method activity activity visual
aids
30 Describe the Lecture/ Explaining, Listening, LCD, What is the
min pathophysiolog Immunological changes discussion asking asking laptop. pathophysiolog
y of burns Burn injury causes widespread questions questions y of burns in
impairment of the immune system.Skin and and association with
barrier to invading organisms is answering taking immunological
destroyed.Circulating levels of questions notes changes?
immunoglobins are decreased,Changes
in WBCs quality and quantity
occur .Depression of neutrophil
movement, phagocytic and bactricidal
activity occur.
All of these changes in the immune
system can make the burn patient more
susceptible to infection.
Clinical Features
 Shock due to pain and

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 hypovolaemia.
 Pain due to exposed nerve What are the
endings. clinical features
 Blisters filled with fluid and of burns?
protein may be present in partial- Listening,
10 thickness burns. Lecture/ asking LCD,
min State the  paralytic ileus as a result of the discussion Explaining, questions laptop What are the
clinical features body’s response to massive asking and clinical features
of burns trauma and potassium shifts. questions taking of burns?
 Unconsciousness or altered and notes
mental status due to hypoxia answering
associated with smoke questions
inhalation.
 Hypotension due to
hypovolaemia.

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Evaluation:

1. What is a burn?
2. What are the signs and symptoms of burns?
3. What are the causes of burns?
4. How are the burns classified?

Summary:

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  We have looked at the definition of burns, types and causes, then classifications according to depth and extent of surface
area injured. we have also looked at the pathophysiology and clinical features such as pain, shock, blisters. We shall continue
tomorrow with management of the patient with burns

Assignment

Read on the management of burns

REFFERENCES

• Cali-Ascani A.m., Cheever H.K., Evans G.N., et al, Diseases, Springhouse Corporation, Pennsylvania
• Kumar P. and Clark M. (2005), Clinical Medicine, 6th edition, Elsevier Saunders, London, UK
• Lewis M.S., Heitkemper M.M., and Dirksen R.S. (2004), Medical-Surgical Nursing, Mosby Elsevier, USA
• Longmore M., Wilkinson B.I., and Rajagopalan R.S. (2005), Oxford Handbook of Clinical Medicine, 6th Edition, Oxford
University Press, New York.
• Monahan etal (2007), Phipps’ medical surgical nursing, 8th edition, Mosby, Missouri.

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