MRS.C.MARY LALITHA KALA ASSOCIATE PROFESSOR, MEDICAL AND SURGICAL NURSING ANRI COLLEGE OF NURSING VISAKHAPATNAM

1. MS.C.MARY LALITHA KALA
LECTURER, MEDICAL AND SURGICAL NURSING
G.S.L COLLEGE OF NURSING
RAJAHMUNDRY

2. DEFINITION:
BURNS ARE CAUSED BY A TRANSFER OF
ENERGY FROM A HEAT SOURCE TO THE
BODY
IT IS A INJURIES THAT RESULTS
FROM DIRECT CONTACT WITH OR
EXPOSURE TO ANY
THERMAL,CHEMICAL, OR RADIATION
SOURCE ARE TERM.

3. TYPES/ ETIOLOGY
1. THERMAL
2. CHEMICAL
3. ELECTRICAL
4. RADIATION

4. ETIOLOGY
 THERMAL BURNS:
 IT IS CAUSED BY EXPOSURE OR CONTACT
WITH FLAME, HOT LIQUIDS, SEMI
LIQUIDS,SEMISOLIDS,OR HOT OBJECTS.
 EXAMPLE:THERMAL BURNS AREV THOSE
SUSTAINED IN THE RESIDENTIAL FIRES,
EXCLUSIVE AUTOMOBILE ACCIDENTS,
SCALD INJURIES,POORLY STORAGE
INFLAMMABLE LIQUIDS.

5. CHEMICAL BURNS
 IT IS CAUSED BY TISSUE CONTACT WITH
STRONG ACIDS, ALKALIZER, ORGANIC
COMPOUNDS.
 CHEMICAL INJURIES TO THE EYES AND
INHALATION OF FLAMES ARE PARTICULARLY
SERIOUS.

6. ELECTRICAL BURNS
 IT IS CAUESD BY HEAT THAT GENERATED BY
THE ELECTRICAL ENERGY AS IT PASSES
THROUGH THE BODY.
 IT CAN RESULTS FROM THE CONTACT WITH
EXPOSED OR FAULTY ELECTRICAL FIRING OR
HIGH VOLTAGE POWER LINES.PEOPLE
STRUCK BY LIGHTENING ALSO SUSTAIN
ELECTRICAL INJURY.

7. RADIATIONAL BURNS
 IT IS A COMMON TYPE OF BURN INJURY
CAUSED BY EXPOSURE TO RADIOACTIVE
SOURCE.
 THESE TYPE OF INJURIES HAVE BEEN
ASSOCIATED WITH NUCLEAR RADIATION
ACCIDENTS.THE USE OF IONIZING RADIATION
IN INDUSTRY EXPOSURE OF UV RAYS(SOLAR
RADIATION)

8. CLASSIFICATION OF BURNS
SUPERFICIAL
PARTIAL
THICKNESS
BURNS
SUNBURN
• EPIDERMIS POSSIBLY A PORTION OF DERMIS
• Tingling, hyperesthesia, recovery within a week, no scaring
DEEP PARTIAL
THICKNESSS
BURNS
SCALDA
• EPIDERMIS, UPPER DERMIS, PORTION OF DEEP DERMIS
• Pain, hyperesthesia, sensitive to cold air, 2-4 weeks, scarring,
contractures, infection
FULL
THICKNESS
FLAME,
PROLONGE
EXPOSURE T
HOT LIQUID,
ELECTRIC
CURRENT,
CHEMICAL
• EPIDERMIS, ENTIRE DERMIS, SUBCUTANEOS, CONECTIVE
TISSUE , MUSCLE AND BONE
• Pain free, shock, hematuria, scarring, loss of function, loss of
digits, grafting necessary

9. TYPES OR DEGREE OF INJURY
 MILD PARTIAL THICKNESS-FIRST DEGREE
BURNS
 MODERATE PARTIAL THICKNESS-SECOND
DEGREE BURNS
 FULL THICKNESS BURNS-THIRD DEGREE
BURNS

13. ZONES OF BURN INJURY
1. ZONE OF HYPEREMIA
2. ZONE OF STASIS
3. ZONE OF COAGULATION

14. PATHOPHYSIOLOGY

15. CLINICAL MANIFESTATIONS
 FLUID AND ELECTROLYTE BALANCE:
 HYPONATREMIA
 HYPERKALEMIA
 INCREASED HEMATOCRIT VALUES
 HYPOVOLEMIA
 DECREASED URINARY OUTPUT
 NAUSEA, VOMITING,ABDOMINAL DISTENSION
 LOSS OF APPETITE

16. RESPIRATORY SYSTEM
 TACHYPNEA
 EDEMA
 AIRWAY OBSTRUCTION
 DYSPNEA
 CYANOSIS
 TRACHEOBRONCHIITIS

17. CARDIO VASCULAR SYSTEM:
 TACHYCARDIA
 BRADYCARDIA
 DECREASED CARDIAC FUNCTION
 PAIN ALTERED LEVEL OF CONSCIOUSNESS
 PSYCHOLOGICAL ALTERATIONS

18. TYPES OF BURNS
1. Minor
2. Moderate
3. Major

19. MODERATE BURN INJURY
 15-25% TBSA IN ADULTS(2 degree)
 <10% TBSA IN ADULTS( 3 degree)
 10-20% TBSA IN CHILDRENS
 MINOR BURNS INJURY
 <15% TBSA IN ADULTS(2 degree)
 10BELOW TBSA IN ADULTS (3 degree)
 10BELOW TBSA IN CHILDRENS

20. MAJOR BURN INJURY
 25-35% TBSA IN ADULT(2 degree)
 >10 % TBSA IN ADULTS (3 degree)
 <10-% TBSA IN CHILDRENS

21. CALCULATION OF BURNS
1. RULE OF NINES

23. RULE OF NINE
 HEAD AND NECK-9%
 ANTERIOR TRUNK -18%
 POSTERIOR TRUNK-18%
 SHOULDER RT AND LT- 18%
 PERINEUM-1%
 RT AND LEFT THIGH- 36%

25. 2. LUND AND BROWER METHOD
 CALCULATION OF PERCENTAGE OF BURNS
BY TBSA

26. 3.PALM METHOD
 IN PATIENTS WITH SCATERRED BURNS, A
METHOD TO ESTIMATE IS PALM METHOD
 THE SIZE OF PATIENT PALM IS 1 % OF
TBSA

27. MANAGEMENT

29. MINOR BURNS
1. WOUND ASSESSMENT
2. TETANUS IMMUNIZATION
3. PAIN MANAGEMENT ( IV MORPHINE)
4. HEALTH EDUCATION

30. MAJOR BURNS

32. DIAGNOSTIC EVALUATION
 HISTORY COLLECTION
 PHYSICAL EXAMINATION
 CT SCAN, MRI SCAN
 RFT, LFT
 CSF ANALYSIS
 CBC,LUMBAR PUNTURE
 NEURO ASSESSMENT,ECG, SERUM BLOOD
LEVEL,

34. MANAGEMENT OF FLUID VOLUME
 FORMULA:
 EVANS
 BROOKES
 BROOK MODIFIED
 PARKLAND
 HYPERTONIC SALINE SOLUTIONS

36. FLIUD CALCULATION
 CONSENSUS
FORMULA
 RL/ ANY OTHER BAL
SALINE SOLUTION:
 2-4 ML x kg body wt x
%TBSA,
 Half to be given in first 8 hrs:
 Remaining half over the next
16 hours

37.  Evans formula
 Brooke formula

38. PARKLAND’S FORMULA

39. PHARMACOLOGICAL
 TOPICAL ANTI MICROBIAL AGENTS
 1% SILVER SULFADIAZINE
 MAFEDINE ACETATE
 SOLUTIONS:
 5%- MAFEDINE ACETATE
 0.5%- SILVER NITRATE

40. COMPLICATIONS OF BURNS
 COMA
 RESPIRATORY FAILURE
 CARDIAC FAILURE
 ASCITES
 LIVER FAILURE
 CONFUSION
 SEPTICEMIA
 SEPSIS
 ISCHEMIA
 NECROSIS
 GANGRENE FORMATION

41. CONTRACTURES

42. SURGICAL INTERVENTION

43. TYPES OF SKIN GRAFT
 AUTO GRAFT
 -FROM OWN BODY
 XENOGRAFT(HETERO GRAFTS)
 -ANIMALS(USUALLY PIGS)
 ALLOGRAFT(HOMO GRAFTS)
 -RECENTLY DECEASED HUMANS OR
PLACENTA MEMBRANE.

46. NURSING MANAGEMENT

47. EMERGENT/ RESUSCITATIVE PHASE
1. IMPAIRED GASEOUS EXCHANGE RELATED
TO CARBON MONOXIDE POISONING
2. INEFFECTIVE AIRWAY CLEARANCE RELATED
TO EDEMA.
3. FLUID VOLUME DEFICIT
4. HYPERTHERMIA R/T TO LOSS OF SKIN
MICRO CIRCULATION
5. PAIN R/T NERVE AND TISSUE INJURY
6. ACUTE RESP FAILURE, SHOCK, ARF,
COMPARTMENT SYNDRME, PARALYTIC
ILEUS, CURLINGS ULCER.