LA CONSOLACION COLLEGE MANILA INSTITUTE OF NURSING BATCH 2011

CASE STUDY
SECOND DEGREE BURN Submitted by: Group 8 Capisen, John Carlo Damot, Arlene Cris Eslaban, Marishel Labindao, John Amor Milanes, Adelbert Miravalles, Angelica Tagapulot, Lysander Mark

INTRODUCTION

A burn is a type of injury to flesh caused by heat, electricity, light, radiation or friction. Most burns affect only the skin (epidermal tissue and dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured. Burns may be treated with first-aid or may require more specialized treatment such as those available at specialized burn centers. Managing burn injuries properly is important because they are common, painful and can result in disfiguring and disabling scarring, amputation of affected parts or death in severe cases. Complications such as shock, infection, multiple organ dysfunction syndrome, and respiratory distress may occur. The treatment of burns may include the removal of dead tissue (debridement), applying dressings to the wound, fluid resuscitation, administering antibiotics and skin grafting.

Second Degree Burns (superficial partial thickness) Second-degree burns affect both the outer-layer (epidermis) and the under lying layer of skin (dermis) causing redness, pain, swelling and blisters. These burns often affect sweat glands, and hair follicles. Symptoms 1. 2. 3. 4. 5. 6. Redness Swelling Pain Peeling skin Shock (pale, clammy skin, weakness, bluish lips and finger nails) White or charred skin

Nomenclature

Layer involved

Appearance Texture Sensation

Time to Complications Example healing

Extends into Second degree Red with clear superficial (superficial blister Blanches Moist (papillary) partial thickness) with pressure dermis.

Painful

Local infection 2-3wks or cellulitis

I.

Patients Data History a. Personal Data Name: Patient X Gender: Male Age: 17 years old Marital Status: Single Religion: Catholic Address: Las pinas b. Past Medical History: Asthma c. Rest and Sleeping Pattern: Minimum 8 hours of sleep d. Activity and Employment: Student e. Diet History: High Carbohydrates and High Calorie f. Vitamins and Milk: None

II.

History of present illness

A 17 yrs old patient from Las Pinas has a known case of Second Degree Burn or Superficial Partial Thickness Burn, 3 hours PTC, patient opened the stove and accidentally exploded causing injury to the patient hence consult (August 17, 2011 2pm). Superficial partial degree burn, face and hand right 2nd degree burn, torso and upper extremities, bilateral.

ANATOMY AND PHYSIOLOGY

1. Parts & Physiology Skin is the largest organ of the body. In adults, the skin covers an area of approximately 2 square meters and accounts for nearly 20% of one's body weight. Its thickness varies from 0.3-4.0 mm depending on the location on the body. The skin is composed of three principal parts: Epidermis

The epidermis is composed of stratified squamous epithelium and is separated from the dermis by a thin basement membrane. The epidermis is not as thick as the dermis and varies in thickness from approximately 0.3 mm on the eyelids to 1.5 mm on the palms of the hands and soles of the feet.

The epidermis is an avascular structure. Therefore, all gases, nutrients and waste products must diffuse to & from the capillaries located in the dermis.

The epidermis is composed of five layers or strata. These layers from the deepest to the most superficial are: 1. Stratum basale 2. Stratum spinosum 3. Stratum granulosum 4. Stratum lucidum 5. Stratum corneum Dermis

The dermis is composed of dense, irregular connective tissue. The dermis varies in its thickness from less than 1 to 4 mm thick. Blood vessels, nerve endings, hair follicles, smooth muscle, glands and lymphatic vessels all extend into the dermis. Dermal Layers The dermis can be divided into two indistinct layer: 1. Reticular layer 2. Papillary layer

Hypodermis

The hypodermis which is also known as the subcutaneous tissue attaches the skin to underlying bones and muscles and also supplies it with blood vessels and nerves. The hypodermis consist mostly of connective tissue and adipose cells. As much as one half of the body's stored fat is located in the hypodermis

2. Function Skin is extremely important to normal physiologic function secondary to the roles that it plays in maintaining homeostasis.

The seven chief functions of the skin are as follow: 1. Regulation of body temperature 2. Protection 3. Sensation 4. Excretion 5. Immunity 6. Blood reservoir 7. Synthesis of vitamin D

DISCHARGE PLANNING M- Medication

Instructed to comply strictly with the following:

Silver Sulfadiazine and Silver Nitrate

E- Exercise
TYPE OF ACTIVITY GENERAL DESCRIPTION INDICATION/PURPOSE

BED REST

An activity wherein the patient is not allowed to do any activity. Patient stays at bed.

To decrease consumption of oxygen and to be able to conserve energy

PASSIVE RANGE OF MOTION (rehabilitative phase)

Passive range of motion exercises is To guarantee to the done for a person by a patient maximum helper. The helper autonomy and does the range of functionality in order to motion exercises ensure the best possible because the person quality of life in the cannot do them by social, family, and himself. working environments.

T- Treatment Advice patient to avoid stress related factors Wound Debridement

H Health teachings Proper wound care, increase fluid intake Encourage deep breathing exercise Adequate bed rest

O- Out patient

Informed client to follow up check up Emphasize the need to be present in medical procedures schedule

The patient should consult the physician if there are complications after discharge for immediate intervention D- Diet TYPE OF DIET GENERAL DESCRIPTION High calories Extra calories can come from foods, which are high in fat and calories like meats, olive oil, nuts, peanut butter and whole milk. INDICATION/PURPOSE Burns are very traumatic. The body's metabolism increases in response to the tissue damage and the need for the body to start repairing. Burn patients need to consume large amounts of calories to compensate for the increased metabolism.

High protein

A high-protein diet is often Muscle starts to break down, and is recommended by bodybuilders lost through the urine and wounds, and nutritionists to help efforts to increasing the burn patient's need build muscle and lose fat. for protein. Lastly, burn patients are highly susceptible to infection, further increasing their needs for High-protein foods include meats, beans, seafood, dairy, nuts adequate calorie and protein intake. s previously stated, protein is and tofu. essential for tissue growth and regeneration. A high-protein diet is indicated in almost all illnesses

S- Signs and symptoms to watch for Watch out for drug side effects such as skin necrosis, erythema multiforme, discoloration, rashes, and interstitial nephritis. Contact physician immediately if these side effects occur for proper intervention.

 Watch out for signs of infection such as swelling, fever, tenderness and pus.