VISION

A premier university in historic

Cavite recognized for
excellence in the development
of morally upright and globally
competitive individuals.

Republic of the Philippines

CAVITE STATE UNIVERSITY
Don Severino de las Alas Campus
Indang, Cavite

College of Nursing

BURNS

Submitted by:
Roxanne Jade K. Dala
Ayr Hershel D. Masenas
Cirmarie Hope B. Millamena
Flora Angeli D. Pastores
Jenivic E. Puedan
Jeth Viel Torrevillas
Group 3B, BSN 4-1

Submitted to:
Evelyn Del Mundo RN, MAN, PHD

MISSION
Cavite State University shall provide
excellent, equitable and relevant
educational opportunities in the arts,
science and technology through quality
instruction and relevant research and
development activities. It shall provide
professional, skilled and morally upright
individuals for global competitiveness.

BURNS
ANATOMY AND PHYSIOLOGY

The integument is an organ, and is an alternative name for skin.

Includes the skin and the skin derivatives hair, nails, and glands.

The bodys largest organ and accounts for 15% of body weight

Three layers:
Epidermis

is the thinner and more superficial layer of the skin

The epidermis is made up of 4 cell types:

(A) Keratinocytes

(B) Melanocytes

(C) Langerhan Cells

(D) Merkel cells

Dermis

the deeper, thicker layer composed of connective tissue, blood vessels, nerves, glands and
hair follicles

Hypodermis

subcutaneous

Adipose tissue which provides a cushion between the skin layers, muscles, and bones

Function:

Thermoregulation

Cutaneous sensation

Vitamin D production

Protection

Absorption & secretion

Wound healing

BURNS

Burns are injuries to tissues caused by

heat, friction, electricity, radiation, or
chemicals.

Scalds from hot liquids and steam,

building fires and flammable liquids and
gases are the most common causes of
burns.

Types of burns:
1.) Heat burns (thermal burns) are caused by fire, steam, hot objects, or hot liquids. Scald burns
from hot liquids are the most common burns to children and older adults.
2.) Cold temperature burns are caused by skin exposure to wet, windy, or cold conditions.
3.) Electrical burns are caused by contact with electrical sources or by lightning.
4.) Chemical burns are caused by contact with household or industrial chemicals in a liquid,
solid, or gas form. Natural foods such as chili peppers, which contain a substance irritating to
the skin, can cause a burning sensation.
5.) Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation
therapy for cancer treatment.
6.) Friction burns are caused by contact with any hard surface such as roads ("road rash"),
carpets, or gym floor surfaces. They are usually both a scrape (abrasion) and a heat burn.

Management

Be sure to warm the whole body with blankets as well as the cold injured parts.

Stay calm, find shelter, change to dry clothes, keep moving, and drink warm fluids to
prevent further heat loss and slowly rewarm yourself.

If small areas of your body (ears, face, nose, fingers, toes) are really cold or frozen,
try home treatment first aid to warm these areas and prevent further injury to skin. Warm
small areas by blowing warm air on them, tucking them inside your clothing, or putting
them in warm water.

Electrical burn

Chemical burn

Management

Prevent contaminated irrigation solution from running onto unaffected skin.

Remove contaminated clothes.

Special situations:

-If contamination with metallic lithium, sodium, potassium, or magnesium has occurred,
irrigation with water can result in a chemical reaction that causes burns to worsen. In these
situations, the area should be covered with mineral oil and the metallic pieces should be removed
with forceps and placed in mineral oil. If forceps are not available, soak the area with mineral oil
and cover it with gauze soaked in mineral oil.

If contamination with white phosphorus has occurred, thoroughly irrigate the area with
water then cover the area with water-soaked gauze. Keep the area moist at all times. The
area can also be covered with petroleum jelly.

If eye exposures have not been irrigated, then this should be started immediately.
Immediate removal of caustic substances in the eye is critical.

Radiation burns

PHASE
Emergent or Immediate
Resuscitative

Acute

Rehabilitation

Friction burns

DURATION
- From onset of injury to
completion
of fluid resuscitation

PRIORITIES
First aid
Prevention of shock
Prevention of respiratory
distress
Detection and treatment of
concomitant injuries
Wound assessment and
initial care
- From beginning of diuresis
Wound care and
to near
closure
completion of wound closure
Prevention or treatment of
complications, including
infection
Nutritional support
- From major wound closure
Prevention of scars
to return
and contractures
to individuals optimal level of Physical, occupational, and
physical
vocational rehabilitation
and psychosocial adjustment
Functional and cosmetic
reconstruction
Psychosocial counseling

Emergent/Resuscitative Phase:

Cool the wound

Establish airway

Supply oxygen

Insert at least 1 large bore IV line

Assess pulse

Monitor blood pressure

Extinguish the flames

Remove restrictive objects

Cover the wound

Irrigate chemical burn

Acute or intermediate phase

Infection prevention

Wound cleaning

Wound dressing

Wound debridement

*Grafting

Autograft

Homograft

Heterograft

Management:
Circulation

The nurse assesses the graft area for signs of adequate blood supply. She inspects the
color of the graft area, which should be the same color as the other skin on the patients
body to see if it has enough blood supply. The nurse also checks to make sure the graft
area is warm as this indicates sufficient blood supply to the area.

Drainage

The nurse checks the patency of drains placed in the graft area. She makes sure they are
not blocked, so drainage can flow out of the graft site instead of accumulating in it and
potentially causing an infection.

Positioning

The nurse ensures blood circulation to the graft area by positioning the patient off the
graft. Taking pressure off the graft and skin surrounding it reduces the risk of decreased
blood supply to the area.

Low Pressure

The nurse may place the patient on a low pressure bed when lying down or low pressure
cushion for sitting down. The less pressure exerted on the graft area, the more likely that
it will be adequately perfused. Low pressure beds and cushions exert low pressure on the
skin.

Complications:

Failure of the skin graft is often due to:

Inadequate excision of the wound bed.

Inadequate vascular supply to the wound bed.

Hematomas and seromas. These form a barrier between the bed and skin graft and
prevent the graft from taking.

Shearing or displacement of the graft. This prevents revascularisation of the graft as

the capillaries cannot link up.

Infection. This can lead to disintegration of the graft or excessive exudate that prevents
the graft from adhering to the bed (Beldon, 2003).

Late complications relate to the appearance and function of the graft. The colour and
texture of a healed graft will contrast with the surrounding skin and, usually, there is
some depression of the wound. Hyperpigmentation of the graft can also be a problem
(Young and Fowler, 1998).

Contraction is the main functional problem and can result in joint contracture and
restriction of function in the surrounding tissue.

CLASSIFICATION OF BURNS
First-Degree
(Minor)

The burned area is painful. The outer skin is

reddened. Slight swelling is present.

Second-Degree
(Moderate)

The burned area is painful. The underskin is affected.

Blisters may form. The area may have a wet, shiny
appearance because of exposed tissue.

Third-Degree
(Critical)

The burned area is insensitive due to the destruction

of nerve endings. Skin is destroyed. Muscle tissues
and bone underneath may be damaged. The area
may be charred, white, or grayish in color.

Rule of nines

A method for rapidly assessing the extent of burns on the skin surface, which determines
the amount of fluid required as replacement therapy

Lund and browder method

- a method for estimating the extent of burns that allows for the varying proportion of body
surface in persons of different ages.

Rule of palm

Quick prehospital assessment used to estimate the extent of burns.

The patients palm not including the surface area of the digits, is
approximately 1% of the TBSA.

The patients palm without the fingers is equivalent to 0.5% TBSA and
serves aas a general measurement for all age groups.

Fluid Replacement:
Formula:
2-4ml x kg body weight x % TBSA burned

Half to be given in first 8 hours

remaining half to be given over next 16 hours

Local and systemic responses to burns

Hypovolemia

Burn edema

Pulmonary injuries

Altered renal function

Altered immunologic defenses

Effects on fluids and electrolytes

Results to:

Hyponatremia

Hyperkalemia

Anemia

Management for minor burns

Cool the burn

Cover the burn with a sterile gauze bandage

Take an over-the-counter pain reliever

Caution:

Don't use ice.

Don't apply egg whites, butter or ointments to the burn.

Don't break blisters.

For major burns:

Don't remove burned clothing.

Don't immerse large severe burns in cold water.

Check for signs of circulation (breathing, coughing or movement).

Elevate the burned body part or parts.

Cover the area of the burn.

Medical management:

Transfer to a burn center.

Manage fluid loss and shock.

Fluid replacement therapy.

Nursing management:

Assess the patients burn injury.

Aseptic management of the burn wounds.

Monitor vital signs.

Inserting of indwelling urinary catheter.

Administering and monitoring intravenous therapy.

Neurologic assessment

Complications of burns

Shock

Heart attack

Formation of scars