The document presents an overview of burn injuries in children, highlighting the types and classifications of burns, their causes, and the associated risks, particularly in young children. It emphasizes the need for prompt management and the significance of understanding burn depth, initial first aid, and medical treatment for various degrees of burns. The document concludes with nursing care theories and references for further reading on pediatric nursing related to burn care.

1. GOOD
AFTERNOON

2. CASE PRESENTATION

3. INTRODUCTION
Danage to the skin or deeper tissues caused by
sun, hot liquids, fire, electricity or chemicals.
The latest data shows that the
unintentional injury is a leading cause of death
among children under age14 year. Toddler and
children are often burned by a scalding or flames.
Most children ages 4 and under.

4. Cont…
Who hospitalized for burn related injuries suffer
from scald burn(65%) or contact burn(20%).
Babies an young children are especially at risk-
because they are curious, small and have sensitive
skin that needs extra protection.

6. DEFINITION
Cutaneous injury caused by heat, electricity,
chemicals, friction, or radiation.

7. CAUSES
 Burns and Scalds
 Electrical
 Chemical
 House fire

8. CLASSIFICATION/TYPES

9. Burn Depth

10. FIRST DEGREE BURNS
 Epidermis affected only
 Red or pink, dry, painful,
blanches to touch
 Epidermis is intact
 Spontaneous healing
within 7 days. Outer
injured epithelial cells
peel

11. SUPERFICIAL PARTIAL THICKNESS
 Entire epidermis &
portion of dermis
(Papillary dermis)
 Painful
 Blisters
 Blanches
 Hair usually intact
 Does not scar, may
pigment differently

12. Sup 2nd degree

13. DEEP PARTIAL THICKNESS
 Reticular dermis
 Mottled red and white
 Not painful to pinprick or pressure
 Does not blanch
 Heals > 3 weeks
 Usually scars
 Need to excise and graft

14. DEEP PARTIAL THICKNESS

15. Deep dermal

16. FULL THICKNESS:
3RD
DEGREE

17. May go into fat or
deeper
 Red, white, brown
 Inelastic and leathery
 painless or numb
 Heals only from the
periphery
 Always excise and
graft

18. Full-thickness

19. Fourth degree
Extend to underlying tissues like fascia, muscle

21. INHALATION INJURY
Exposure to heat and toxic products of combustion
 50% of fire deaths are related to inhalation injuries
 Asphyxia/Carbon Monoxide displacement of oxygen

22. INHALATION INJURY DIAGNOSIS
 Closed-space fire
 Face burns

23. PATHOPHYSIOLOGY
 Loss of fluids
 Inability to maintain body temperature
 Infection

24. Cont…
 Patients with large burns (≥15 percent TBSA for
young children and ≥20 percent for older children
and adolescents) develop systemic responses to
these mediators.
 For patients with 40 percent TBSA or more,
myocardial depression can occur .
 As a result, patients with major burns may
become hypotensive (burn shock) and edematous
(burn edema).

25. PATHOPHYSIOLOGY
METABOLIC RESPONSE
 Following resuscitation, children with major
burns develop a hypermetabolic response that
results in a dramatic increase in energy
expenditure and protein metabolism .
 Evidence suggests that modulation of the
hypermetabolic response with therapies such as
beta blockers and human growth hormone may
improve outcomes for severely burned children

26.  Systemic capillary leak usually persists for 18 to
24 hours. Protein is lost from the intravascular
space during the first 12 to 18 hours after a burn,
after which vascular integrity improves.

27. SIGNS AND SYMPTOMS
BOOK PICTURE
 Lacrimation
 Cough
 Hoarseness
 Dyspnea
 Disorientation
 Anxiety
 Wheezing
PATIENT PICTURE
• Lacrimation
 Cough
 Dyspnea
 Anxiety

28. Cont…
 Conjunctivitis
 Carbonaceous sputum
 Singed hairs
 Stridor
 Bronchorrhea

29. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Blood test
 Ph level

30. ASSESSMENT

31. BURN EXTENT
Total Body Surface Area (TBSA)?
1. Rule of nines
2. Lund and Browder chart
3. Patients palm = about 1% TBSA

32. 1. RULE OF NINES
 Pediatric Rule of Nines
– For each year over 1 year of age, subtract 1%
from head,
– add equally to legs.

33. Cont…
 Adult anatomical areas =
9% BSA (or multiple)
 Not accurate for infants
or children due to larger
BSA of head & smaller
BSA legs.
 Burn diagrams illustrate
adult – child differences

34. 2. LUND & BROWDER CHART

36. 3. PATIENTS PALM
Patient’s palmar surface (hand + fingers) = 1% TBSAPatient’s palmar surface (hand + fingers) = 1% TBSA

37. BURN DEPTH
Factors:
 Temperature
 Duration of contact
 Dermal thickness
 Blood supply
 Special Consideration: Very young and very old
have thinner skin

38. MANAGEMENT

39. FIRST AIDS

40. Stop Burning Process
 Remove patient from source of injury
 Remove clothing unless stuck to burn
 Cut around clothing stuck to burn, leave in
place

41. MEDICAL MANAGEMENT

42. PAIN CONTROL

43. Ice Pack-----DO NOT USE EVER
 DOES NOT
– Reverse temperature
– Inhibit destruction
– Prevent edema
 DOES
– Delay edema
– Reduce pain

44. NON-MEDICATION METHODS
 Cover burns with plastic wrap
– Wet dressings will stick and cause more pain
– Other burn dressings are expensive and not
necessary
– Quik Clot is expensive and will not provide
any patient benefit

45. MEDICATION
 Medications
– Opioids
– Narcotics
– Pain medications
– IV Analgesia

46. RESUSCITATION

47. IV ACCESS
 < 15% TBSA – oral resuscitation
 15 – 40% TBSA – one large bore IV
 > 40% -- two large bore IV’s
 IV’s should be in the upper extremities
 Suture IV’s started through burns

48. FLUID RESUSCITATION
 Start IV with RL, through burn OK
– < 6 years = 125mL/hr
– 6-13 years = 250mL/hr
– >13 years = 500mL/hr

49. DRESSINGS
1) Initially consider covering burns with temporary
covering of plasticized polyvinyl chloride film or
cling
 film prior to initial assessment of wound
occurring.
 a) The film should never constrict movement or
be applied to the face or head area.

50. Cont…
2) Ensure adequate analgesia
3) Clean and debride the wound
a) Clean wound with warmed 0.9%NaCl..
b) Remove devitalised tissue (loose nonviable skin)
c) Tense large blisters should be drained by popping
with a sterile needle and may need debriding,

51. Cont…
d) Blisters over digits should not be debrided
4) Definitive dressing
a) The preferred acute burns dressing in CED is a
nanocrystalline silver dressing (eg Acticoat).
b) Nanocrystalline silver

52. NURSING MANAGEMENT
WITH NURSING THEORY

53. NURSING THEORY
 Varginia Henderson theory
 Metaparadigms
 Components

54. NEEDS AND PROBLEMS AS PER
HENDERSON’S THEORY

55. COMPONENTS NEEDS
1. Eat and drink adequately.
2. Eliminate body wastes.
3. Move and maintain
desirable postures.
4. Sleep and rest.
1. Patient have need to
maintain body fluids.
2. Patient have need to
eliminate body waste.
3. Patient have need to
move and maintain the
lower and upper
extremities.
4. Patient have need to take
proper rest.

56. COMPONENTS NEEDS
5. Select suitable clothes-
dress and undress.
6.Maintain body temperature
within normal range by
adjusting clothing and
modifying environment.
7. Keep the body clean and
well groomed and protect
the integument
8. Avoid dangers in the
environment and avoid
injuring others.
5. Patient have need to
suitable clothes dress
6. Patient have need to
maintain body
temperature.
7. Patient have need to body
clean and well groomed
8. Patient have need to
prevention of risk of
injuries

57. NURSING DIAGNOSIS

58. DIET
AND
HEALTH EDUCATION

59. CONCLUSION

60. SUMMERIZATION

61. BIBLIOGAPHY
 Wong’s Hockenberry J. Marilyn. Wilson David.
Essentials of Pediatric Nursing. 8th
Edition. New
Delhi: Published by Elsevier Pvt. Ltd.
 https:// Burn-India.com
 https:// en.m.wikipedia.org/wiki/burn
 http://www. mayoclinic.org// burn

62. THANKS
THANKS