6. Best power point for nursing students chapter six.pptx

November 12, 2024
BURN
Learning Objectives
After studying the material in this chapter, the
student will be able to:-
Define burn injury.
Differentiate different causes of burn in different
areas.
Identify different classifications and degrees of
burn.
Recognize first aid measures for different degrees
of burn.
BY masino .T.

November 12, 2024 BY masino .T.
Definition
 Burn: is an injury to the skin and deeper tissues
caused by hot liquids, flames, radiant heat, direct
contact with hot solids, caustic chemicals,
electricity, or electromagnetic (nuclear) radiation.
Causes of burn
Thermal injury
Chemicals
Electric accidents
Radiation exposure

Classification of burn
Burns can be classified according to their cause
as it is mentioned above.
Burn injury is also classified to determine its
severity depending on the extent or depth of the
body affected.
Depending on the depth of the injury classified as
1. Superficial burn or first degree burn
2. Partial thickness burns or second degree burns
3. Full thickness burn or third degree burn

1. Superficial burn or first degree burn
 It is an injury that involves only the epidermis
 It is caused by a flash of contact with hot liquids, objects
or sun burn or radiation exposure.
Presentations
a. Skin appears pink to red
b. Dry skin
c. Slight swelling
d. No blister formation
e. Sever pain
A superficial burn heals rapidly and healing is with out
scaring.

First Aid Measures
• Apply cold water
applications or submerge
the burned area in cold
water.
• Apply a dry dressing if it is
necessary

2. Partial thickness burns or second
degree burns
It involves the epidermis and part of the
dermis
It is caused by contact with Hot liquids, Hot
objects, Chemical agents
For a relatively longer time than superficial
burns.

Presentations
It has a greater depth than first degree burn
The skin appears red and wet due to loss of
plasma through the damaged layers of the skin.
Presence of blisters
Intense pain , due to the involvement of the
nerve endings
Considerable swelling for a longer time
Thermal flame burns and severe scaled burns
( burn with hot liquid) could be taken as an
example

First aid measures
Immerse the burned part in
cold water.
 Apply freshly ironed cloths
that have been wrung out in
ice water.
 Blot to remove and dry
gently.
 Apply dry sterile gauze or
clean cloth as a protective
bandage.
 Do not break blisters or
remove tissue.

3. Full thickness burn or third degree burn
It involves all the layers of the skin, the
epidermis, the dermis and can extend beyond
the subcutaneous layer in to muscles, bone or
other organs.
It is caused by contact with extreme heat sources
 Example could be
 Hot objects or liquids
 Flames
 Chemicals
 Electricity

Presentation.
The skin appears white and waxy or
Dark brown or black
There is a deep tissue distraction
Complete loss of all layers of the skin
No pain on the areas where there is complete
loss of skin structures as nerve endings are
completely damaged
Pain at the surrounding of the burn area,
there is partial or superficial burn

First aid measures
• Do not immerse an extensive
burned area or apply ice water
over it, because cold may
intensify the shock reaction.
Do not remove adhered
particles of charred
clothing
Cover burns with thick,
sterile dressings or a freshly
ironed or laundered sheet
or other household linen.

Determining the extent of burn surface
area
The severity of burn is also described in terms
of the extent of the involved body.
The surface area of the involved part of the
body is approximated by the “ rule of nines” , in
which specific regions of the body represent 9%
or multiples of 9 % of the total surface.

Estimation of body surface area for adults
Body region ( Adult ) Accounting percent
Head and neck 9 %
Anterior trunk 18 %
Posterior trunk 18 %
Arm 9 % (X 2 = 18 %)
Leg 18 % (X 2 = 36 %)
Genital area ( perineum ) 1 %

Estimation of body surface area for infants
 N.B. the palm of an individual represents 1 % of
the total body surface area.
Body region ( infant ) Accounting percent
Head and neck 18 %
Anterior trunk 18 %
Posterior trunk 18 %
Arm 9 % (X 2 = 18 %)
Leg 14 % (X 2 = 28 %)

Severity of burn
The severity of burn is determined by
1. The age of the victim
a. Children of under five years old
A burn is considered severe if it is in children of below 5
years old and elderly of beyond 55 years old
Children has a greater body surface area than their total
size hence
 They will have a great lose of fluid
 Great risk to develop shock and renal failure
 Children has poor immune status and are at
great risk to develop severe infections

Cont...
b. Elderly of above fifty five years old
Have poor healing process
Have poor immune status and are at great
risk to develop severe infections
May have underlying diseases or medical
conditions that affect their response to
burn.

2. Parts of the body involved
 Burn involving the following body parts should be
considered as severe and great care is required for
burns of Face, arm, leg, chest, joints, genitalia
3. Degree and total surface area of the burn
The total surface area of the burn in association
with the depth or degree of the burn determines its
severity
Superficial burns of more than 50 % of TBSA
Partial thickness burns of more than 15 % in adults
and more than 10 % in children of the TBSA
Deep burns of more than 5 % of TBSA

4. Cause of the burn
 Electric burns
 Chemical burns and
 Burns associated with inhalation injury
 Coexisting medical problems, e.g.
Diabetes mellitus, renal disease

Different types of burn
1. Chemical burns
2. Electric burns
3. Inhalation injuries
1. Chemical burns
Chemical burns require immediate care since
the longer the chemical in contact with the
body the greater the potential for injury.

Management of chemical burn
Protect your self from being involved in the
accident
Wear gloves and eye protection or fluid proof
dressings
Dry chemicals: brush before gone to any other
procedure ,then flush with tepid water
Wet chemicals: flush with copious amount of
fluid at least for 20 minutes.
Minimize further body contamination by making
sure that fluid runs away from the injury and not
toward uninjured part.

2. Electric burns
Electric burns cause severe damage to the whole body.
Electric injury will always seek to flow to the ground,
as the energy enters the body it will seek the path of
least resistance to exit the body.
All tissues between the entrance and the exit will
potentially be injured due to the extreme heat
generated by the resistance of the body to the
electricity.
The heart produces its own electrical energy from
chemical reactions and it may disturb the function of
the heart and result in arrhythmia or cardiac arrest.

Management of Electric burns
 Never attempt to remove the patient from the electric
source
 Try to shut down or off the electric power from its main
source.
 Never touch a patient that is in touch with the electric
source.
 Provide oxygen
 Monitor the victim for cardiac arrest, prepare to
administer CPR
 Assess for the entrance and the exit
 All tissues in between should be assessed for possible
injury
 Refer the victim as soon as possible, though there may

3. Inhalation injuries
These indicate the involvement of the
respiratory system. It may be noticed by
Facial burns and Singed nasal hair
Burned specks of carbon in the sputum
Presence of actual burns of the oral mucosa,
ddifficulty in swallowing
A sooty or smoky smell on breath
Respiratory distress, restriction of chest wall
movement, chest tightness, strider, wheezing,
hoarseness, coughing, cyanosis

General Management of heat Burn
Remove the patient from the source of the
burn
Stop burning process, remove burnt clothes
and flush with tepid water
Establish and maintain an open air way
If breathing is inadequate provide artificial
breathing support or oxygen therapy
Estimate the involved body surface area, using
the rule of nine

General mgt cont...
Determine the depth of the burn, superficial,
partial, or full thickness
Apply sterile dressings and bandages or burn
sheet
Maintain body temperature
 Do not use oils to stop burning process as oil has a
capacity to hold heat
 Do not use ice water to stop burn process as it may
result in hypothermia
 Manage other associated injuries

Effect of burn on different systems of the
body
1. Circulatory system
 Burn injury causes extreme fluid loss and it results over
load to the heart
 Burns increase the capillary permeability or the ability of
fluid to exit the vessels.
 Fluid will also leak from the damaged tissues to areas in
between the cells and it causes edema or swelling, which
will be double in the next 24 hours.
 All these fluid loss will result in shock, hypoperfussion.
 Hence major burns require great amount of fluid
replacement.

2. Respiratory system
Swelling on the face or the neck due to burn on
the areas may cause air way closure.
Inhalation of over heated air may also cause
laryngeal swelling which will lead to
accumulation of fluid in the lungs.
Smoke inhalation may cause toxic gas
poisonings.
Circumferential burn to the chest restricts
breathing movement.

3. Renal system
The decreased blood flow due to the lost fluid will
result in decreased blood flow to the kidneys; this
result in decreased kidney out put may result in pre-
renal failure.
The cell distraction resulted from the burn injury will
form many wastes in the blood, the kidneys are
responsible to filter this blood,
Filtering such blood results in blockage of the kidney
or may result in intrinsic renal failure.

4. Nervous system
 Burns may cause nerve damages and will result
in loss of functioning to the inured area, long
term muscle wasting, joint dysfunction because
of scaring.
 Such patients, who are in crises, need not only
medical care but also psychological help.

5. Gastrointestinal system
o As there is low amount of blood the blood will
re-routed from this system to other parts of the
body.
o The existing nausea and vomiting causes an
upset and chemical imbalance.
o The long term exposure to such stress result in
development of ulcer called curling ulcer.
o Hence the gastrointestinal system should also
be considered in the treatment of burn by
providing antacids.

Complications of burn
1. Loss of great amount of fluid leads to shock and
renal failure
2. Infection
3. Development of tetanus
4. Contractures and deformities
5. Asphyxia in case of inhalation injury
6. Coexisting injuries, fractures, amputation
7. Development of stress ulcer ( Curling Ulcer)
8. Development of Marjolins Ulcer, rare and long term
complication

6. Best power point for nursing students chapter six.pptx

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