IT IS USEFUL FOR 3RD YEAR BSC NURSING STUDENTS

1. Burns
Suguna S Bapu
Lecturer

2. Burns
• Burns is defined as the injuries that results
from direct contact wit or exposure to any
chemical, thermal or radiation source.
(JOYCE M BLACK)
• Burns is defined as injury to the tissues of the
body caused by heat, chemicals, electric
current or radiation.
(LEWIS)

3. INCIDENCE
• Burns can occur at all age groups and socio
economic groups.
• An estimated 1 million Americans and
100,000 Canadians seek medical care each
year for burns.
• Approximately,100,000 are hospitalized and
70,000 people required extensive care
services and an estimated 12,000 of these
people die annually as a direct result of burns.

4. Types
• Chemical burns
• Thermal burns
• Electrical burns
• Radiation burns
• Smoke and inhalation burns

5. Chemical Burns
• Chemical burns are caused by contact with
strong acids, alkalis or organic compound.
• It can be result from contact with certain
household cleansing agents and various
chemical used in industry and agriculture.

6. Chemical Burns

7. Thermal burns
• Thermal burns are caused by exposure to or
contact with flame, hot liquids, semi liquids
• (e.g steam),semisolids (e.g tar) or hot objects.
E.g residential fires, explosive automobile
accidents, cooking accident.

8. Thermal Burns

9. Electrical burns
• It is caused by heat, that is generated by the
electrical energy as it passes through the
body.
• Direct damage to nerve and vessels causing
tissue anoxia and death can also occur.
• It can result from contact with exposed or
faulty wiring or high voltage power lines.

10. Electrical Burns

11. Radiation burns
• This are least common types of burn injury and
are caused by exposure to a radiation source.
• This types of injuries have been associated with
nuclear radiation accidents, the use of ionizing
radiation in industry and therapeutic irradiation.
• Sun burn from prolonged exposure to UV rays is
also considered to be a radiation burns.

12. Radiation Burns

13. Smoke and inhalation burns
• It results from the inhalation of hot air or noxious
chemical and caused damage to the tissues of the
respiratory tract.
• A) carbon monoxide poisoning : CO poisoning
and asphyxiation account for the majority of
death at a fire scene.
• It is produced by the incomplete combustion of
burning material
• It is subsequently inhaled and displaced oxygen
on the hemoglobin molecule, causing hypoxia,
carboxyhemoglobinemia and ultimately death.

14. Classification of burns injury
• Burns injuries are classified according to the
depth of the injuries and the extend of the
body surfaced areas injured.

15. Burn Depth

16. Burn Depth Categories

17. Pathophysiology of burns

18. Jacksons Burns Model

19. Clinical Manifestations

20. Cont.

21. Cont..

22. Cont..

23. Assessment
• Rule of 9
• Lund and Browder Chart
• Palm method-

24. Rule of Nine

25. Lund and Browder Chart

26. Palm Method

27. Management

28. Cont..

29. Cont..

30. Cont..

31. Cont..

32. Fluid calculation in burns
• Brookes Formula
• Modified Brookes Fromula
• Evans Formula
• Parkland Formula

34. Parkland Formula

35. Brookes Formula

36. Evans Formula

37. Modified Brookes/ Parkland Formula

38. Phases of Burn Injury
• . There are three phases of burn injury, each
requiring various levels of patient care. The
three three phases are
• emergent phase,
• intermediate phase,
• and rehabilitative phase.

39. Emergent Phase
• The emergent phase starts with the onset of
burn injury and lasts until the completion of
fluid resuscitation or a period of about the
first 24 hours. During the emergent phase, the
priority of patient care involves maintaining an
adequate airway and treating the patient for
burn shock

40. Intermediate Phase
• The intermediate phase of burn care starts about
48–72 hours after the burn injury. Alterations in
capillary permeability and a return of osmotic
pressure bring about diuresis or increased urinary
output. If renal and cardiac functions do not
return to normal, the added fluid volume, which
prevented hypovolemic shock, can now produce
manifestations of congestive heart failure.
Assessment of central venous pressure gives
information regarding the patient’s fluid status.

41. Rehabilitative Phase
• The final stage in caring for a patient with
burn injury is the rehabilitative stage. This
stage starts with closure of the burn and ends
when the patient has reached the optimal
level of functioning. The focus is on helping
the patient return to a normal injury-free life.
Helping the patient adjust to the changes the
injury has imposed is also a priority.

42. Burns Rehabilitation
Stage of Shock Stage of Eschar Stage of Healing
and Reconstruction

43. Phases of Rehabilitation
Acute phase: 48hrs-
wound closure.
.Chronic phase: wound
closure-functional ADL
regainment.

44. Complications of healing in burn
• i. Pain: Background pain, pain due to anxiety,
Procedural, Break-through pain.
• ii. Edema.
iii. Inflammatory Response.
• iv. Compartment syndrome.
• v. Hypertrophic scarring.
• vi. Keloid.
• vii.Toxic Epidermal Necrolysis.
• viii.Reduced ROM.
• ix. Impaired functional capacity.
• x. Psychological problems.

45. Assessment
Primary assessment
• Airway.
• Breathing.
• Circulation.
• Neurologic status.
Secondary assessment
• Type and Mechanism of injury
• Severity and extent of burn
• Depth of burn

46. Physiotherapy Assessment
• On observation:
degree of burn,
severity of burn,
extent of burn,
edema,etc.
• Edema
assessment: site,
pitting, non-
pitting.
• Burn wound area assessment:
Laser dopler flowmetry, clock
method
On palpation: Area to be palpated
burnt area with sterile methods and
the area beside it to assess for
assessment of perception of
sensation.

47. • Hydrotherapy for cleansing 30 minutes
Adequate cleansing is achieved by mild soap.
Mechanical debridement Chemical
debridement Surgical debridement Wet
dressing, Wet-to-dry dressing, Wet-to-moist
dressing. Accuzyme, Collagenase Santyl, Elase.
Tangential excision. Fascial excision. Cleansing
1 Debridement of wound1 Treatment of
burns: I. Emergent Phase: 2 Treatment of
burns: I. Emergent Phase:

48. • Wound covering1 Biological wound dressings
Biosynthetic wound dressings Synthetic
wound dressings 1. Xenograft 2. Allograft 1.
Biobrane 2. Calcium alginate 1. Thin film
dressing 2. Composite dressing

49. • Acute Phase Aims: • Protect/promote healing.
• If can not be managed with conservative
treatment then surgery specified. • Reduce
pain and edema. • Reduce risk of
complications by maintaining immobilization.
• Optimize scar appearance. • Decrease
complications of scar /prolonged positioning
on range of motion and function. • Prevent
contractures • Prevent deformities/loss of
range

52. POSITIONING

53. SPLINTING

54. REHABLITATION

55. Cont..

56. Cont..

57. Cont..

58. Cont..

59. Cont..

60. Cont..

61. Cont..

62. Cont..

63. Nursing Diagnosis
•
• Impaired Physical Mobility
• Deficient Knowledge
• Disturbed Body Image
• Fear/Anxiety
• Impaired Skin Integrity

64. Cont..
• Imbalanced Nutrition: Less Than Body
Requirements
• Risk for Ineffective Tissue Perfusion
• Acute Pain
• Risk for Infection
• Risk for Deficient Fluid Volume
• Risk for Ineffective Airway Clearance

65. Thank You