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Running head: FULL THICKNESS BURN 1
Full Thickness Third Degree Burn
Kayla Bigbee
California Baptist University
Author Note
This paper is presented to Professor Toro in partial fulfillment for the
requirements of Adult Health II, NUR 440 on October 2, 2015

FULL THICKNESS BURN 2
Full Thickness Third Degree Burn
Burns are one of the most communal forms of traumatic injuries and one of the third
leading causes of accidental death in the United States. According to the Centers for Disease
Control and Prevention (CDC) (2012), 1.1 million burn injuries require medical attention.
Roughly 50,000 of these burn victims require hospitalization; 20,000 have major burns involving
at least 25 percent of their total body surface, and approximately 4,500 of these people die
(2012). Burns can result from a multitude of causes such as Ultraviolet Radiation, explosions,
burst of steam, heated liquids or metals, fires, electrocution, or direct contact with a flame or
flammable clothing. Burns are classified by four levels (degrees) that encompass the depth and
damage the burn has caused the tissue of the affected area(s). Third degree burns are the second
to most serious burn that can occur on the human body (Nursing Central, 2012). Serious burns
can be a devastating injury both physically and emotionally. This paper will discuss the
description and pathophysiology of third degree burns, signs and symptoms related to this
condition, medication and treatment, nursing care and a personal story from a victim of a third
degree burn.
What is a Full Thickness Third Degree Burn?
The human body is protected by layers of skin and fat which include the epidermis,
dermis and subcutis. These layers of skin play a vital role for the human body by providing
prevention of water loss, regulation of body temperature, protection from infection, and defense
against light (Porth and Grossman, 2014). Third degree burns destroy both the epidermal and
dermal layers of the skin. They may also damage the underlying fat, bones, muscles and tendons.
The burn site may appear charred (black), white, red, or brown. Normally there will be no
blanching in red areas due to interruption of the blood supply to the affected area. There will also

be no feeling in the area since the nerve endings are destroyed. In addition to color, the burn may
also appear to be sunken in due to the underlying destruction of subcutaneous fat and muscle
(Morton and Fontaine, 2012). The loss of hair follicle destroys the ability of the skin to
regenerate. Burn injuries to the skin affects skin function which can potentially lead to
combinations of infection, dehydration and hypothermia (2012).
Severity and Classification
Burn severity is classified by the degree and depth of the burn and the instrumental agent,
along with time and circumstances surrounding the burn injury. Morton and Fontaine (2012) list
several factors that must be measured to assess the severity of the burn. These factors include the
percentage of body surface area burned, the depth of the burn, the anatomical location of the
burn, the person’s age, the person’s medical history, the presence of concomitant injury, and the
presence of inhalation injury (2012). Some methods listed by Moton and Fontaine (2012) use
percentages of total body surface area (TBSA) to estimate the extent of a burn. The quickest
method is call the “rule of nines” or “rule of palms” which is normally used as initial assessment
or can be used to estimate small scattered burns. The rule of nines divides the body into parts by
multiples of 9%. Burns may involve only part of the surface of a body part or it could extend
along the entire body part. An example would be if the arm was burned only on the anterior
portion, then the TBSA would be 4.5%, but if the entire arm was burned then the value would be
9% (2012).
Another method that is more extensive and highly recommended for larger burns is the
Lund and Browder method (Morton and Fontaine, 2012). The Lund and Browder method is
highly recommended and is known to be more accurate due to the fact that it takes into account
the age and development of the patient. The surface measurements are given to each body part in

terms of the patient’s age. However, this method is known to be time-consuming and should be
done after initial resuscitation efforts have been made (2012).
The American Burn Association (ABA) (2015) developed a Severity Grading System
which determines the magnitude of the injury and provide information needed for proper care by
hospital staff. The severity is categorized as minor, moderate or major. Patients who are
classified with moderate or major burn injuries are normally referred to a burn center and or
transferred for specialized care (2015). Moderate and major burns must be taken seriously and
action must be taken fast because they may lead to a plethora of other systemic complications in
the body.
Pathophysiology
The injury of cells begin when the tissues are exposed to an energy source, such as
thermal, chemical, electrical or radiation energy. Morton and Fontaine (2012) measure varying
degrees of injury by zones. The zone of coagulation is where the most damage has occurred to
the tissue and it has reached 113 degrees Fahrenheit. This zone has lost the ability to rejuvenate
and requires surgical intervention. The zone of stasis surrounds the zone of coagulation and
contains cells that are most at risk during burn resuscitation. These cells can either recover or
become necrotic within 24-72 hours, depending on intervention and course of damage (. The
next zone is called the zone of hyperemia and contains areas of increased blood flow which can
bring needed nutrients to the tissue for recovery and remove waste products. This area will heal
rapidly and no cell death should occur (2012).
Systemic response. Most burn victims are confronted with hemodynamic instability,
impaired respiratory function, a hypermetabolic response, major organ dysfunction and sepsis.
The extent of injury along with the greatness of response rely heavily on each other.

Hemodynamic instability begins almost immediately with injury to the blood supply (capillaries)
in the injury site. Fluid is lost from vascular and interstitial places which is why it is common to
see victims in a form of hypovolemic shock. Respiratory system dysfunction is another common
problem associated with burns and occurs when the victim has been trapped in a structure and
has inhaled significant amounts of smoke, carbon monoxide and other fumes. Manifestations of
respiratory system dysfunction include hoarseness, drooling, inability to handle secretions,
hacking cough, and labored/shallow breathing. Blood gases will show a drop in partial pressure
of arterial oxygen. It is common for signs of respiratory injury and obstruction to be delayed for
twenty-four to forty-eight hours after a burn. Monitoring patients for early signs of respiratory
distress and other pulmonary conditions is necessary. Metabolic and nutritional requirements are
known to increase due to the stress of a burn injury. The body will secrete stress hormones such
as catecholamine and cortisol in order to maintain homeostasis. Heat production will normally
increase to maintain body temperature. Increased oxygen consumption, increased glucose use,
and protein and fat wasting is a characteristic response to burn trauma and infection.
Hypermetabolism will normally appear within 7-17 days of burn injury. The last and most
significant complication of the acute phase of a burn injury is sepsis. Sepsis may arise from a
burn wound, pneumonia, urinary tract infection, or an infection somewhere else in the body.
Since the skin is the body’s first line of defense and works hand in hand with the immune
system, the body is open to bacterial infection once a severe burn occurs.
Treatment and Medication
Treatment for burn victims includes both immediate treatment and long term treatment.
Initially, the first step is to stop the burning process, cool the burn, provide pain relief and cover
the burn. Active cooling can help prevent the progression of the burn by removing heat. Immersion

or irrigation with lukewarm water for at least 20 minutes can be extremely helpful (Porth and
Grossman, 2014). Immediate submersion is more important than removal of clothing, which may
delay the cooling involved areas. Applying ice water is not recommended because it can actually
block the blood flow to the affected area turning it from partial thickness to a full thickness burn.
Once a patient has been hospitalized, the immediate treatment focuses on cardio-
respiratory function, treatment of pain, wound care, and emotional support. Wound care focuses
on protection from infection and further injury of burned areas. Protective coverings are used to
avoid pathogens from entering the wound. Deep third degree burns are usually treated by excision
and skin grafts. Any incisions must be done timely before eschar formation can cause hypoxia and
necrosis of the underlying tissues and organs. Skin grafts are surgically implanted as soon as
possible, often at the same time the burn tissue is excised. Full thickness skin grafts include the
entire thickness of the dermal layer. They are used primarily for reconstructive surgery or for deep,
small areas. Other treatment measure including positioning, splinting and physical therapy to
prevent contractures to maintain muscle tone.
Medications. The goal of medication administration for burn patients is to assist with
pain management, provide protective barriers against microbes and pathogens and to reduce
swelling and inflammation (Meyers Medical Pharmacy, 2014). For major burns, various
medications and products are used to promote healing. Some of these treatments and medications
include water-based therapy, fluids to prevent dehydration, pain and anxiety medications, burn
creams and ointments, dressings, drugs that fight infection and a recommended tetanus shot
(The Mayo Clinic, 2015). Antimicrobial ointments used on burn patients include, but are not
limited to: sulfadiazine, mafenide and silver nitrate. Sulfadiazine is applied 1-2 times daily in a
layer that is 1.5 mm thick. Its indication is prevention of wound sepsis in patients with second

and third degree burns (Deglin and Vallerand, 2009). Mafenide and Silver nitrate are also topical
ointments that are applied 1-2 times a day 1.5 mm thick. The goal for these medications is to
prevent infection in the exposed tissue (2009).
If the patient develops an infection or if the patient’s risk of developing an infection is
high, I.V. antibiotics will be administered to the burn victim. Some antibiotics used such as
oxacillin, mezlocillin and gentamicin help treat infection. Oxacillin is administered via
intravenous infusion in doses of 250-2000 mg every four to six hours and up to twelve grams a
day. Most broad spectrum antibiotics are used to treat the most common types of bacteria
(Deglin and Vallerand, 2009).
Since pain and anxiety are priorities in the treatment of a burn victim, various pain and
anti-anxiety medications are often used. An example of a pain medication would be a
nonsteroidal anti-inflammatory drug (NSAID). Ketoprofen is and NSAID that belongs to this
group and works by helping reduce the hormones that cause inflammation and pain in the body
(Meyers Medical Pharmacy, 2014). During dressing changes especially, NSAIDS will be used
along with an anti-anxiety medication to help reduce the amount of discomfort to the affected
burn sight(s) (2014).
Nursing Care
Two appropriate nursing diagnoses for a patient with a severe burn injury are impaired skin
integrity and risk for infection. The first diagnoses is impaired skin integrity related to thermal
injury evidenced by disruption of the skin surface and destruction of the skin layers. Some
appropriate interventions would be to assess the patient’s degree of injury and available blood
supply to affected area, assess pain level, assess nutrition status and assess for signs of infection
(Nursing Central, 2012). Nursing actions for this diagnoses would include to assist with

debridement and care of the affected areas, to administer pain medication and antibiotics when
schedule or before wound care, and supply adequate nutrition and fluid therapy to prevent further
fluid (Gulanick and Myers, 2007). The second nursing diagnosis is risk for infection related to
inadequate primary defenses as evidenced by destruction of skin layers. Nursing goals should be
to reduce risk for infection and to observe for signs and symptoms of infection. Beneficial
interventions for a severely burned patient would be to provide isolation when necessary,
implement proper hand hygiene, administer intravenous antibiotics if applicable, and provide
appropriate wound coverings and wound care to the patient (2007). Providing defense techniques
against infection and providing comfort to the patient are the most beneficial ways to help the
patient to have more success in the healing process after a severe burn (Nursing Central, 2012).
Most cases involving burn victims are caused by unforeseen circumstances. There are a
multitude of ways in which a person can become severely burned and some cases can be avoided
with proper patient education. It is important for both healthcare workers and citizens to become
aware of the factors that may play a role in putting one at risk for being a burn victim. Healthcare
workers play an important role in the overall healing and prevention of infection in severely burned
patients. With an understanding of how to properly care for burn patients, healthcare workers can
make a difference in the outcomes of these patients.
Personal Story
It was merely a week ago when my life completely changed. It was roughly 4pm and I
was driving home from school Thursday after my geriatrics class ended. I remember sitting in
my car in traffic on the 91 freeway, making a mental to-do list of homework, chapters I needed
to read and what I was going to make for dinner tonight since my husband was going to be home.
Suddenly, I felt and heard a huge crash behind my car. A pickup truck had smashed into the back

of my car and before I could blink my car swerved and crashed directly into one of the cars in the
lane next to me. I couldn’t process what was happening, I was in shock as I witnessed the front
of my car billow up in flames. I tried to recompose myself and open my door, but the door was
stuck. The flames were coming toward me as I reached for the passenger’s door with my right
arm. That’s when my right arm caught on fire. I screamed in pain, but no one could hear me. I
managed to open the door and trample out of the passenger’s side of my car. Screaming and
helpless I tried to think to myself “remember what you learned in grade school: stop, drop and
roll”. I ran away from my burning car and, with my heart racing, I dropped to the ground and
rolled back and forth until I became weak and lethargic. I think the flame on my arm was
extinguished right before I blacked out.
I woke up that evening in the hospital and remembered looking at my arm and noticing it
was covered in white bandages. The doctor came and told me what had happened. He told me I
have suffered a Full-Thickness third degree burn to my right arm. I couldn’t really process was
he was saying because I was still in shock. He explained to me that because of the extent of my
burns, I would have to undergo a series of procedures, skin grafting and physical therapy. He
told me that my arm would never look the same or function as it did before. I remembered
saying, “how could this happen? Why did this have to be my right arm, my good arm? How will
I ever finish school or graduate this year?” The doctor mentioned that I would need to put
nursing school on the back burner. I was distraught and thoughts began to flood my mind about
my entire life. How will I be able to afford paying off these loans without a proper education and
career? How can I go through life with this impairment? Will I ever be able to play guitar again?
Or feel in my arm again? My husband will never be able to look at me the same when he sees my
hideous arm and my scars…I hope no one called him because I don’t want to see his reaction.

Now what am I good for? I am so disappointed that I allowed something like this to happen. If I
would’ve stayed after class to study with my nursing friends, then maybe this would’ve never
happened! I am literally scarred for life. Even if I can go back to school how would I be able to
learn to do IV’s when my arm is not capable of fine motor skills anymore? I am hopeless and
lost. How can this happen God? What is your purpose in allowing this to happen? I feel so
drained and depressed by this awful circumstance.
During my stay in the burn unit, the only thing that has kept me alive inside is one of the
nurses that has been caring for me. I broke down just yesterday, and she sat by my side and held
my hand. She gave me no false hope or wishful thinking, but she did listen to me and pray for
me. I was comforted by the fact that she was willing to set aside the to-do list for my care and
pay attention to how I was feeling inside. Parse refers to this type of listening as “true presence”,
where the nurse was able to simply be there for me during this difficult time.

References
Centers for Disease Control and Prevention (2012). Burns: Treatment and Prevention. Mass
Trauma Fact Sheets, 60(32), 703-709. Retrieved September 29, 2013 from
http://www.cdc.gov/masstrauma/factsheets/public/burns.pdf
Deglin, J., & Vallerand, A. (2009). Davis’s drug guide for nurses (11th ed.). Philadelphia, Penn.:
F.A. Davis.
Gulanick, M., Myers, J. L., (2007). Nursing care plans: Nursing diagnosis and intervention (6th
ed.). St. Louis, MO: Elsevier Mosby.
Mayo Clinic (2015). Burns. Retrieved October 2, 2015 from
http://www.mayoclinic.org/diseases-conditions/burns/basics/treatment/con-20035028
Morton, P. G. & Fontaine, D. K., (2012) Critical Care Nursing: A Holistic Approach (10th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Nursing Central (2012) http://nursing.unboundmedicine.com/nursingcentral/ub/
Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview. Pittsburgh,
Pennsylvania: A Discovery International Publication.
Porth, C., & Grossman, S. (2014). Pathophysiology: concepts of altered health states (9th
ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Meyers Medical Pharmacy (2014). Treatment for Burns. Retrieved October 1, 2015 from
http://www.myersmedicalpharmacy.com/custom-medications/treatments/burns.php

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