Nursing Care Plan – Burn

[سلطان حكمي]

A burn is a type of injury that may be caused by heat, cold, electricity, chemicals, light, radiation, or friction. Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. Muscle, bone, blood vessel, and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerves. Depending on the location affected and the degree of severity, a burn victim may experience a wide number of potentially fatal complications including shock, infection, electrolyte imbalance and respiratory distress. Beyond physical complications, burns can also result in severe psychological and emotional distress due to scarring and deformity. It is generally accepted that a burn affecting more than one percent of the body surface, (approximately area of the casualty’s palm) should be assessed by a medical practitioner.









[1]


A burn is damage to the skin’s tissues, usually caused by excessive heat.


Burning


Heat is the most obvious cause of burn injuries. This can be direct contact with fires, radiators or hot liquids, but also the radiated heat from an extreme source of heat, such as a furnace or open fire. Burns can also be caused by chemicals, electricity, the sun’s rays, friction (rubbing or chafing) or extreme cold.


Burns usually affect the skin, but other important areas of the body can also be injured. For example, the airways and lungs can be damaged as a result of inhaling hot fumes and gases.


Types of burn


The severity of a burn depends on how deeply it has affected the tissue. There are three categories of burn: superficial, partial thickness and full thickness. These were previously referred to as first, second and third-degree burns.


Burns Types


Superficial burn


This is a burn that only affects the surface of the skin. The skin appears and slightly swollen and the burn is almost always painful. A common cause this type of burns is too much exposure to sunlight.


Partial thickness burn


This is a deeper skin burn, but it does not the whole depth of the skin. The skin appears deep red or purple, swollen and blistered. The surface may have a weeping, wet appearance. The skin is extremely painful and hypersensitive, even to air movement.


Full thickness burn


The full depth of the skin is damaged and the skin appears dry and leathery. The skin may be pale or blackened. These burns are surprisingly painless, because the nerve endings within the skin are also destroyed.


Other burn sites


Burns to the face, singeing of eyebrows or nasal hair black deposits in the mouth or sputum indicate that the airways may be burnt and immediate medical attention should be sought.


What to do if someone is burnt?


Personal safety should be the first priority of anyone offering first-aid to a person with burns. It is important to be aware of any ongoing risk of fire, chemicals, or electricity. There may also be risk of toxic fumes or explosion e.g. due to nearby petrol or gas supply.


The next step is to stop the burning process. Any clothing that is not stuck to the burn should be carefully removed. The affected body surface areas should then be flooded with cold water until medical help, if necessary, is available.


Home treatment


Very minor burns can be treated at home. Superficial burns usually don’t need any dressings. Moisturizing, after-sun or calamine lotions can ease some of the discomfort.


When to seek medical help


Medical help is needed:
For all partial and full thickness burns.
For superficial burns covering an area larger than the palm of the hand.
For burns on the face, hand or in the grain.
Where there is any doubt the extent of the burn or how to deal with it.
Hospital treatment




At the hospital, doctors will continue first-aid measures and protect the damaged skin with dressings.




Healthy skin prevents loss of fluid from the tissue underneath and is also a very effective barrier to infection. These functions are lost when the skin is burned. After severe burns, large quantities of fluid can be lost through the skin. This can have a serious affect on the heart and circulation. This is why people with serious burns need to be closely monitored and often require intravenous fluids to help their circulation.




Recovering from burns




The time taken for burns to heal depends on how serious they are. Most superficial burns heal within about two weeks and do not usually leave a scar.




Deeper burns take longer to heal and sometimes require skin drafts. This is a plastic surgery technique using skin from an unaffected part of the body to repair an injured area of skin that is not going to be able to heal itself. Full thickness burns tend to result in scars that can be difficult to treat. Specialist treatment by plastic surgeons in these cases is aimed at minimizing such scars.




Fire prevention




For most people, the greatest threat of injury or death from fire is in the home




The most common causes of fire are:

Smoking related fires (e.g. cigarette ends/matches)
*ng-related (e.g. chip pans)
Heaters and electric fires.
A simple bedtime routine can prevent fires.
Make sure all cigarettes are extinguished. Do not smoke in bed.
Turn off all electrical appliances that don’t need to be on (e.g. hairdryers)
Turn off portable heaters.
Make sure open fires have a suitable fireguard and are safe to leave.
Close all doors to prevent any fire spreading.
Burn Emergencies



One of the most painful injuries that one can ever experience is a burn injury. When a burn occurs to the skin, nerve endings are damaged causing intense feelings of pain. Thousands die as a result of their burns. Many require long term hospitalization. Burn are a leading cause of unintentional death, exceeded in numbers only by automobile crashes and falls.




Classifying burns




Burns are classified in two ways: Method ad degree of burn.




Methods are:




1. Thermal




2. Chemical




3. Electrical




4. Light




5. Radiation





Degrees are:




First Degree Burn




Superficial – First degree burns typically take 3 to 6 days to heal. The superficial or first layer of skin is damaged. Examples of a superficial – First degree burns are: mild sunburns, contact burn injuries, or heat burns.




Second Degree burn




Superficial – Second degree burns usually heal in less than 3 weeks depending on severity. The deeper or thicker the burned skin the longer the injury makes take to heal.




Third Degree Burn




Deep – Third degree burns are severe and may require skin graphs and a protracted recovery period – more than 3 weeks. Full-thickness burns, without skin grafts; heal only at the edges by scarring. A skin graft is a very thin layer of skin that is cut from an unburned area on the body and
put on a badly burned area.










Determining the severity of burns

Source of the burn – a minor burn caused by nuclear radiation is more severe than a burn caused by thermal sources. Chemical burns are dangerous because the chemical may still be on the skin.
Body regions burned – burns to the face are more severe because they could affect airway management or the eyes. Burns to hands and feel are also of special concern because they could impede movement of fingers and toes.
Degree of the burn – The degree of the burn is important because it could cause infection of exposed tissues and permit invasion of the circulatory system.
Extent of burned surface areas – It is important to know the percentage of the amount of the skin surface involved in the burn. The adult body is divided into regions, each of which represents nine percent of the total body surface. These regions are the head and neck, each upper limb, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower limb and the back of each lower limb. This makes up 99 percent of the human body. The remaining one percent is the genital area. With an infant or small child, more emphasis is placed on the head and trunk.
Age of the patient – This is important because small children and senior citizens usually have more severe reactions to burns and different healing processes.
Pre-existing physical or mental conditions – Patients with respiratory illnesses, heart disorders, diabetes or kidney disease are in greater jeopardy than normally healthy people.
Treatment of burns



Cool a burn with water. Do what you must to get cool water on the burn as soon as you can. Go to the nearest water faucet and turn on the cold spigol and get cool water on the burn. Put cool, water-soaked cloths on the burn. If possible, avoid icy cold water and ice cubes. Such measure could cause further damage to burned skin.




Anatomy and physiology of the skin




The skin is made up of three layers and is the largest organs of the body




1. Epidermis




a. The surface or outlet layer




b. Serves as a barriers between out body and the environment




1. Dermis




1. Thick layer of collagen connective tissue below the thin epidermis.




2. Contains the important support structures and sensory nerves, i.e. hair follicles, sweat glands, oil glands.