Burn: Types, Treatment, and Nursing Management

Burn: Types, Treatment, and Nursing Management

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What is Burn  

  • 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.
Burn classification / Types of Burn
Burn classification / Types of Burn

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 –

Rule of Nine

Head and neck 9%
Upper extremities 18% (9*2)
Lower extremities 36% (18*2)
Back and chest 36% (18*2)
Genital 1%
Total Burn 100%

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

↓                                  ↓                                      ↓

Loss of myocardial loss of kidney  accumulation
Function function  of fluid into

      

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-

  1. What is the most common cause of burn?

    Thermal burn.

  2. Which type of burn causes cognitive necrosis?

    Acidic chemical burn.

  3. What Region of Inhalation burns?

    Hot smoke.

  4. What is the Most common source of radiation burn?

    U.V. rays.

  5. What is the Rule of nine?

    Rue of nine is the burn body surface area calculation formula

  6. How to Calculate Burn body surface of radiation burn?

    Rule of nine.

  7. According to rule of nine, severe burns indicate

    Burn body surface area more than 25%.

  8. Deep full thickness burn include which burn?

    Third-degree burn

  9. Which type of burn depth causes the blister formation?

    Superficial partial thickness burn

  10. Which type of burn causes no pain

    3rd degree burn

  11. Complete epidermis and dermis burn

    Full thickness burn.

  12. Most common grafting procedure in burn

    Autograft.

  13. A deep full thickness burn wound is

    Black open wound.

  14. What region of the Burn causes the sensation loss?

    Destruction of nerve endings.

  15. What indicates the Hydration status of a burn patient

    Hypovolemia.

  16. In burn patients, fluid is calculated by

    Parkland formula.

  17. What is the Parkland formula?

    4 mL RL * body weight * body surface area.

  18. First nursing action in burn patient

    Open airway.

  19. The acute phase of burn management starts after

    72 hours.

  20. What is the Final phase of burn management?

    Rehabilitative phase.

  21. What are Common nursing actions to control Burn infection?

    Use barrier nursing.

  22. Which type of bed is used for a burn patient?

    Bed cradle.

  23. What are the 5 types of burns?

    Thermal burn
    Chemical burn
    Electrical burn
    First-degree burn
    Second-degree burn
    Third-degree burn

  24. How do you classify burn?

    Burn classification A/C to body surface area –
    Thermal burn
    Chemical burn
    Electrical burn
    Depth of burn-
    First-degree burn
    Second-degree burn
    Third-degree burn

  25. Should I put ice on the burn?

    Yes or not maybe depends on which type of burn-on-burn type

  26. Should you cover a burn or let it breathe?

    yes

  27. What are the four phases of definitive burn care?

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

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