Concept of Clinical Presentation on Burn Injury. By Rakesh Datta. M.Sc. N. Write up clinical case scenario for Burn Injury.

1. Clinical Presentation
On
Burn

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Patient Profile
• Name : Mr X.
• Gender: Male
• Hospital No: XXXXXX
• Age:43 years.
• Diagnosis: 2nd Degree Burn Injury(51%)
• Date of Admission:27-04-2020
• Name of the Surgery done: Tracheostomy on :29-04-2020.
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History Collection
• Introduction
• Personal History
• Family History
• Socio-economic status
• Psychological History
• Spiritual History
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Past Medical History
• No significant medical history of illness.
• No surgical history.
• Not on any previous medication.
• No history of hospitalization.
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Present Medical History
Chief complaints: Burn injury (chest, face, both hands, both thigh
and abdomen )
History of Chief complaints
Initial Treatment Done
Treatment in CMC
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Blood Investigation
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Date Name of the Investigation Exam Values
27-04-2020 PCV 34%
27-04-2020 Total Count 13300/cumm
27-04-2020 Platelets 3.46 lakhs
27-04-2020 HIV Negative
27-04-2020 HbsAg Negative
27-04-2020 HCV Negative
27-04-2020 Sodium 130 mmol/l

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INVESTIGATION
Date Potassium 4.7 mmol/l
27-04-2020 Bicarbonate 19 mmol/l
27-04-2020 Random Sugar 110 mg/dl
27-04-2020 Haemoglobin 10.5 gm%
27-04-2020 LFT
27-04-2020 Bilirubin Total 0.86 mg/dl
27-04-2020 Direct 0.32 mg/dl
27-04-2020 Protein Total 3.5 g/dl
27-04-2020 Albumin 3.7 g/dl
27-04-2020 AST 26 U/L
27-04-2020 ALT 13 U/L 7

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Investigation
27-04-2020
Urea 14 mg %
27-04-2020
Creatinine 0.42 mg %
27-04-2020
Alkaline Phosphatase 51 U/L
Culture
Culture Blood No growth so far.
Culture Pus Few pus cells,
moderate gram
positive cocci in pairs
Urine No growth
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Physical Examination
• General Appearance : Burn injury over face, chest, both hands, both
thigh and abdomen .
• LOC : Conscious and oriented
• Vitals: (Day 1)
 Temp : 97°F
PR: 108/ mt
RR: 26/ mt
SPO2: 97 %
BP: 98/60 mm of Hg
Pain : 8/10 (VAS) 9

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Day 2
• Vitals:
• Temp : 99°F
PR: 108/ mt
RR: 26/ mt
SPO2: 94 % on 5 Lt O2/min
BP: 106/68 mm of Hg
Pain : 7/10 (VAS)
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Day 3
• Vitals:
• Temp : 99.4°F
PR: 122/ mt
RR: 28/ mt
SPO2: 96 % on 5 Lt O2/min
BP: 110/84 mm of Hg
Pain : 7/10 (VAS)
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Medication
Name of the medication Dose Route Frequency Nursing
Considerations
Inj. Morphine 5 mg S/C Prn GCS, SPO2, Secretions
Inj. Meropenam 2 g IV Q8H Renal and Hepatic
Inj. Paracetamol 1 g IV TDS Hepatic Function
Inj. Diclofenac 75 mg IV BD Renal.
Inj. Pantoprazole 40 mg IV OD Consider general
symptoms
Tab. Vitamin C 500 mg NG BD GIT
Tab. Cobadex CZS 1 Tab NG OD GIT
Inj. Emeset 8 mg IV Prn Allergy 12

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Burn Injury
A burn is a type of injury to skin, or other tissues,
caused by heat, cold, electricity, chemicals, friction, or radiation.
Most burns are due to heat from hot liquids (called scalding),
solids, or fire. While rates are similar for males and females the
underlying causes often differ.
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Causes of Burn Injury
• Friction burns.
• Cold burns.
• Thermal burns.
• Radiation burns.
• Chemical burns.
• Electrical burns.
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Types of Burn Injuries:
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Types Symptoms Wound Appearance
Superficial Partial-
Thickness (1st Degree)
Tingling, hyperplasia,
pain is soothed by
cooling
Reddened; blanches with
pressure ,dry minimal or no
edema possible blisters
Deep Partial-
Thickness(2nd Degree)
Pain, hyperplasia ,
Sensitive to cold air
Blistered, mottled red base;
broken epidermis; weeping
surface , edema
Full-Thickness
(3rd Degree)
Pain free ,shock
,haematuria and
possibly haemolysis,
Dry ; pale white ,leathery or
charred , broken skin with fat
exposed ,edema

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Calculation Of TBSA(Total burn surface area)
• Rule of Nines
• Lund and Browder Method
• Palmer Method
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Rule of Nines
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Lund and Browder Method
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Palmer Method
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Management of Burn Injury
Phases Duration Priorities
Emergency/resuscitative From onset of injury to completion
fluid resuscitation
First aid, prevention of shock,
prevention of respiratory distress
Acute /intermediate From the beginning of diuresis to
near completion of wound care
Wound care and closure
Prevention and treatment of
complications including infections
Nutritional support
Rehabilitation From major wound closure to return
to individual’s optimum level of
physical and psychosocial
adjustment
Prevention of scars
Physical ,occupational and
vocational rehabilitation
Functional and cosmetic
reconstruction
Psychological counselling
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Fluid management of Burn:
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DIET
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Theory application
Assessment
Basic conditioning factors
Age:
Gender
Health status
Health care system
Family
Pattern of living
Environment
Recourses
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Universal Self-care Requisites
• Air
• Water
• Food
• Activity
• Social interaction
• Prevention
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Development of self-care requisites
• Able to manage in –home care post discharge
• Need of assistance
• Spiritual belief reconstruction
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Health deviation Of self care requisites
• Poor knowledge regarding burn and its complication
• Adherence to the therapeutic regimen
• Worried about the post surgery changes
• Adjusted with the limited moments, diets and treatments.
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Nursing Diagnosis
• Impaired gas exchange r/t CO poisoning, smoke inhalation
evidenced by nasal singeing and presence of fumes over the
nasal flares.
• Ineffective airway clearness r/t edema and effects of smoke
inhalation as evidenced by breathing difficulty and
tracheostomy tube secretion.
• Fluid volume deficit r/t increase capillary permeability and
evaporative losses from burn wound as evidenced by soakage
from burn wound and electrolyte imbalance and tachycardia. 27

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Continued…
• Pain r/t tissue and nerve injury and emotional impact of injury
as evidenced by pain score (7/10).
• Hypothermia r/t loss of skin microcirculation and open wounds
as evidenced by mixed 2nd degree burn and .
• Risk for infection r/t inadequate primary and secondary
defences as evidenced by burned skin, traumatised tissue and
reduced Hb. increased total count and increased temperature.
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Continued…
• Imbalanced nutrition less than body requirement r/t
hypermetabolic state, protein catabolism and restricted oral
diet as evidenced by 51 % of TBSA, weakness and NG tube
feeding.
• Fear/Anxiety r/t hospitalization, isolation procedure , trauma
experience ,threat of death as evidenced by his increased tension,
uncertain future and decreased self-assurance and insomnia.
• Spiritual distress r/t life changes and self alienation as
evidenced by his feeling towards that God has abandoned him,
inability to pray ,refuses interaction with family and friends . 29

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• Patient evaluation.
• Self evaluation.
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Evaluation