Burn child health Nursing 3rd year presentation..pptx

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1. Burn Presented By; Salam B.Sc. Nursing 3 rd year.

2. OBJECTIVES Introduction
Definition
Epidemiology
Causes
Risk factor
Classification
Pathophysiology
Clinical features
Diagnostic evaluation Management Complications
Summary
conclusion
bibliography

3. Introduction A burn is a type of injury to skin or other tissue caused by heat ,cold, electricity, chemical ,friction and radiation. Most burn are due to heat from hot liquid solid or fire. Burns are common and serious childhood or adulthood injury. Boys more affected than girls. Most affect only the skin ,but sometimes deeper structures are affected.

4. Definition A burn is an injury to the skin or other organic tissue primary caused by heat or due to radiation, radioactivity, friction, electricity ,or conducts with chemicals. According to WHO

5. Epidemiology India records 70 lacs burn injury annually of which 1.4 lacs people die and 2.4 suffers from disability.
70℅ of cases are in 15-35 years age.
4 out of 5 cases are either women or children.
80% cases with women are related to kitchen related accidents.
11 th leading cause of death / Injury of children age 1-9 years.

6. Causes 1. Chemical Burn: This type burn is caused when living tissue is exposed to corrosive substances such as acid and base.

7. Continue....... These burns tend to be deep, as the corrosive agent continues to cause coagulative necrosis until completely removed.

8. Causes 2. Electrical Burn; It occurs with faulty electrical wiring.
It might not be visible but can cause critical internal injuries

9. Causes 3. Radiation burn: It occurs due to exposure to radiation.
High exposure to X- rays during medical imaging or radiotherapy can also result in radiation burn

10. Causes 4.Scald Burn: It is form of burn from heated fluids such as hot oil, boiling water or steam.

11. Causes 5. Inhalation Injury- It occurs as a result of exposure to Asphyxiants ( e.g carbon monoxide) and smoke. Commonly occurs with flame injuries, particularly if the victim is trapped in an enclosed, smoke- filled space.

12. Causes 6. Cold injuries- Acute cold injuries from industrial accidents and frostbite. Exposure to liquid nitrogen and other such liquids will cause epidermal and dermal destruction.

13. Risk factors Cooking stoves Hot liquids.

14. Continue..... Hot objects Match sticks

15. Normal anatomy of skin

16. CLASSIFICATION OF BURN 16 On the Basis of Depth Superficial (1 st ) Degree Superficial Partial Thickness (2 nd ) Degree Deep Partial Thickness (3 rd ) Degree Full Thickness (4 th ) Degree On the basis of severity Minor Burn Moderate Burn Major Burn

17. Superficial (1 st ) degree burn Affects only epidermis or outer layer of skin.
Burn site is red, painful, dry, with no blisters.

18. Superficial partial thickness(2 nd ) degree burn Involves epidermis and part of dermis layer.
Burn site appears red, blister & may be swollen & painful

19. Deep partial thickness(3 rd ) degree burn All layer of skin is destroyed
Extend to subcutaneous tissue
Nerve ending, sweat glands and hair follicles are destroyed
No pain

20. Full thickness(4 th ) degree burn All skin layers including underlying muscle, tendon, & ligament.
Burn skin is waxy white to a charred black & tend to be painless.
Slow rate of healing.
Usually require skin graft and is fatal

21. On the Basis of severity Given By American Burn Association Minor Burn: <10% TBSA burn in adults
<5% TBSA burn in younger or older patients.
<2% full-thickness burn.

22. On the Basis of severity Moderate Burn: 2 nd degree burn of 15-25% TBSA in adults or <10- 20% TBSA in children
3 rd degree burn of <10% TBSA without involvement of special areas like eyes, ears, face, perineum
Excludes all electrical, inhalation injury and also extremes of age, poor risk patient .

23. On the Basis of severity Major burn: 2 nd degree burn >25% TBSA in adults or >20% TBSA in children
All 3 rd degree burn >10% TBSA
All burn involving special areas like eyes, ears, face, hands, perineum.
All electrical, inhalation injury, concurrent trauma, and all poor risk patient.

24. Classification by Surface Area Total body surface area (TBSA): can be calculated in percentage by following methods: Rule of nine Palm method Browder chart

25. Rule of nine

26. Palm method One hand surface “child’s own hand” with closed fingers amounts to 1% of body‘s surface area of burns. It serves as a general measurement for all the age groups.

27. Browder chart.

28. Pathophysiology Board

29. Clinical feature of burn Pallor Cynosis Poor muscle tone Failure to recognise familiar people Rapid pulse Low blood pressure Edema

30. Continue Airway obstruction Dyspnea Tachypnea Restlessness Cough and drooling Decreased urine output

31. Diagnostic evaluation History collection Assessment of burn area CBC ABG analysis Chest X-ray

32. Management First aid measures. Fluid replacement. Additional measures. Nutritional support. Wound management. Rehabilitation.

33. First aid measures Remove from heat source. Lie flat on ground and roll. Extinguishing fire. Not apply cotton and house hold articles. Avoid pouring of water over burn area. Oral fluid/ ORS Do not disturb blisters.

34. Continue. .. Keep airway patent. Turn child to one side. Mouth to mouth breathing. Transfer to hospital.

35. Fluid replacement. Park land formula; In first 24 hours. 4ml of RL × weight in kg × %of total body surface area. For first 8hours. One half of calculated fluid from time of injury . For next 16 hours. Remaining half of the Fluid. Next 24 hours. 2ml Of ringer lactate /kg /℅ of burn.

36. Additional measures. Airway management. Oxygen therapy, ventilatory support. Tetanus prophylaxis. Sedation and analgesics. IM injections should be avoided. Systemic antibiotics depends on cultural report. Urinary catheter if needed.

37. Nutritional support. Adequate nutrition for healing. Initially kept child NPO. Start oral fluid if bowel sound heard. Protein rich diet.

38. Davies formula for Requirement of supplements. Protein requirement: 3 gram of protein/ kg body weight +1 gram / ℅ of TBSA burned. Calorie requirement: 60 kcal / kg body weight + 35 kcal / % of TBSA burned Others: Potassium and vitamin supplements like Zinconia and Folvite.

39. Wound management. Wound debriment. Sedation and analgesics. Remove tights clothes or ornaments. Clean wound with saline or savlon. Remove loose and dead tissue. Cover of wound with antibacterial / ointment /saline vaseline gauze. Antibiotics.

40. Continue... Application of tropical agents such as; -Silver sulfadiazine -Silver nitrate -Mefinidine acetate cream.

41. Debridement Debridement of devitalized tissue, removal of damaged agents, cleansing and then dressing are important aspects.

42. Excision and Skin Graft.

43. Rehabilitation. “Rehabilitation starts on the day of Injury” Psychological support; Allow to express thoughts, feelings, fears, and anxieties regarding injury.
Support family and friends’ communications and visits.
Arrange for the patient to talk with other patients who have had a similar injury and are progressing satisfactorily.
Plastic surgery has been a source of tremendous hope and comfort for burn injury patients.

44. Plastic surgery 44 11/15/2018 Nursing Management Of Patient With Burn

45. Mobilization and positioning Early mobilization - Patient is encouraged to carry out his own activities of daily living. Splinting - care must be taken to ensure the splint does not cause a pressure sore. Positioning -In general joint should be positioned in extension.
-Anti contracture positioning is the goal of any splinting and positioning program.

46. Nursing Management. Assignment History taking: Burn (Electrical, thermal, chemical )
Physical Examination
Vital sign
Level of pain
Site of burn
Total body surface area % of burn
Condition of wound
Degree of burn
Sign of infection

47. Complications of burn. Early Complications; Shock and electrolyte imbalance.
Airway obstruction.
Hypothermia.
Acute renal failure. Late complications; Wound infection
Post burn contracture
Itching and dermatitis

48. Nursing Diagnosis Impaired gas exchange related to carbon monoxide poisoning, smoke inhalation as evidenced by dyspnea .
Ineffective airways clearance related to edema as evidenced by airway obstruction and shortness of breath.
Pain related to tissue and nerve injury and emotional impact of injury as evidenced by pain scale.
Fluid volume deficit related to increased capillary permeability and evaporative losses from the burn wound as evidenced by dehydration. Hypothermia related to loss of skin microcirculation and open wound as evidenced by temperature monitoring. Risk for infection related to breakdown of skin integrity.

49. Summary Introduction
Definition
Epidemiology
Causes
Risk factor
Classification
Pathophysiology
Clinical features
Diagnostic evaluation
Management
Complications

50. Conclusion While some burns May be treated with first aid , most burns are severe injuries that require immediate Medical attention. In general , if you are unsure of the severity of any burn , seek medical attention promptly.

51. BIBLIOGRAPHY Book reference: Sharma Rimple ,textbook of pediatrics, 3 rd edition, published by Jaypee brothers, page no 605-616. Dutta Parul, textbook of pediatrics, 3 rd edition, published by Jaypee brothers, page no 516-522. Net references : https://www.slideshare.net/AswaniB1/burns-in-children-240523134 https://www.slideshare.net/mubinaHafeezi/burn-in-children-237492431 https://slideplayer.com/slide/6444915/