BURN

Medical Concept of
Burns
 DEFINITION

A burn is an injury resulting from exposure to

heat, chemicals, radiation, or electric
current
 ETIOLOGY
 THERMAL BURN
Thermal burn result from exposure to dry heat (flame) or moist heat
(steam and hot liquids). They are the most common burn injuries and
occur most often in children and older adults

 CHEMICAL BURN
Chemical burn are caused by direct skin contact with acids, alkaline
agents, or organic compound
ELECTRICAL BURN
The severity of electrical burns depends on the type and
duration on current, and amount of voltage.

RADIATION BURN
Radiation burns are usually associated with sunburn or
radiation treatment for cancer. These kinds of burns tend to
be superficial, involving only the outermost layers of the
epidermis. All functions of the skin remain intact
PATHOPHYSIOLOGICAL CONCEPT
 The client with a minor Burn (Sunburn)

Sunburn result from exposure to ultraviolet light. Such injuries, which

tend to be superficial, are more commonly seen in client with lighter
skin. Because the skin remains intact, the manifestations in most cases
are mild and are limited to pain, nausea, vomiting, skin redness, chills,
and headache. Treatment is performed on an outpatient basis and
generally consist of applying mild lotions, increasing liquid intake,
administering mild analgesics, and maintaining warmth. Older adults
should be monitored for evidence of dehydration.
The client with a major Burn

The pathophysiologic changes that result from major burn injuries involve all
body systems. Extensive loss of skin can result in massive infection, fluid and
electrolyte imbalances, and hypothermia. Often the person inhales the
products of combustion, thus compromising respiratory function. Cardiac
dysrithmias and circulatory failure are common manifestations of serious burn
injuries. A profound catabolic state dramatically increases caloric expenditure
and nutritional deficiencies. An alteration in gastrointestinal motility
predisposes the client to developing paralytic ileus, and hyperacidity lead to
gastric and duodenal ulcerations. Dehydration slows glomerular filtration rates
and renal clearance of toxic wastes and may lead to acute tubular necrosis
and renal failure.
 CLINICAL MANIFESTATION
1. INTEGUMENTARY SYSTEM
Depending on their intensity, burns consist of one, two, or three concentric three-dimensional
zones closely corresponding on the skin surface to the depth of the burn.

2. CARDIOVASCULAR SYSTEM
The effect of a major burn are manifested in all component of the vascular system, and
include hypovolemic shock (burn shock), cardiac dysrhythmias, cardiac arrest, and vascular
compromise.

3. RESPIRATORY SYSTEM
Pulmonary damage may result from either direct inhalation injury or as part of the systemic
response to the injury
Gastrointestinal system
Dysfunction of the gastrointestinal system is directly related to the size of the burn
wound. Clients with ≥20% TBSA experience decreased peristalsis with resultant
gastric distention and increased risk of aspiration

Urinary System
During the early stages of the burn injury, renal blood flow and glomerular filtration
rates are greatly reduced from the decreased intravascular blood volume and the
release of antidiuretic hormone by the posterior pituitary

Immune System
In the burn client, the serum levels of all immunoglobulins are significantly
diminished.

Metabolism
Two distinct phases characterize the body’s metabolic response to the burn injury.
 THERAPEUTIC MANAGEMENT
 Prehospital Management
Treatment at the injury scene includes measures to
limit the severity of the burn and support vital
functions. Before attempting to remove the client
from the source of burn injury, rescuers must
ensure their own safety. Depending on the
causative agent, rescuers may need to consult with
experts to determine the best way to eliminate
the source of the injury
 Emergency and Acute Care
The nurse obtain a history of the injury,
estimates the depth and extent of the
burn, begins fluid resuscitation, and
maintains ventilation according to
protocol.
Prevention
Burn prevention topics for older adults are as follow :
Have a relative or neighbor routinely check for the odor of gas
Check the smoke detector battery once a month
Wear close-fitting clothing when cooking
Use a cooking timer with a loud alarm
Never lay anything over a heating device
Set the temperature of the hot water heater no higher than 120oF
Install antiscald devices in bathroom plumbing
Encourage no smoking in the house
 NURSING
CONCEPT OF
BURNS
NURSING CONCEPT OF BURNS
 Assessment

Nursing assessment is continuous from the initial

contact with the client with a burn injury. This
section describes the survey conducted when the
client arrives at the emergency department. Once
there, the staff must act quickly to obtain the
client’s history of the burn injury, including the time
of injury, causative agents, early treatment, medical
history, and client’s age and body weight.
 NURSING DIAGNOSIS
1.Impaired skin integrity
2.Deficient fluid volume
3.Acute pain
4.Risk for infection
5.Impaired physical mobility
6.Imbalanced nutrition
7.Powerlessness
 INTERVENTIONS
Impaired skin integrity
1. Estimate the extent and depth of the burn wound and recalculate
extent of unhealed burns weekly.
2. Elevate burned or newly skin grafted extremities at or above heart
level.
3. Immobilize skin graft sites for 3 to 5 days or as ordered
4. Provide special skin care to sensitive body areas :
a. Clean burns involving the eyes with normal saline sterile water.
b. Gently wipe burns of the lips with saline-soaked pads
c. Gently debride burns of the nose, and apply mafenide acetate
(Sulfamylon) cream.
d. Apply mafenide acetate (Sulfamylon) cream to burns of the ear.
Dificient fluid volume
1. Assess blood pressure and heart rate frequently.
2. Monitor hemodynamic status, including central venous
pressure (CVP) and pulmonary artery wedge pressure
(PAWP).
3. Follow prescribed protocols for intravenous fluid
rescucitation.
4. Monitor intake and output hourly.
5. Weigh daily.
6. Test all stools and emesis for the presence of blood.
7. Maintain a warm environment.
8. Monitor for fluid volume overload.
Acute pain
1.Measure the client’s level of pain, using a consistent
measurement tool.
2.Medicate before painful procedures and determine
when PCA is appropriate.
3.Administer intravenous narcotic analgesic as
prescribed.
4.Explain all procedures and expected levels of
discomfort.
5.Use methods of nonnarcotic pain control in
combination with medications for pain.
6.Allow the client to verbalize the pain experience.
THANK YOU