its include next portion of burn which include clinical menifestation, diagnostic evaluation, complication, and management

1. BURN
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. Learning Objectives
At the end of the class the students will be
able to:
• Enlist the clinical manifestation of burn
• Explain the management
• Describe emergencies treatment of burn

3. Clinical Manifestation
Degree of injury
• 1st Stage : It is superficial
• 2nd Degree : Partial thickness, appear wet or
• 3nd Degree : Full thickness damage by dermis.

4. • Hypothermia
• Diminished fluid volume
• Hypopvolemic shock
• Urine out put decreased, conc. Urine and
elevated specific gravity.

5. • Elevated blood urea nitrogen (BUN)
• In GI absence of bowel sounds,
• flatus, nausea, vomiting and
• abdominal distention

6. • Alternation in Respiration
• Cardiovascular System
Pain responses
Substantial pain
Two type pain : Back ground pain,Procedural pain
Altered level of consciousness

7. Psychological Reactions to several burn
• Conservation withdrawal.
• Denial
• Regression
• Anger and hostility
• Depression
• Anxiety.

8. DIAGNOSTIC EVALUATION
1. Complete blood count: Initial increased hematocrit
(Hct) suggests hemoconcentration due to fluid
shift/loss.
2. Arterial blood gas: Reduced PaO2/increased PaCO2
may be seen with carbon monoxide retention.
3. Carboxyhemoglobin: Elevation of more than 15%
indicates carbon monoxide poisoning/inhalation injury.

9. 4. Serum electrolyte: Potassium level may be initially
elevated because of injured tissues with RBCs
destruction and decreased renal function.
5. Alkaline phosphate: Elevated because of interstitial
fluid shifts/impairment of sodium pump.
6. Serum glucose: Elevation reflects stress response.
7. Serum albumin: Albumin/globulin ration may be
reversed as a result of loss of protein in edema protein.

10. 8. BUN: Elevation reflects decreased renal
perfusion/function.
9. Random urine sodium: More than 20mEq/L indicates
excessive fluids resuscitation; less than 10mEq/L
indicates inadequate fluid retention.
10. Chest X-ray: May appear normal in early postburn
period even with inhalation injury; however true
inhalation injury presents as infiltrate.

11. 11. Fiberoptic bronchoscopy: Useful in diagnosing extent
of inhalation injury.
12. Lung scan: May be done to determine extent of
inhalation injury.
13. ECG: Signs of myocardial ischemia/dyssrhythmias
may occur with electrical burns.
14. Photographs of burn: Provide documentation of burn
wound.

12. COMPLICATIONS
1. Acute complication:
Hypovolemic shock.
Renal failure.
Respiratory and cardiac arrest

13. 2. Chronic complication:
Wound infection.
Contracture.
Burn psychosis.
Stress ulcer.
Hypertrophy of scarring (kelloid).

14. Management of minor burns
Minor burns injury in the adult  less than 15%
of TBSA if patient is younger than 40 years.
If patient older than 40 years  10% TBSA.

15. MEDICAL MANAGEMENT OF
BURN
A.Emergent period or immediate phase:
• Emergent period of the burn management
refers to the first 48 to 72 hours postburn
when the patient is admitted to the hospital.
1.Airway management: Airway management of
burns is an extremely important consideration
that lead to devastating complications if not
properly conducted.
•

16. • Hyperbaric oxygen therapy (HBOT):
Hyperbaric oxygen therapy is a non invasive
mode of medical treatment in which the patient
is entirely enclosed in a pressure chamber
filled with oxygen at a pressure greaterthan
one atmosphere. Hyperbaric oxygen therapy is
also used in the treatment of smoke inhalation.

17. • Fluid management: After an airway has been
established, support of circulation is addressed.
Burn injuries cause tremendous losses fluid
through the wound as well as into the burn
wound and adjacent tissues in the form of
edema. Fluid loss is best immediately replaced
through two large caliber peripheral
intravenous catheters.

18. Nursing care of minor burn wounds
a) Wound assessment and initial care of
wound.
b) Tetanus immunization.
c) Pain management
d) Health education

19. Emergent phase
• Begins at the time of injury, with a pre-hospital
care and concludes when capillary integrity is
restored,
• It should begin with removing the victim from
the source of the burn

23. Emergency Management of Chemical
burns
• Wear appropriate protective garb globe.
• Remove the chemical - patient’s body.
• Flush chemical - with saline solution or water.
• Remove clothing including shoes, watches,
jewellery and contact lenses if face is exposed.
• Blot, do not rub, skin dry with clean towels.

24. • Cover all burned area with dry, sterile dressing
or clean dry sheet.
• Monitor airway, if airway is exposed to
chemicals.
• Attempt to determine type of chemical
exposure.

25. Emergency Management of Inhalation
injury
• Remove patient from toxic event.
• Establish and maintain airway, anticipates need
for incubation of resp. distress.
• Administer O2
• Be prepared to incubate if respiratory distress
occurs.
• Remove patients clothing.

26. • Establish I/V line with large gauge needle.
• Monitor vital signs
• Place patient in a high fowler’s position
• Assess for facial and neck burns
• Prepare for emergency, endotracheal
intubations if indicated.

27. Emergency Management of Electrical
Burns
• Remove patient from contact with current source
• Avoid contact with electric current during rescue
• Assess for patient Airway, breathing and circulation
• CPR if necessary
• Establish and maintain airway
• Administer 02, Establish I/V line.

28. • Remove patient clothing
• Assess burn area
• Check pulses distal to burns
• Monitor heart rate and Rhythm
• Cover burn sites with dry sterile digressing
• Assess for any other injuries e.g. fractures
• Monitor vital signs including level of
consciousness.

29. Emergency Management of Thermal
Burns
• Remove patient from environment and stop the
burning process.
• Maintain airway
• Administer fluid
• Monitor vital signs
• Remove clothing and jewellery

30. Immediate Patient Care
• Clothes are carefully removed
• Weight and height recorded
• Patient is placed on or between sterile or
pathogen free sheet
• Reassurance and support given

31. Environment Preparation :-
• Mattress is completely covered with a plastic
sheet
• Sterile microden sheeting on top of this
bedding
• The room should be well equipped.

32. Transfer to a Burn Centre :
• I/V infusion
• Check urine output
• Maintain patient airway
• Given adequate pain relief
• Wound are covered with sterile, dry dressing.

33. Summary
So far we have discussed about clinical
manifestations, management of burn.

34. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.

35. Thank You