BURNS

CHILD HEALTH
NURSING
AGENDA
Introdu
Definition
ction
causes
pathophysiolog
Assessment
y of
Diagnostic
burns
management
evaluation
complication
 INTRODUC
TION
Thermal injuries are the
third most common cause of
accidental death in children.
Burns are the second
leading cause of injuries in
age group between 1 and 14
years. 80% of burn injuries
occur within home. injuries
that result from direct
contact with or exposure to
by thermal, chemical,
DEFINITIO
Injuries that result from

N
direct contact or
exposure to an thermal,
chemical electrical or
radiation source are
termed as burns
 CAUSES
SCALD INJURY
FROM MOIST
HEAT
• Scald injuries are the most
common cause among
children.
• Eg toddlers out of curiosity
may pull a pot of hot
water ,spill a hot cup of
coffee or tea on
 CAUSES
FLAME

• It occurs due to contact

with stove, heater etc.
 CAUSES
ELECTRICAL
INJURY

• It is often result from high

voltage electrical current.
 CAUSES
CHEMICAL
INJURY

• It is often due to toddler’s

curiosity to taste acid or
alkalis caustic soda etc.
 CAUSES
RADIATION

• This can occur in children

from overexposure.
ASSESSM
ENT OF
BURNS
1. EXTEND
OF INJURY
2. DEPTH
OF INJURY
3.
SEVERITY
• PARTIAL • Minor burns
THICKNESS. • Moderate
• Modified rule
1st degree burns
of nine.
2nd degree • Severe burns
• Rule of 5
• FULL
• According to
THICKNESS
age.
3rd degree
• Palm method
4th degree
 Diagnostic
evaluation
HISTORY
COLLECTION
PHYSICAL
EXAMINATION
X RAY (SMOKE INHALATION
BURNS)
Blood analysis for:
• Serum electrolyte
• Blood urea nitrogen
• Serum protein
• Serum albumin
• ABG analysis

WOUND CULTURE FOR STARTING

ANTIBIOTIC
MANAGEM
ENT
• MEDICAL
MANAGEMENT
• SURGICAL
MANAGEMENT
• NURSING
MANAGEMENT
 MEDICAL
MANAGEM
ENT
 1.Once the flame is
extinguishable, cool

IMMEDICAT water should be poured

over the area.

E FIRST 2.The burned area is

covered with a clean dry

AID cloth or dressing to

prevent contamination.

MANAGEM 3.Immediately the child

should be transported to

ENT medical facility.

 MAJOR BURN
Emergency
care INJURY
1. It begins at the time of injury and continues until child’s condition
stabilizes in about 48-72 hrs
2. Assess airway, breathing, circulation and initiate CPR.
3. Provide intubation, oxygen therapy and ventilatory assistance.
4. Provide IV sedation
5. Insert and IV line to deliver fluids at rapid rate, if extensive burn injury
insert a central line.
6. Weigh the child to calculate fluid requirement and administer fluids
according to the body weight.
7. Insert indwelling foley’s catheter to obtain specimen and measure
hourly urine output.
8. Examine the burn wound.
 MAJOR BURN
Establishment
INJURY of
adequate airway
1.If the child has burn injury over the face, nares, neck
, chest or upper respiratory tract.
2.Examine oral and nasal mucosa for edema.
3.Administer oxygen therapy
4.ABG analysis should be done
5.Intubate if needed
 MAJOR BURN
FluidINJURY
replacement
therapy
Fluids to be used for iv
administration: isotonic saline
solution such as ringer’s lactate
(RL) in 5% dextrose.
 FORMULA FOR FLUID
CALCULATION
Baxter Brooke’s Parkland
formula formula
• For first 24 hours
• formula
For first 24 hours
• For first 24 hours • 4 mL x body weight
• Colloids=0.5mlxk (kg) x %TBSA .
administer 4ml/
Give half of the fluid in
kg body weight/ gxTBSA the first 8 hours, and the
%of burn • 5% of dextrose other half over the next
• Half of the fluid is may be 16 hours .
given in 8 hour
and next half in administered
remaining 16 according to the
hours
age
• Saline=1.5ml x
FORMULA FOR FLUID
CALCULATION
Next 24 hours:
• Colloids=0.5ml x kg x TBSA.
• 5% dextrose may be given
according to the age
 MAJOR BURN
Administration
INJURY of
medication

• TT prophylaxis.
• Penicillin prophylaxis
• Analgesic such as morphine
sulfate.(0.001 mg/kg injuries
>20% of TBSA
 MAJOR BURN
Management
INJURY of
burn wound
After initial phase, the primary
concern is about burn wound.
OBJECTIVES
• Closure of wound
• Prevention of infection
Management of burn
wound
PRIMARY EXCISION
• In children with large and full
thickness burn wound, excision is
performed
• Early excision of deep partial and
full thickness burns reduces the
incidence of infection and the
threat of sepsis.
Management of burn
wound
debridement
• Partial thickness burn require
debridement to promote healing
removing the dead or debris tissue
that requires analgesic and
sedation
Management of burn
wound
Topical anti microbial
• EXPOSURE: wound are left open to air.
agents
crust forms on partial thickness burns
and eschar forms on full thickness burns.
• OPEN: topical anti microbial agent is
applied directly to the wound surface.
• MODIFIED: anti microbial agents are
impregnated into the gauze and applied
to the wound.
• AGENTS: silver sulfadiazine, povidone
SURGICAL
MANAGEM
ENT
 NURSING
MANAGEM
ENT
DIAGNOSI
S
MANAGING BURN
WOUND
• Nurses play a primary role in
wound management
• Changing the dressing daily
• Assess the sign of infection
• Document the burn wound
changes
PROVIDE PAIN
RELIEF
• Narcotic analgesic should be given
regularly prescribed.
• Non pharmacological supportive
techniques such as distraction,
imagery and relaxation
 PROVIDING
NUTRITIONAL
SUPPORT
• Monitor nutritional status of child by
taking daily weight.
• Maintain I/O chart.
• Along with IV fluid, supplemental
enteral feeding.
• NG feeds should be continued till
 PROVIDE
EMOTIONAL
• Age appropriate activities should be
SUPPORT
incorporated into the child’s day.
• Allow parents to spend time with
child and provide love and
affections.
• Peer contact should be reintroduced
for older children.
• The parents must develop trust in
staff and support them in providing
care to their child.
• Nursing management should
 Monitoring
physiologic
• Vital signs are monitored.
response
• CVP monitoring should beto
done to
treatment
monitor cardiovascular and fluid
status.
• Lungs should be auscultated
frequently.
• Hydration status is monitored with
hourly intake and output
measurement.
• GI status should be evaluated 2
hourly .ant acid therapy should be
REHABILIT
ATIVE
BURN
CARE
 SCAR
MANAGEM
ENT
• The pressure garments
should be worn 24 hours a
day for maximum
effectiveness.
• Orthotic splinting devices
may be prescribed.
• Massage may aid scar
maturation parents should
 PHYSICAL
EXERCISES
PROGRAM
• Encourage the child to
perform independently the
activities of daily living
 Providing skin
care and wound
• management
The toddler should be
bathed with mild soaps.
• Observe the skin for any
breakdown blisters.
• After bathing the baby, the
skin should be gently
patted dry and lubricated
with emollient.
• Areas of blisters should be
covered with gauze.
• If the burns injuries are
 Providing
social
Re-entry
• Family and children must
be prepared for social re
entry.
• Parents should be alerted
to observe for depression
and social withdrawal in
children.
COMPLICAT
IONS
 1. Hypovolemic shock
2. Respiratory failure

EARLY 3.
4.
Renal failure
Paralytic ileus

COMPLICA 5.
6.
GI bleeding
Hypertension seizure and

TION depression
7. UTI
8. thrombophlebitis
 1.Anaemia
2.Malnutrition
LATE 3.Growth failure
COMPLICA 4.Marjolin’s
TION ulcer(carcinoma
in burn scar)
5.Phsiological
trauma
CONCLUSIO
N