A burn is an injury to tissue

resulting from application of

heat,radiation,chemicals and
electricity.
NOTE: A large burn is a major
illness and can be life
threatening.
 The following are some of the causes
of burns:-
 Scalds (Hot bath and spilled hot
beverages)
 Flames (clothing ignited by fire or
open flames)
 Flash explosion-combustion fuels)
 Contact (hot metal )
 Electricity
 Chemicals such as caustic acids and
alkali
 Radiation such as ultra violet, X-rays
 Friction from contact with moving
objects
 Thermal Burns- caused by a
flame, flash, scald or contact
with hot objects-
 Chemical Burns-
 Tissue injury and destruction
from necrotizing substances
Mostly caused by acids
 -burns from electrical current,
either alternating current (AC)
or direct current (DC).
 Assessment of patients with electrical
burns should be done thoroughly
 Check for wounds of electric current
entry and exist and suspect
underlying tissue and organ damage.
Radiation burns-uncommon
but can serious.
 Caused by sunburn, nuclear
radiation accidents.
 Degree of injury depends on
length of exposure
 Burn injuries can be classified
on the basis of the extent or the
depth of the injury.
 The extent is expressed as a
percentage of the total body
surface area.
 Depth is classified as partial or
full thickness.(a better way than
the older method of degrees).
 In the past, burns were defined by degrees
 first-degree, second-degree or third-
degree burns.
 The ABA now advocates for a more explicit
definition categorizing the burns according
to depth of skin destruction that is: -
Partial-thickness or Full-thickness.
. Involves the entire epidermis and
varying depths of the dermis
Small vessels bring blood to area and
leak plasma, cause blisters.
Pain increases, nerve endings exposed,
and stimulation (touch or temperature
changes)
Heal in 10-21 days, usually no scar but
pigment changes
4/1/2011 17
FULL-THICKNESS BURN(THIRD DEGREE)
 A third degree burn destroys all layers of skin
and any or all of the underlying structures (fat,
muscles, bones and nerves).
 The burn appears brown or black (charred)
with the tissues underneath sometimes
appearing white.
 This type of burn can be extremely painful
Healing time depends on the severity of the
burn.
NB:
 Deep second- and third-
degree burns (called full-
thickness burns) will likely
need to be treated with
skin grafts.
 This burn is critical and
requires immediate
medical attention.
ANAEMIA:

is present when there is a decrease in the

level of hemoglobin in the blood, due to
bleeding.
DEHYDRATION: due to continuous loss of
fluids
INFECTIONS :May be as a result of using un
sterile equipment's
Patient may be in shock from pain and
hypovolemia
 Severe pain in partial thickness burns-
pain absent in full thickness burns
 Intense thirst due to fluid loss
 Reduced urinary output due to fluid
loss
 All signs of dehydration
Drug Therapy
-Analgesics such as morphine in severe cases

-Tetanus Toxoid 0.5mls im

-Antimicrobial agents such as sulphur zinc
cream povidine cream
-Antibiotics e.g ciprofloxacin 500mg BD for
5days or according to Culture results of pus
swab
Fbc :Blood for Hemoglobin
and Haematocrit levels
which are usually reduced
due to bleeding from the
wound.
 Urea and electrolytes – there is usually
reduced serum protein, albumin, globulin
and so on.
 ETC
I.Depth of burn - This estimates the burns
according to depth of skin destruction that is;
partial-thickness or full thickness.
II.Extent of burn - This estimates the TBSA
affected by the burns.
The two commonly method used for
determining the total body surface area affected
or the extent of a burn wound are: - the rule of
nine and Lund-Browder chart
 III. Location of burn – This is related to
the severity of the burnt injury in
consideration of the affected part of
the body e.g. face and neck
 circumferential burns of the chest
may inhibit respiratory function
THE RULE OF NINES CHART
Head and neck 9%
Left arm 9%
Right arm 9%
Anterior Trunk 18%
Posterior Trunk 18%
Left leg 18%
Right leg 18%
Perineum 1%
Total 100%
IV fluids
 How much and what type of fluid,
 work out the requirement from the following
formula;
Volume = weight x percent burn x 4ml = 70 x
30 x 4
 this volume is then given at different rates;
◦ first 8 hrs - give half of total
◦ next 16 hrs – give half of total
◦ next 24 hrs - give half of total
NOTE: The greatest loss of fluids occurs in first 48
hrs Analgesia, preferably IV Routine medication:
Tetanus toxoid.
Fluid resus should be instituted as soon as
possible. The volume of fluid infused depends
upon the %BSA, time passed since injury and
patients weight.
In the first 24 hours:
Parklands: Crystalloid resuscitation with
Hartmanns
24 hour fluid requirement = 4 x %BSA x Wt
(Kg)
Give half over the first 8 hours, and the
remainder over the next 16-24 hrs
Admit:
 Greater than 15% burns in an adult
 Greater than 10% burns in a child
 Any full thickness burn
 Burns of special regions: face, hands, feet,
perineum
 Circumferential burns
 Inhalation injury
 Associated trauma or significant pre-burn
illness: e.g. diabetes
On admission:
 Get a history, include time and place of burn,
causing agent, details of the accident (can
provide clue to the depth of burn)
 Age of patient, weight,
 Ask for possibility of inhalational injury
 Examination:
 complete full physical
examination from head to toe
Drug Therapy
-Analgesics such as morphine in severe cases
-Tetanus Toxoid 0.5mls im
-Antimicrobial agents such as sulphur zinc
cream povidine cream
-Antibiotics e.g ciprofloxacin 500mg BD for
5days or according to Culture results of pus
swab
Care of the Burn wound
 Topical Silver sulphurdiazine (SSD) is the main
agent used.
 Topical SSD and bulky dressings which are
changed daily are the main methods of local
wound care.
 Daily baths help in the process debridement.
 Dressings Simple dressings with vaseline gauze
are cost effective and work well.
 Objectives:
 To prevent shock
 To improve tissue perfusion
 To relieve pain
 To prevent infection
 To allay anxiety
 To prevent complication e.g. contractures
 To promote wound healing
1.Maintenance of Airway
 -Maintenance of an adequate airway is
the first priority, especially if the
patient has been exposed to smoke
2.Avoid wound contamination
The burn should be covered with a sterile or
clean cloth to avoid contamination of the
wound.
•Prevention of infection starts at the time of
admission hence, put patient on a clean bed.
•Injury to the skin destroys the body’s first line
of defence thus infection sets in easily.
Important to clean wound on regular basis.
•Use aseptic technique and sterile gloves during
wound care.
•Care for the patient in a special burns unit
3.Assess Percentage of Burn
This will help in proper management of the
burns.
4.Weigh the Patient
This is important because it will help in
rehydration and prevention of circulatory
overload and dehydration.
 prevent shock by prompt fluid
replacement.
 It is important to bear in mind that survival
of burnt victims depends on adequate fluid
administration.

Types Of Fluids
The 3 types of fluids considered in
replacing the lost fluids are;
1 .Colloids including plasma expanders
such as Dextran.

2.Electrolytes like, Sodium Chloride,

Ringers Lactate e.t.c

3.Non electrolytes fluids such as 5%

glucose.
 Parklands Formula(Crystalloid
Resuscitation Formula)
 4ml RL X Weight(Kg) X % BSA
burned =ml RL for the first 24hours.
 Half is to be given in the first 8hours, half
to be given over the next 16hours.
Psychological Care
This is done to allay anxiety and their by
promoting recovery.

Maintenance of Body temperature

This is a critical factor because the severely
burnt patient has lost some of the ability to
regulate body temperature.
Therefore, the environment must be warm
enough to prevent hypothermia.
Infection Prevention
Careful asepsis must be put into
consideration when handling the wound to
prevent contamination.

Wound Care
The nurse should maintain sterility and keep
the procedure clean so as to minimize the
chances of infection. The use of gowns,
masks, surgical gloves will reduce the risks of
contamination. The wound must be cleaned
daily to promote healing.
 Change the dressing daily (twice daily if
possible) Use as aseptic technique
1.OPEN OR EXPOSED METHOD
 Isolation technique is essential
 • When nursing the patient, wear sterile
gown, mask and apron, sterile linen may also
be put on the bed.
 • Minimise discomfort-patients loose more
heat from burned surfaces than normal skin.
 Covering the wound with topical
antimicrobial agents.
 A thin layer of gauze is used to
cover the wound
 Clean the wound once or twice
daily

 Wounds are cleaned and dressings changed
at least once or twice daily.
 Promote mobility by 2nd day of injury-Any
delay may result in contractures.
 Topical agents applied to the wound, help
decrease infection and fasten wound healing.
The agents include: Silverdene, Silver, Nitrate,
Povidone, Furacin, Geramycin, Neomycin.

 Daily inspection and cleaning of the wound
 Remove the Escher (slough) to support
healthy tissue regeneration because slough
contains dead tissue, moisture and warmth
that are conducive media for microbe’s
growth.
 Saline bath is more comfortable method of
removal of dressing.
 Place the body parts correctly in anatomical
position to prevent deformities.
 Apply splint currently if indicated
 Assess always the splinted limbs for
adequate circulation, or cyanosis.
Complaints of pain and pressure must not be
ignored
 Exercises of the arm when condition allows,
to prevent and correct contracture
 Involve the physiotherapist
 Ensure adequate nutritious food
 Give high protein diet, vitamins and vegetables for tissue repair.
 Daily bath-to prevent infection and promote
self-esteem
 Oral care-to promote appetite and prevent
oral infection
 Hair care-for self-esteem
 Nail care-to prevent injury
Hygiene care necessary for maintaining body
integrity
 Temperature
 Pulse
 B/P
 Respiration
ELIMINATION PATTERN
 Monitor the intake and output and record the findings on the appropriate chart.
 Any deviation (e.g. constipation), in the normal bowel motion should be reported.
REST AND SLEEP
Time your procedures in order to minimise disturbance
Give prescribed pain reliever.
 Inspect the wound for daily the for
following signs of infection Redness,
warmth, pain, and an elevated WBC count
 It should have all accessories needed in place
 It should be quiet, clean and well ventilated
with minimal traffic.
 In addition administer analgesics to promote
further rest