Burn: Types, Treatment, and Nursing Management

• A burn is an emergency and life-threatening condition that causes the destruction of the surface. A layer of the body due to exposure to thermal, chemical, electrical and radiation sources.
• Burn affects the major system of the body and causes systemic body function loss.

Cause of burn

Thermal burn –

•  A thermal burn is the most common cause of burn.
• Thermal burns occur due to exposure or contact with Fire, hot liquids, flame, hot metal, flash, and stem.

Chemical burn –

• occurs due to organic and inorganic substances.
• Acidic products cause coagulative necrosis and alkaline chemicals cause colliquative necrosis.

Electrical burn –

• Electrical burn occurs due to exposure to electric current, or short circuits.
• The intensity of electrical burn depends on – the voltage mode of current and time of touch to electricity.

Other Burn –

• Inhalation burns occur due to hot smoke.
• Radiation burn occurs due to sunlight, X-Ray.

Risk factors of burne

• Fire
• Hot summer
• During cooking
• Occupational hazards
• Electricity repairing.

A/C to body surface area – 

Estimation of burn, on basis of body surface area. Total body surface area – 100%.

“Rule of nine ” is used to measure burn body surface area.

Rule of nine –

According to the “Rule of nine,” an estimated burn surface area is less than 25% is indicated → mild to moderate burn.

If more than 25% burn indicates → severe burn.

Mild to Moderate Burn = 25% of body area is burned

Severe burn = more than 25% burn

Based on depth  

First-degree burn

• Superficial thickness burn
• Superficial partial thickness burn

Second-degree burn

1. Deep partial thickness burn
2. Full thickness burn

third degree burn

1. Deep full thickness burn.

Superficial thickness burn

• Burns involve the epidermis.
• Cause – sunburn, flash, hot liquid
• Symptoms – pain, redness, tingling sensation, erythema, and swelling.
• Symptoms subside after 48 hours.
• Recovery within 3 – 7 days.

Superficial partial thickness burn

• Burns involve the epidermis and superficial areas of the dermis.
• Cause – hot liquid, cooking, steam, chemicals.
• Symptoms – blister formation, pain, redness, tenderness, pink and moist wound.
• Mild pigmentation formation and no scar formation.
• Edema present.
• Burn is sensitive to cool air.
• Burn recovery within 10 – 21 days.

Deep partial thickness burn

• Burns involve the complete epidermis and incomplete dermis skin layer.
• Cause – scalds, flash, flame
• Symptoms – No blister formation, alternative pain
• Red wound
• Dry wound with a deep white area
• Moderate edema
• Tissue necrosis
• Hypoxia and ischemia
• Scar formation.
• The recovery period is 3 – 6 weeks.
• Deep partial thickness burn requires skin grafting.

Full thickness burn

• Burn involved the complete epidermis and complete dermis layer.
• Cause – electrical current, chemical, long time exposure with hot liquid and heat, flame etc.
• Symptoms – deep red, white, yellow, Brown or black wounds.
• Dry hard eschar formation in the full-thickness burn.
• Edema will be present in full-thickness burns.
• No pain was present in the full-thickness burn.
• Loss of sensation due to nerve-ending destruction.
• Some disabilities and deformities.
• Recovery is possible by skin grafting and is dependent on months.
• An escharotomy procedure is done.

Deep full thickness burn

• Burn involves the epidermis, dermis, subcutaneous fat, muscles, organs etc.
• These types burn the bones.
• Symptoms – black open wound.
• Sensation completely absent
• Scar formation
• No pain
• Visible bone, organ, mass and vessels
• Blood leakage.
• Skin grafting (autograft) is required.
• Recovery depends months to years.

Pathophysiology of Burn

Burn

↓

Increase capillary permeability

↓

Excessive loss of body fluid

↓

Hypovolemia

↓

Decreased cardiac output

↓

↓                                  ↓                                      ↓

Lungs

↓                                   ↓                                       ↓

Heart failure               kidney failure             edema and

Infection

↓

Multi-organ dysfunction.

Sign and Symptom of Burn

Burn effect on Respiratory System –

• acute respiratory distress syndrome (ARDS)
• Respiratory failure
• Pulmonary edema
• Hypoxia.

Burn effect on Cardiac System –

• cardiac failure
• Hypertension and shock
• Tachycardia.

Burn effect on Renal System –

• oliguria and anuria
• Loss of kidney function
• Decrease GFR
• Acute kidney failure.

Burn effect on GIT-

• GI bleeding
• Peptic ulcer
• Decrease peristalsis movement
• Decrease GI perfusion.
•  

Burn effect on Integumentary System-

• inflammation
• Skin loss
• Alopecia
• Sensation loss.
• Thermoregulatory
• increase BMR
• Heat loss.

Electrolytes Imbaance in burn –

• hyperkalemia
•  Hypovolemia.

Burn Medical management

1. Emergency / Resuscitation phase
2. Resuscitative phase
3. Acute phase
4. Rehabilitation phase.

Emergency / Resuscitation phase of Burn

• Begins from burn to regain capillary permeability.
• Emergency / resuscitative phase 48 – 72 hours period phase.
• Include –

Burn Prehospital care

• Prehospital care from burn to when emergency care is obtained.
• Remove the source of the burn from the victim.
• Monitor ABC ( Airway, breathing and circulation )
• Physical examination and assess any trauma and injury.
• Patient cover with sterile or clear clothes.
• Remove any metal items, jewelry from the patient.
• Transfer the patient to the emergency department

Burn Emergency department care

• Monitor patient burn type, degree of burn, and site of the burn.
• ABC analysis.
• Airway clearance and administer 100% oxygen.
• Administer IV line to maintain hydration status.
• Monitor any respiratory distress and arrange intubation equipment.
• ABG analysis (arterial blood gas).
• Maintain NG tube and catheterization administration.
• Provide all prescribed medication such as – antibiotics, analgesics, TT injection, etc.
• Cover the patient with a bed cradle.

Burn Resuscitative phase

• The resuscitative phase starts from 48 hours to 72 hours.
• Start from fluid administered to capillary permeability regain.
• Administration according to the Parkland formula.

Parkland formula –

• 4ml RL * weight in kg * total burn surface area.
• Calculated half fluid administers within 8 hours and remaining half fluid administer within next 16 hours.
• The effectiveness of administration is assessed by urine output.
• Mental patient NPO and provide total parenteral nutrition.
•  Administer analgesics to relieve pain.
• Escharotomy and fasciotomy procedure provide.
•  

Acute phase of Burn

Acute phase starts after 48 – 72 hours.

Acute phase starts from a patient is hemodynamically stable to wound closure.

Acute phase includes –

• Appropriate wound care and treatment
• Wound closure and dressing
• Surgically wound cleaning and debridement
• Skin grafting ( autografting )
• Nutritional support
• Administration medication
• Pain management
• Infection control and prevention
• Physical therapy
• Health education.

Rehabilitative phase of Burn

Rehabilitative phase is a final phase of burn patient care.

Rehabilitative phase include –

• Provide physiological and emotional support.
• Promote wound healing.
• Increase the strength of organ function.
• Minimise the complication and deformities.

Complications of burn

• Loss of body function
• Deformity
• Disturb body image
• Renal failure
• Disturb body image
• Gastrointestinal haemorrhage
• Local edema
• Bone marrow suppression.

Nursing management of Burn

• Nurse monitors patient ABC (Airway, breathing, circulation) and vital signs.
• Maintain Airway clearance administer 100% oxygen therapy.
• Avoid the exposure of burn from the victim.
• Nurse Identify the type of burn, site, severity and pain intensity.
• Nurse monitored the burned body surface area according to the rule of nine.
• Nurse help in pre hospital care and emergency department care.
• Cover the patient with sterile cloth, by using a bed cradle.
• Calculate the fluid according to parkland formula.
• Nurses administer half fluid within 8 hours and remaining half fluid next 16 hours.
• Administer TT injection and analgesic after burn as soon as.
• Maintain patient NPO and administer NG tube.
• Provide total parenteral nutrition.
• Provide appropriate wound care and treatment.
• Nurses help in providing skin autografting.
• Provide appropriate care of graft and donor site.
• Nurses isolate the patient and prevent infection.
• Nurses use proper barrier nursing.
• Monitor hourly urine output.
• Provide physical therapy and health education.
• Provide physiological support due to disturbing patient body image.

Reference – Nclex sounder 2nd edition Page no. 553 to 560.

Burn Question and Answer-