Burns, nursing assessment of burns (history collection, physical assessment, role of nines and calculation, burns, causes, classification, pathophysiology, clinical manifestation, diagnostic evaluation, medical management, surgical management, nursing management, first aid, complication.

1. BURNS
PREPARED BY DOLISHA WARBI

2. NURSING ASSESSMENT OF BURNS:
HISTORY COLLECTION:
Ø Patient demographic detail:
Ø Types of burns (chemical/electrical/flame/flash/etc..)
Ø Time of injury:
Ø Place of injury (open/closed):
Ø Level of pain:
Ø Level of consciousness:
Ø Duration of exposure to agents:
Ø Intentional burn injury:
Ø Any known allergies:
Ø Typical signs of burns:
§ Pain,
§ Redness,
§ Swelling,
§ Blister,
§ Charring,
Ø Chief complaint:
Ø Past medical history:
Ø Family history
Ø Social history:
Ø Last tetanus shot:
Ø “AMPLE”
§Allergies
§Medication
§Prior illnesses
§Last meal time
§Event preceding the injury

3. PHYSICALASSESSMENT / EXAMINATION OF BURNS:
ü Airway
ü Breathing: beware of inhalation and rapid airway
ü Compromise
ü Circulation: fluid replacement
ü Disability: compartment syndrome
ü Exposure: percentage area of burn.
ü Fluid and electrolyte loss:
ü Dept of burns: (superficial burns/partial thickness
burns/ full thickness burns)
ü Appearance description and location(s)
§ Redness
§ Blister
§ Edema
§ Weeping of fluid
§ Scarring
§ Sloughing of skin

4. ü Assess extent of body surface burns
Area of face, hands and perineum
Assess for dyspnea, stridor, hoarseness
ü Assess extend of burns injury:
Palmar method (1%)
Role of nine – immediate appraisal

5. • The rule of nine assess the percentage of burns and is used to help guide treatment decisions, including food
resuscitation and becomes part of the guidelines to determine transfer to a burns unit.

6. CALCULATION:
According to Parkland formula
§ Head and Neck (anterior + posterior) 4.5%*2 = 9%
§ Trunk (anterior + posterior) 18%*2 = 36%
§ Upper extremities - Anterior (front – L&R 4.5%*2 = 9%), Posterior (back – L&R 4.5%*2 = 9%) Total = 18%
§ Perineum = 1%
§ Lower extremities – Anterior (front – L&R 9%*2 = 18%), Posterior (back – L&R 9%*2 = 18%) Total = 36%
§ Overall total (%) = 9+36+18+1+36 = 100%
Test:
A 35-year-old female patient has deep partial thickness burns on the front and back of both arms, anterior trunk,
back of the leg, anterior and posterior sides of the right leg, posterior head and neck, and perineum.
What is the total body surface area percentage that is burned?

7. BURN:
DEFINITION:
Burns can be defined as any injury that result from the direct contact or exposure to any thermal chemical,
electrical or radiation sources.
A burns occur when there is injury to the tissues of the body.

8. CAUSES:
• Fire/flame.
• Hot liquid or steam.
• Hot metal, glass or other objects.
• Electrical currents.
• Friction by rubs against a rough surface.
• Radiation, such as that from X-rays.
• Sunlight or other sources of ultraviolet radiation, such as a tanning bed.
• Chemicals such as strong acids, dye, paint thinner or gasoline.
• Inhalation of hot gases, steam, or smoke during fires can cause burns to the airways and lungs, leading to
respiratory injuries.
• Abuse.

9. CLASSIFICATION:
• First-degree (superficial) burns. First-degree burns affect only the outer
layer of skin, the epidermis. The burn site is red, painful, dry, and has no
blisters. Mild sunburn is an example. Long-term tissue damage is rare and
often consists of an increase or decrease in the skin color.
• Second-degree (partial thickness) burns. Second-degree burns involve the
epidermis and part of the lower layer of skin, the dermis. The burn site looks
red, blistered, and may be swollen and painful.
• Third-degree (full thickness) burns. Third-degree burns destroy the
epidermis and dermis. They may go into the innermost layer of skin, the
subcutaneous tissue. The burn site may look white or blackened and scarred.
• Fourth-degree burns. Fourth-degree burns go through both layers of the
skin and underlying tissue as well as deeper tissue, possibly involving
muscle and bone. There is no feeling in the area since the nerve endings are
destroyed.

10. First-degree
Second-degree
Third-degree
Fourth-degree

11. PATHOPHYSIOLOGY:
Burn
Ischemia of brain, kidney and vital organ
Organ failure e.g. Kidney
Reduce blood flow to the vital organ like a GI tract and kidney
Fluid and blood is losses from vessel
Fluid plasma accumulate and cause edema
Fluid plasma leak out on the interstitial space
Causes permeable to the vessel
Due to etiological factor

12. CLINICAL MANIFESTATION:
ü Pain
ü Redness and inflammation
ü Blistering
ü Swelling
ü Peeling and sloughing
ü Numbness or tingling
ü Charred or blackened skin
ü Difficulty breathing
ü Shock
ü Scarring
ü Injury to deeper lavers of dermis
ü Cold and clammy skin
üTachycardia
üHypotension due to shift of fluid
üDecreased heart rate
üHoarseness of voice mostly due to smoke
üConfusion
üIrritability
üSubconscious to unconscious
üLoss of motor action

13. DIAGNOSTIC EVALUATION:
§ History Taking
§ Physical Examination
§ ABG
§ Chest x- ray, CT - scan
§ Pulse oximetry
§ Capnography
§ Fibreoptic laryngoscopy and bronchoscopy

14. MEDICAL MANAGEMENT:
qCooling the burn with cool water for a few minutes.
qOver-the-counter burn creams or ointments, such as aloe vera or petroleum jelly.
qWound care, including cleaning the wound, debriding dead tissue, and applying topical antimicrobial agents.
qPain medications, such as acetaminophen, ibuprofen, or opioids.
qTopical treatments containing lidocaine or other numbing agents may be used to provide local pain relief.
qFluid resuscitation aims to restore and maintain adequate hydration and circulation.
qNutritional supplementation, including protein, vitamins, and minerals, to support tissue repair and immune
function.
qAntimicrobial dressings, topical antibiotics, or systemic antibiotics may be used to prevent or treat infections.
qWound care, including cleaning and dressing changes, is essential to minimize the risk of infection.
qPhysical therapy, occupational therapy, and psychological support to help patients recover function and adjust
to any disabilities or changes in appearance.

15. SURGICAL MANAGEMENT:
Ø Bursectomy - Removal of the affected bursa.
Ø Open bursectomy - In open bursectomy, a larger incision is made directly over the affected bursa, and the
bursa is removed surgically.
Ø Arthroscopic bursectomy - A thin, flexible instrument with a camera (arthroscope) is inserted into the joint to
visualize the bursa. Surgical instruments are then inserted through additional small incisions to remove the
inflamed bursa.
Ø Skin grafting - A patch of skin that is removed by surgery from one area of the body and transplanted, or
attached, to another area.

16. NURSING MANAGEMENT:
ü Monitor vital signs.
ü Secure patient airway (ABC).
ü Administered strong analgesic (pethidine).
ü Provide enough fluid to the patient.
ü Apply antiseptic topical cream to prevent from infection.
ü Provide adequate nutrition to the patient.
ü Provide psychological support to the patient and family.
ü Assess the patient condition regularly.
ü Regular dressing to the burns area with proper care.
ü Administered the prescribed medication.
ü Observed the healing process of the patient.
ü Educate the patient condition and the important of the medical intervention.
ü Assist the patient in needs.
ü Instruct the patient for the rehabilitation and the need for follow up care.

17. FIRST AID:
§ Stop the burning
§ Assess ABC
§ Remove constricting jewelry and clothing.
§ Run burns under cool water for 10min.
§ Call for medical helps.
§ Cover the burns with sterile clean cloths
§ Assess for associate trauma
§ In case of chemical burns, clothing which has been soaked by the chemical agent must be removed immediately
§ Evaluate the degree of burns and treat the priority’s need first.
§ Administered 100% of oxygen as prescribed.

18. COMPLICATION:
1. Arrhythmia (electrical burn).
2. Dehydration.
3. Disfiguring scars and contractures.
4. Edema (excess fluid and swelling in tissues).
5. Organ failure.
6. Pneumonia and respiratory problem.
7. Seriously low blood pressure (hypotension) that may lead to shock.
8. Infection and sepsis.
9. Psychological impact.
10. Hypothermia.

19. THANKS YOU