Presented by: Group 3 | NCMB312 RLE

Table of contents

Pathophysiology Importance of
01 Disease Process of Burn 02 Diagnostic and
Injuries
Laboratory Test

03 Nursing Care Plan 04 Drug Study

Introduction
 Mr. D, male, 38 year old was rushed to the emergency room of FUMC Antipolo, with burn of half of the face
and half of the posterior head manifested by severe erythema without blisters patient is complaining of
painful sensation with tingling. Upon assessment of the trunk nurse C, saw a large blister over his anterior and
posterior trunk with broken epidermis and with wet, shiny, and weeping surface, with edema and painful
sensation. His
right arm’s wound surface is red and dry with moderate edema. Mr D’s both lower extremities appear black and
with
absent sensation on the injured area. Peripheral IV access was initiated on the left arm, and vital signs monitored
closely. The nurse assessed patient for hoarseness in voice, harsh cough, neck swelling and stridor when
auscultated.
A conservative approach was employed to treat the burned face and head.

Doctor’s order:
Start IV- line PLR 1L, monitor vital signs Q1 hour, insert a foley catheter connected to urine bag, prepare intubation set,
maintain on NPO status, insert NGT, monitor intake and urine output at least at minimum, monitor daily weight,
suggest escharotomy.

Therapeutics:
Give tetanus IM as prophylaxis, administer Gentamicin Sulfate TIV, administer tramadol TIV, administer Ranitidine TIV,
apply Silver Sulfadiazine Topical, apply Neosporin Topical.
PATHOPHYSIOLOGY
DISEASE PROCESS OF BURN INJURY

01
 RULE OF NINES
DEPTH LEVEL OF INJURY CLINICAL FEATURES
(Lund-Browder method)

1ST DEGREE - SUPERFICIAL Epidermis Dry, red; blanches; painful

2ND DEGREE - SUPERFICIAL Blisters; moist, red, weeping;

Papillary Dermis
PARTIAL THICKNESS blanches; severe pain to touch

Blisters; wet or waxy dry;

2ND DEGREE - DEEP PARTIAL Reticular Dermis; most skin reduced blanching; decreased
THICKNESS appendages destroyed pain sensation to touch; pain
present to deep pressure

Waxy white to leathery dry and

inelastic; does not blanch;
3RD DEGREE - FULL Epidermis and Dermis; all skin absent pain sensation; pain
THICKNESS appendages destroyed present to deep pressure; pain
resent to surrounding areas of
2nd-degree burn

Pain to deep pressure, in the

Involves fascia, muscle and/or are of burn; increased pain in
4TH DEGREE
bone surrounding areas of 2nd
degree burn

- (Bittner & Woodson, 2014)

 1st degree burn
(half of the face and half

SIGNS & SYMPTOMS

of the posterior head)
HEAT
1st degree burn
(right arm)

slide of Pathophysiology Tracing

Coagulation necrosis of skin and subcutaneous tissue 2nd degree burn
(anterior and posterior
trunk)

3rd degree burn

Activation of Mast Cells and (both lower extremities)
Damaged Keratinocytes
Macrophages
TOTAL OF 80 % total body
surface area
Release of vasoactive substances/ Secretion of
proinflammatory cytokines

Direct stimulation of
Increased capillary permeability Irritation of dermal vascular plexus
nociceptive nerve ending

painful sensation
Signs & with tingling Increased vascular permeability
Symptoms

Process
Dilation of the blood
Laboratories
painful sensation vessels
DISEASE PROCESS
severe
Diagnostics & erythema
Laboratories without blisters red and dry
wound surface
Decreased intravascular volume Leaking out of fluid in the blood vessels

moderate
Complete large Accumulation of fluid edema
edema
Hemoconcentration Blood blister in one area
Count

wet, shiny, and

Thin epidermal layer forming
Increased blood tissue Test for weeping
Electrolyte and fluid-filled vesicle breaks open
viscosity Serum Na surface
pH imbalance
and K

Initially body compensates

with increase peripheral
vascular resistance
broken
epidermis
Electrocardiogram
Cardiac output decreases
(ECG)
Decreased blood flow
to skin, Kidneys and
Gastrointestinal Tract

Increased intestinal Renal tissue

Urinalysis
permeability and destruction
mucosal atrophy
Decreased peristaltic
movement and
absorption

Paralytic ileus and

Stools for occult blood
gastric distention
Majority of somatosensory
Subcutaneous tissue
structures are completely Vasodilation in the fascia Cutaneous capillary bed is
containing Pacinian corpuscle
injured underlying subcutaneous tissue destroyed
remains intact

Absent sensation on Wound appears

the injured area black

Carboxyhemoglobin

Capillary Blood Glucose

Assessment for hoarseness in

voice, harsh cough, neck
swelling and stridor when
auscultated
Find a theme

Mercury Venus
It’s the closest planet to the Venus has a beautiful name
Sun and the smallest one in and is the second planet
the Solar System from the Sun
Importance of the
Laboratories
ordered.
Carboxyhemoglobin
Serum Sodium test
Serum Potassium Test
Complete Blood Count
 Urinalysis
❖ A urinalysis is a test of your urine. It's used to detect and manage a wide range of disorders, such
as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the
appearance, concentration and content of urine (Mayo Clinic, 2021).

● Kidney function may be altered as a result of decreased blood volume due to the compensatory
response to intravascular volume loss. Destruction of red blood cells at the injury site results in
free hemoglobin in the urine. If muscle damage myoglobin is released from the muscle cells and
excreted by the kidneys causing the urine to be red. If there is inadequate blood flow through
the kidneys caused by the hemoglobin and myoglobin occluding the renal tubules, acute tubular
necrosis and acute kidney injury can occur(Hinkle & Cheever, 2018).

● Urinalysis is done to determine the presence of myoglobin or hemoglobin in the urine that can
indicate kidney damage.
● Brown or red to amber colored transparent urine can be seen.
Electrocardiogram
❖ An electrocardiogram (ECG) is a simple test that can be used to check the heart's rhythm
and electrical activity. Sensors attached to the skin are used to detect the electrical signals
produced by your heart each time it beats. These signals are recorded by a machine and
are looked at by a doctor to see if they're unusual (National Health Service, 2021).

● As a compensatory response to intravascular fluid loss, the sympathetic nervous system

releases catecholamines, resulting in an increase in peripheral resistance
(vasoconstriction) and an increase in pulse rate that further decreases tissue perfusion.
When a burn injury occurs, there is an immediate decrease in cardiac output that can lead
to cardiac stress (Hinkle & Cheever, 2018).

● An ECG is obtained to assess for cardiac dysfunction to prevent further damage and
complications to the heart.
● In patients with extensive burns, modified the ECG electrode by welding the ECG button
to a crocodile clip. The ECG lead is then joined to this electrode and the crocodile clip is
attached to the staples (Ravindran, 1997).
 Stool for occult blood test
❖ The stool guaiac test looks for hidden (occult) blood in a stool sample. It
can find blood even if you cannot see it yourself. It is the most common
type of fecal occult blood test (MedlinePlus, 2021).

Negative
● -No blue colour on or at the edge of the stool sample
How is Stool Guaiac test performed? (Beckman Coulter, January)
○ A doctor may collect a small amount of stool -No blue streaks
○ A small amount of stool is smeared on a test card
○ Application of 1 drop of developer to the center of each test field.
○ Continue applying a second drop of developer to each test field.
○ For larger samples, add more drops of developer.
○ Observe the test fields for up to 60 seconds.
○ Apply only one drop of developer to the Performance monitor. Read
within 10 seconds.
Positive
-Blue color on or at the edge of the stool sample
-Blue radial streaks starting at the stool sample.
 Stool for occult blood test
● Most common GI alterations in patients with burns are paralytic ileus
(absence of intestinal peristalsis), Curling’s ulcer, and translocation of
bacteria. The most common is there may be decreased perfusion and
increase in acid production due to the stress response of the body. This Negative
makes perfect conditions or an ulcer to develop specifically in the -No blue colour on or at the edge of the stool sample
-No blue streaks
duodenum. Curling's ulcer is an acute peptic ulcer of the duodenum
resulting as a complication from severe burns when reduced plasma
volume leads to sloughing of the gastric (Hinkle & Cheever, 2018).

● Stool for occult blood test is done to identify if the patient developed
peptic ulcer as occult blood in the stool suggest gastric or duodenal
erosion
Positive
-Blue color on or at the edge of the stool sample
-Blue radial streaks starting at the stool sample.
 Capillary Blood Glucose Test
❖ Capillary blood glucose is a convenient way to monitor the blood glucose
level.
❖ The procedure involves pricking the finger with a lancet and putting the blood
on a glucose meter strip. The strip is usually already inserted into the machine.
Your results will show on the screen.

● Result of body’s response to stress, cortisol and catecholamine are release.

There is an increased mobilization of glycogen stores and gluconeogenesis.
Subsequently, glucose is produced, along with an increase in insulin
production. However, insulin’s effectiveness is decreased because of relative
insulin insensitivity. This results in an elevated blood glucose level(Lewis,
Dirksen, Heitkemper, & Bucher, 2014).

Normal: 70 mg/dL-99 mg/dL

● Capillary blood glucose test is done to is identify the blood glucose of the
patient to see whether he developed hyperglycemia.
 Priority
Nursing Care Plan
Assessment Diagnosis Planning Intervention Rationale Evaluation
Assessment Diagnosis Planning Intervention Rationale Evaluation
 Potential
Nursing Care Plan
 Mr. D, male, 38 year old was rushed to the emergency room of FUMC Antipolo, with burn of half of the face
and half of the posterior head manifested by severe erythema without blisters patient is complaining of
painful sensation with tingling. Upon assessment of the trunk nurse C, saw a large blister over his anterior and
posterior trunk with broken epidermis and with wet, shiny, and weeping surface, with edema and painful
sensation. His
right arm’s wound surface is red and dry with moderate edema. Mr D’s both lower extremities appear black and
with
absent sensation on the injured area. Peripheral IV access was initiated on the left arm, and vital signs monitored
closely. The nurse assessed patient for hoarseness in voice, harsh cough, neck swelling and stridor when
auscultated.
A conservative approach was employed to treat the burned face and head.

Doctor’s order:
Start IV- line PLR 1L, monitor vital signs Q1 hour, insert a foley catheter connected to urine bag, prepare intubation set,
maintain on NPO status, insert NGT, monitor intake and urine output at least at minimum, monitor daily weight,
suggest escharotomy.

Therapeutics:
Give tetanus IM as prophylaxis, administer Gentamicin Sulfate TIV, administer tramadol TIV, administer Ranitidine TIV,
apply Silver Sulfadiazine Topical, apply Neosporin Topical.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Risk for infection Within ____ of

● Upon assessment related to nursing intervention
patient showed inadequate the patient achieve
large blisters over primary defenses timely wound
his anterior and (traumatized healing; be free of
posterior trunk with tissue) purulent drainage or
broken epidermis erythema
and with wet, shiny
and weeping
surface
● Patient’s right arm
wound is red and
dry with moderate
edema.
● Patient’s both lower
extremities appears
black with absent
sensation on the
injured area.
Assessment Diagnosis Planning Intervention Rationale Evaluation
DRUG STUDY
 DRUG MECHANISM OF INDICATION CONTRA SIDE EFFECTS NURSING
ACTION INDICATION CONSIDERATION

Generic name: The vaccine The tetanus Hypersensitivity •Redness, pain, •Inspect visually
Tetanus Toxoid produces an toxoid is a to any tenderness, for extraneous
active immune vaccine used in component of swelling, or a particulate
Brand name: response of the the management the vaccine, hard lump where matter and/or
Tetanus body by and treatment of including a the shot was discoloration
developing tetanus. thimerosal, a given prior to
Classification antibodies and mercury administration
Vaccines antitoxins It is also for derivative,is a •Mild fever whenever
against the active contraindication solution and
Dosage toxoids and immunization of for further use of •Mild fussiness, container permit.
0.5 mL per IM acellular adults against this vaccine. crying
pertussis tetanus. •The vaccine
Route antigens. •Joint pain should not be
IM or used if
Intramuscular •Body aches particulate
matter or
•Mild drowsiness discoloration is
found.
•Mild vomiting
 NURSING CONSIDERATION

•Shake vial well before withdrawing each dose.

•Inject intramuscularly or subcutaneously in the area of the vastus lateralis or high

deltoid

•The vaccine should not be injected into the gluteal area or areas where there may be a
major nerve trunk.

•Before injection, the skin over the site to be injected should be cleansed with a suitable
germicide.

•
 DRUG MECHANISM OF INDICATION CONTRA SIDE EFFECTS NURSING
ACTION INDICATION CONSIDERATION

Generic name: Gentamicin It is indicated in Contraindicated Common side

Gentamicin injection is used the treatment of to the persons effects include
Sulfate to treat serious the following with the the following:
bacterial infections when following
Brand name: infections in caused by conditions: •Nausea
N/A many different susceptible •Vomiting
parts of the organisms. •Low Ca in blood •Diarrhea
Classification body. Burns and •Dehydration •Decreased
Aminoglycosides Gentamicin serious skin •Parkinsonism appetite
belongs to the lesions. Given •Myasthenia •Pain at the
Dosage class of by the gravis, a skeletal injection site
3mg/kg/day medicines intramuscular muscle disorder •Headache
devides in 3 known as route, but can •Ringing in the •Fever
equal doses aminoglycoside be given ears •Joint pain
administered antibiotics. It intravenously •Decreased •Unusual
every 8 hours. works by killing when kidney function tiredness
bacteria or intramuscular •Sensation of
Route preventing their administration is spinning or
IV, IM growth. not feasible. whirling
 DRUG MECHANISM OF INDICATION CONTRA SIDE EFFECTS NURSING
ACTION INDICATION CONSIDERATION

Generic Name: Binds to mu-opioid It is indicated for -head injury -stridor -Assess onset,
Tramadol receptors in CNS, the management type, location and
Inhibiting of moderate to Other possible Other possible duration of pain.
Brand name: ascending pain moderately severe contraindication: side effects:
N/A pathways. pain. -Assess for drug
-hypersensitivity to Frequent; history and review
Possible brand Drug Rationale: tramadol or -dizziness medical history.
name: In this given opioids. -vertigo
Ultram, conZip, scenario, tramadol -in pt suffering -nausea -Assess BP and
Ryzolt was prescribed from acute -constipation RR before and
because the intoxication with -headache periodically after
Classification: patient is alcohol. -drowsiness during
Analgesic complaining of -pt with epilepsy administration.
pain sensation not adequately Occasional:
Dosage: and tingling. controlled by -vomiting -Assess bowel
N/A Tramadol helps to treatment. -pruritus and bladder
relieve the pain. -tremor function. Report
Frequency: -diarrhea urinary frequency
N/A -diaphoresis or retention.

Route:
IV
 NURSING CONSIDERATION

-Monitor patient for seizures.

-Dosage should be adjusted according to pain severity and response.

-Intravenous injections must be given slowly over 2-3 minutes.

-Do not administer in the event of severe respiratory depression.

-Monitor daily pattern of bowel activity, stool consistency.

PATIENT/FAMILY TEACHING

-Avoid alcohol and other narcotics or sedatives.

-Report severe constipation, difficulty breathing, excessive sedation, seizures, muscle weakness and tremors.

-
 DRUG MECHANISM OF INDICATION CONTRA SIDE EFFECTS NURSING
ACTION INDICATION CONSIDERATIO
N

Generic Name: Inhibits histamine It is indicated for There is no -hoarseness in -Obtain complete
Ranitidine action at histamine the prevention and contraindication in voice health history
H2- receptors of treatment of peptic the given scenario. -neck swelling including allergies,
Brand name: gastric parietal ulcer disease drug history and
N/A cells. (duodenal and Other possible possible drug
gastric acid) side effects: Other possible interactions.
Possible brand side effects:
name: Drug Rationale: -Hypersensitivity to -Assess for
Zantac In the given ranitidine. -diarrhea presence/history
scenario, ranitidine -Renal -constipation of
Classification: was prescribed to disease,renal -headache gastroesophageal
H2 blockers patient because failure and renal -dizziness reflux disease or
the body is under impairment -Abdominal pain gastric ulcer.
Dosage: stress which -Hepatic disease
N/A producing too -Obtain vital signs.
much gastric acid.
Frequency: Ranitidine works by -Assess for liver
N/A decreasing the and kidney
amount of acid dysfunction.
Route: your stomach
IV makes.
 NURSING CONSIDERATION

-Monitor serum creatinine, AST and ALT

-Administer over at least 5 minutes. Rapid administration may cause hypotension and arrhythmias.

-Administer with meals or immediately afterward and at bed time to prolong effect.

PATIENT/FAMILY TEACHING

-Avoid smoking while taking this drug.

-Abstain from alcohol while taking this medication.

-Instruct patient or family to report if have sore throat, fever, unusual bruising or bleeding, confusion and
hallucination.
 DRUG MECHANISM OF INDICATION CONTRA SIDE EFFECTS NURSING
ACTION INDICATION CONSIDERATION

Generic Name: This product contains This medication is used No contraindication given No side effects Before you apply this
Not indicated in the neomycin, Bacitracin to prevent and treat in the scenario given in the medication, clean the skin
and polymyxin, minor skin infections scenario surface then dry it
scenario thoroughly.
antibiotics that work by caused by cuts, scrapes Possible
stopping the growth of or burns. Contraindications:
Brand Name:
bacteria. Possible Side Apply topical drug as
Neosporin Aminoglycoside Effects: indicated. If necessary, a
Hypersensitivity bandage may use to cover
Classification: Other types of skin the area
Antibiotics Neomycin infections (fungal
Hypersensitivity or other bacterial
Dosage and infection) Do not apply the ointment
Frequency Polymyxin over large skin areas
Not given in the case Hypersensitivity
scenario
Clean the wound and use a
Ophthalmic new bandage each time
Route administration you apply the medicine.
Topical

Use the ointment for as

many as recommended on
the label or by your doctor,
even of your symptoms
start getting better.
 DRUG MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
ACTION CONSIDERATION

Generic Name Silver sulfadiazine Drug Indication: No contraindication given No side effects given Administer drug as indicated
SILVER disrupts bacteria by This medication is used in the scenario in the scenario
SULFADIAZINE damaging the cell with other treatments to Assess burned tissue for
membrane and the help prevent and treat infection
Brand Name cell wall rather than wound infections in Possible Side Effects:
by inhibiting folic patient with serious Possible Monitor for hypersensitivity
There is no brand
name given in the acid synthesis. burns. Contraindications: Pain, burning or reaction
scenario itching of the treated
Sulfonamide skin Monitor any new or
Classification Drug Rationale Hypersensitivity increased skin reactions at
Sulfa Antibiotics Based on the given case Skin and mucous the site of application,
scenario, Silver membrane (such as including rash, burning,
Sulfadiazine is gums) may become itching, pain, and necrosis.
Dosage and currently taken by the blue or gray
Frequency patient to prevent and Report any suspicious skin
Not given in the treat wound infections. Easy bruising/bleeding reactions to the physician.
scenario
Be alert for signs of
leukopenia, including fever,
Route sore throat, and signs of
Topical infection. Report these signs
to the physician.
 NURSING CONSIDERATION

Assess patient for skin rash frequently during therapy

Maintain sterility when preparing and administering the medication.

Moisture, and direct light. Keep from freezing.

Implement wound care procedures as needed to cleanse burns and ulcers. Make sure the drug is reapplied and dressings are changed according to
the recommended procedures.

Teach patient that drug is contraindicated in patients who are hypersensitive to silver sulfadiazine or any of the other ingredients in preparation

Instruct patient to comply to the physician’s order on the frequency of application of the drug to maximize effectiveness

Store the medicine in a closed container at room temperature, away from heat,

Check that the patient and family or caregivers understand topical application and wound care procedures and adhere to the recommended dosing
schedule.

Check that the patient understands topical application and wound care procedures and adhere to the recommended dosing schedule

Instruct patient and family/caregivers about prevention of other types of skin ulcers and the need for visual inspection to prevent recurrence or
development or new ulcers.
 References
Pathophysiology:
Bittner, E., & Woodson, L. (2014, December). Acute and Perioperative Care of the Burn-Injured Patient. Retrieved from PubMed:
https://www.researchgate.net/figure/Classification-of-Burn-Depth_tbl1_269284527
Hinkle, J. L., & Cheever, K. (2017). Brunner and Suddarth's Textbook of Medical-Surgical Nursing. Wolters Kluwer Health/Lippincott Williams & Wilkins.
Yu, Y. (2013, December 2). DEEP PARTIAL THICKNESS BURNS: PATHOGENESIS AND CLINICAL FINDINGS. Retrieved from The Calgary Guide to
Understanding Disease: https://calgaryguide.ucalgary.ca/deep-partial-thickness-burns-pathogenesis-and-clinical-findings/
Yu, Y. (2013, December 2). SUPERFICIAL PARTIAL THICKNESS BURNS: PATHOGENESIS AND CLINICAL FINDINGS. Retrieved from The Calgary
Guide to Understanding Disease: https://calgaryguide.ucalgary.ca/superficial-partial-thickness-burns-pathogenesis-and-clinical-findings-2/
Laboratories:
Beckman Coulter. (January). Interpretation of Hemoccult. Retrieved from https://www.gpsupplies.com:
https://www.gpsupplies.com/mwdownloads/download/link/id/106/
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Philadelphia: Wolters Kluwer.
Lewis, S. L., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Ninth Edition Medical-Surgical Nursing: Assessment and Management of
Clinical Problems. Missouri: Elsevier.
Mayo clinic. (2021, October 14). https://www.mayoclinic.org. Retrieved from Mayo Clinic: https://www.mayoclinic.org/tests-
procedures/urinalysis/about/pac-20384907
MedlinePlus. (2021, October 8). MedlinePlus. Retrieved from https://medlineplus.gov: https://medlineplus.gov/ency/article/003393.htm
National Health Service. (2021, September 7). https://www.nhs.uk. Retrieved from NHS: https://www.nhs.uk/conditions/electrocardiogram/
Ravindran, R. S. (1997, September). https://pubs.asahq.org. Retrieved from ASA Publications:
https://pubs.asahq.org/anesthesiology/article/87/3/711/36269/A-Solution-to-Monitoring-the-Electrocardiograph-in
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Mercury Venus
It’s the closest planet to the Venus has a beautiful name
Sun and the smallest one in and is the second planet
the Solar System from the Sun

Mars Saturn
Despite being red, Mars is Saturn is a gas giant and has
actually a cold place. It’s full several rings. It’s composed
of iron oxide dust of hydrogen and helium
 Introduction
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Venus
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10%
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Mercury Venus Mars

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