Burn

Nursing management to burn patient

1. BURN CINDRELLA BURGE MSC NURSING 1 ST YEAR MSN DEPT. TMVCON, TMU

2. ANATOMICAL AND PHYSIOLOGICAL REVIEW OF SKIN

3. The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects from microbes Helps regulate body temperature Permits the sensation of touch, heat and cold

4. Layers of skin Epidermis Dermis Thin superficial layer Thickness 0.05mm to 0.1mm Nourished by blood vessels in the dermis Connective tissue below the epidermis Thickness varies from 1 to 4 mm Consist of hair follicles and sweat glands

5. Subcutaneous tissue Lies below the dermis and is not part of the skin Contains loose connective tissue and fat cells Also called hypodermis

6. Burn

7. Introduction A burn occurs when there is injury to the tissues of the body caused by heat, chemicals, electric current or radiation. The resulting effects are influenced by the Temperature of the burning agent, Duration of contact Type of tissue that is injured

8. Definition Burn is a damage to the skin or deeper tissue caused by sun, hot liquids, fire, electricity or chemicals.

9. Classification of burn injury according to depth

10. Types Layers involved Appearance Texture Sensation Healing time Prognosis Superficial 1 st degree Epidermis Red without blister Dry Painful 5- 10 days Heals well Superficial partial thickness 2 nd degree Extends into superficial dermis Redness with clear blister blanches Moist Very painful 2-3 weeks Local infection but no scarring Deep partial thickness 2 nd degree Extends into deep dermis Yellow or white, less blanching Dry Pressure/ discomfort 3-8 weeks Scarring, contractures Full thickness 3 rd degree Extends through entire dermis Stiff and white/ brown, no blanching Leathery Painless Prolong and incomplete Scarring, contracture, amputation 4 th degree Extends through entire skin and into underlying fat Black, charred with eschar Dry Painless Requires excision Amputation

11. Classification of burn injury related to severity Depth of burn Extent of the burn- calculated in % of total body surface area Location of burn

12. Depth of burn In the past, burns were defined by degree, first degree, second degree and third degree. The American burn association now recommends a more precise definition of second and third degree burn, categorizing them according to depth of skin destruction- partial-thickness, full-thickness burn.

13. Skin- reproducing cells are located throughout the dermis and along the shafts of the hair follicles. If there is significance damage to the dermis, there are not enough remaining skin cells to regenerate new skin.

14. Extent of burn One method is commonly used for determining the TOTAL BODY SURFACE AREA (TBSA) affects or the extent of a burn wound is the rule of nines . The rule of nines, is easy to remember, is considered adequate for initial assessment of an adult burn patient.

15. Location of burn The severity of burn injury is related to the location of the burn wound. Burns to face and neck, chest and back may inhibit respiratory function due to mechanical obstruction. Burns of hands, feet, joints and eyes are concern because they make self care very difficult. Burn to the ears and nose are susceptible to infection because of poor blood supply to the cartilage.

16. Pathophysiology

17. Phases of burn management

18. Pre- hospital care At the scene of the injury, priority is given to removing the person from the source of the burn and stopping the burning process Electrical injury- removal of patient from contact with the source of current .

19. Small thermal burns- covered with a clean and cool, tap water- dampened towel, for patient’s comfort and protection until definitive medical care is instituted. If thermal burn area is large, attention needs to be focused 1 st on airway, breathing or circulation If burn is large , it is not advisable to immerse the burned body part in cool water since doing so might lead extensive heat loss.

20. The burn should never be covered in ice as this could cause frostbite. As much burned clothing as possible should be removed to prevent further tissue damage. The patient should then be wrapped in a dry clean sheet or blanket to prevent further contamination of the wound to provide warmth .

21. It is important for the individual involved in pre-hospital phase of burn care to adequately communicate the circumstances of the health of the injury to the hospital based health care providers.

22. Emergent phase

23. Emergent phase Is the period of time required to resolve the immediate, life threatening problems resulting from burn injury. This phase usually last 24 to 48 hours. Primary concern- onset of hypovolemic and edema formation. This phase ends when fluid mobilization and diuresis begins. Fluid electrolyte imbalanced, inflammation, risk of infection,

24. Clinical manifestation Shock Pain Hypovolemia Blisters Severe dehydration Adynamic ileus - paralysis of intestinal motility, signs like- absent/ decreased bowel sounds. Shivering Unconsciousness

25. Complications in emergent phase Cardiovascular system- includes – dysrhthmias , hypovolemic shock, circulation to the extremities can be severely impaired, and microcirculation is impaired because of the damage to the skin structure that contain small capillary systems. respiratory system- includes – abnormal breath sound, difficulty in swallowing, total airway obstruction, dyspea , wheezing, altered mental status and respiratory infection.

26. Urinary system- includes- decreased blood flow to the kidneys which result in acute renal failure.

27. Nursing management of patient with burn in emergent phase 1. Fluid therapy Assess fluid needs Iv fluid replacement Insert urinary catheter Monitor urine output 2. Wound care Wound cleansing Assess extent and depth of burns Administer tetanus toxoid

28. 3. Pain and anxiety Assess and manage pain and anxiety 4. Psychosocial care Provide psychological support to the patient and family 5. Physiological therapy Provide comfort to the patient as per his/her need. 6. Nutritional therapy Assess nutritional need Begin feeding patient by most appropriate route as soon as possible.

29. Drug therapy 1. analgesics – Morphine, methadone, non steroid inflammatory drug: ketoprofen . 2. sedatives- Haloperidol: produces antipsychotic and sedative effects, promote sleep. 3. Gastrointestinal support- Antacid (neutralizes stomach acid)

30. Nutritional support Vitamin A,C,E and multivitamins (promotes wound healing) Minerals- iron or zinc (promote cell integrity and hemoglobbin )

31. Acute phase

32. Defining acute phase From beginning of diuresis to wound closure

33. Pathophysiological changes

34. Nursing management Fluid therapy- continue’ Wound care – cleansing, observe for complication, assess wound daily, Nutritional therapy- continue Physical therapy – active/passive ROM exercises, counseling and teaching the patient about health

35. Rehabilitation phase Definition- Begins when the patients burn wounds have healed to return to optimal physical and psychosocial care.

36. Pathophysiological changes If adequate ROM is not instituted The new tissue will shorten causing a contracture Discoloration of scars will fade somewhat with time Patient experience discomfort from itching where healing is occurring Old epithelium is replaced by news cells Blister and skin tears are likely to develop Newly health areas can be hypertension or hypotension to cold, hot, touch

37. Nursing management of patient with burn, under- rehabilitation phase Counsel and teach pt. and family Encourage and assist patient in resuming self care. Prevent and minimize contractures and assess like hood for scarring Prepare the pt. for discharge home or transfer to rehabilitation hospital.

38. Conclusion

39. BIBLIOGRAPHY Chintamani , Textbook of lewis’s Medical Surgical Nursing, page no. 533, published by Ritu Sharma, in 2011. Brunner and suddharth’s textbook of Medical Surgical Nursing, 2015 P.k . Panwar , textbook of medical surgical nursing

40. Thank you