KENYA METHODIST UNIVERSITY

SCHOOL OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF NURSING

UNIT CODE: NRSG 227

UNIT NAME: ADULT NURSING 1&2

TASK: CASE STUDY ASSIGNMENT

INSTRUCTOR: CAROLINE GITHAE

TOPIC: BURNS

REG NO: BSN-1-0385-3/2021

NAME: GLORIA CHERONO

INTRODUCTION

Meru teaching and referral hospital is a public hospital level 5 that was established by the
government to promote health, teaching and the effective health in general to the public in the
country and specifically to enable people living within Meru County. It is located in township
sub-location, municipality location, Mirigo division, Imenti north constituency in Meru County
in Kenya. It has about over 300 bed capacity. This Hospital has two departments; Outpatient
department and Inpatient department. The outpatient has the administration offices, Casualty
Centre, Maternal Child Health (MCH), Palliative clinic, Emergency room, NHIF offices, a
pharmacy, Eye care unit, dental care unit, the laboratory and different consultation rooms and
casualty. The inpatient department is made up of the following wards Covid-19 ward, Maternity
ward, Labor ward, surgical ward, medical ward, dialysis, physiotherapy, dental department,
special clinics, and pediatric ward. It also has a CT scan, ultrasound, an X-ray, magnetic
resonance imaging (MRI) department and theatre. It also has a mortuary as a well. Vision of the
hospital
A community free from the need to travel far to access quality specialized health services.
Mission of the hospital
To enable the community access specialized health services through the option and use of
advanced technology, appropriate skills development and practice and research.
Core values of the hospital
Stewardship-we strive to be accountable for resources bestowed to us in our healing ministry.
Teamwork-we acknowledge diverse skills, talents and ideas that we all bring together and seek to
coordinate this and our efforts to service of our people.
Services offered: Emergency, in and outpatient, intensive care, Dental, maternity, medical
laboratory, Diagnostic imaging, and Renal dialysis. I was placed in the pediatric ward for five
weeks. It is under a nurse in charge and a deputy nursing in charge who work hand in hand with
staff nurses and student nurses, doctors, nutritionist, and patients caregivers. Every morning the
staff and students in morning shift receive report at 7:30am, we gather at the nursing station for
handing over of report from the night duty nurses and each of the day nurses are assigned to
specific categories of patients to give nursing care that day. All challenges and concerns are
discussed during the report. Drugs are administered at 9:00am, 3:00pm, 9:00pm and 3:00am as
per the treatment sheets. At 6.30pm the evening shift hand over to the night duty nurses. Morning
shift runs from 7.30am to 4.30pm, evening shift from 12.30pm to 6.30pm and night shift from
6.30pm to 7.30am. Activities I was involved in:
Description of the placement:
I was placed in the male surgical ward for four weeks it is under a nurse in charge and a deputy in charge
who works hand in hand with staff nurses, doctors nutritionist and patient caregivers. Every morning the
student and staff in the morning shift receive report from the night nursing staff and each of the day
nurses are assigned to specific categories of patients to provide nursing care on that day. All challenges
and concerns are discussed during the report .Drugs are administered at 9am,3pm,9pm and at 3am as
per the treatment sheets . At 6:30pm,the evening shift hand over to the night duty nurses .Morning shift
runs from 7:30am to 12:30pm ,evening shift from 12:30pm to 6:30pm and night shift from 6:30pm to
7:30am.

Activities I was involved in :

Admission of a client to the ward which includes detailed history taking and physical examination and
taking of vital signs .

Drug administration

Assisting in feeding patient and giving health education

Preparing a patient for theatre and receiving a patient from theatre.

Blood transfusion done under the supervision of a qualified nurse.

Wound dressing

Oxygen administration to patients with low oxygen saturation.

Discharging of a patient

PATIENTS BIOGRAPHICAL DATA

NAME: PETER KIRIMI

AGE:40

GENDER: MALE
DATE OF ADMISSION:17/06/2023

RELIGION: CHRISTIANITY

TELEPHONE NO: 0717271563

MARITAL STATUS: MARRIED

OCCUPATION: TAXI DRIVER

IP NO: 2023-31884

DIAGNOSIS: SECOND DEGREE DEEP AND SUPERFICIAL BURNS

CHIEF COMPLAIN

Second degree deep and superficial burns of the face and bilateral lower and upper limbs.

HISTORY OF PRESENTING ILLINESS

The client was well until 17th June when he woke up at 3am to realized that his house had been caught
by fire due to electric faults. He was rushed by neighbors to Mutuathe dispensary before being referred
to Meru Level 5 Hospital. He sustained second degree burns on the face, the upper and the lower limbs.

The burns were characterized by reddish weeping skin, some blisters and painful sores. Pain was
aggravated when the patient tried to move the limbs. The patient tried to pour water on the burns which
didn’t help. On arrival, the client was reviewed at the outpatient department and started on ceftriaxone
and paracetamol and later admitted to the male surgical ward.

PAST MEDICAL HISTORY

No known history of chronic illness e.g diabetes or hypertension

No known history of TB infections or acute infections

No history of blood transfusion

No history of previous admission

No known history of food or drug allergies

No history of surgical procedures

FAMILY HISTORY

No history of chronic illness in the family

There is no occurrence of recent deaths in the family

The patient lives in a nuclear family with one wife and two children

Both parents are alive

SOCIO/LIFESYLE HISTORY

He is a taxi driver

Patient uses miraa at least 4 times in a week

Patient has a good sleep pattern and sometimes play football as a form of exercise.

PHYSICAL EXAMINATION

General appearance

The patient appeared to be calm but not confident showing off his skin.

HEAD

On inspection, the hair is black in color, well distributed and has scars from the burns. The patient has
scars on the right side of the face. On palpation, no masses the hair was smooth in texture. There is n
tenderness on the head.

On auscultation, there are no bruits on the temporal arteries

EYES

On inspection, the eyes are well aligned, eyebrows are well distributed, no discharge from the eyes. The
muscles of the eyes function well. The eyes can accommodate light well and far and near objects.

On palpation, no scars, no masses or tenderness on the eyelids or around the eyebrows. The conjunctiva
is pink in color.

NOSE

On inspection, no scars, skin color is well distributed. There is no discharge coming out from the nose.
The olfactory nerves are functioning well, patient has a good sense of smell.

On palpation, there is no tenderness on the sinuses.

EARS

On inspection, no scars, no discharge ,skin is the same color as that of the rest of the body, ear pinna are
well aligned and are symmetrical. Auditory nerves are functioning well. The patient has a good sense of
hearing.

On palpation, no masses or tenderness on the ear pinna and the lobes.

MOUTH

On inspection, the lips are slightly pink and moisturized. Teeth are well aligned with complete dental
formula. Patient reports to have good sense of taste for sour, bitter and sweet taste. Gums are pink in
color and not swollen.

NECK
On inspection, the skin color is well distributed, no scars, good range of motion. No pain when
swallowing.

On palpation, the trachea is symmetrical, the carotid pulse is present. There is no venous distension,
thyroid glands and submandibular lymph nodes are not palpable. There are no masses or tenderness.

On auscultation, no bruits on the carotid arteries.

CHEST

On inspection, the skin color is well distributed, chest movements are present. The chest expands
symmetrical and apical pulsation is visible. The breasts are well aligned symmetrically.

On palpation masses, no tenderness, normal chest expansion, about 2cm. axillary lymph nodes are not
palpable.

On percussion, there were resonance when the patient took a deep breath sound to indicate air filled
lungs and dullness to the left anterior side of the chest, the heart and the right lower anterior side of the
chest, the liver.

On auscultation, breath sounds were okay, no wheezing, no stridor, no crackles. Heart sounds were
rhythmic. No heart murmurs heard.

ABDOMEN

On inspection, the skin color is well distributed, no scars, the umbilicus is at the center of the lower
quadrants of the abdomen. Abdominal movements indicating respiratory functioning.

On auscultation, bowel sounds are heard indicating bowel movements. No bruits on the abdominal aorta
and the vesicular arteries.

On percussion, tympanic sounds were heard to indicate presence of air and fluids in the abdomen.
Dullness was also heard on the upper quadrants, indicating the presence of the liver and spleen.

On light palpation, there was no tenderness felt.

On deep palpation, liver is slightly felt in position.

Special techniques were also performed:

Rebound tenderness test, to test if patient has appendicitis. The test was negative.

Murphy sign test; to test if patient has cholecystitis. The test was negative.

UPPER EXTREMITIES

On inspection, skin color is well distributed. Patient has scars on both limbs from wound healing due to
burns. No finger clubbing. Palms are pink in color. Free range of motion on both limbs.

On palpation, capillary refill of about two seconds. Radial pulse and brachial pulse are present. Skin
temperature was warm. There are no signs of peripheral edema.

LOWER EXTREMITIES
On inspection, the scars on both limbs are visible and the right limb has a fresh wound from burns that is
red in color. No free range of motion on the right limb since the wounds are still fresh and patient
complains feeling of pain.

On palpation, there is tenderness on the right lower limb at the sight of the wound.

Popliteal and femoral pulses are present. There is no evidence of peripheral edema.

On auscultation, no bruits are heard on the femoral arteries.

LITERATURE REVIEW

BURNS

A burn is an injury to the skin or other organic tissues primarily caused by heat or due to radiation,
radioactivity, electricity, friction or contact with chemicals.

Thermal burns occur when some or all of the cells in the skin are destroyed by:

Hot liquids(scalds)

Hot solids (contact burns)

Flames (flame burns)

Burns injuries are described according to the depth of the injury and of the body surface injured. The
depth of a burn depends on the type of injury, causative agent, temperature of the burning agent,
duration of contact with the agent and skin thickness. Burns are classified according to the depth of
tissue destruction.

EPIDEMILOGY

More than 300,000 people sustain burn injuries each year. Burns are the third leading cause of injury-
related death in both children and adults. Thermal burns are more common among adults compared to
scalds in children. Most fire related flames occur in homes and even places of work, might be due to
electric faults as it is seen as one of the main causes of burns in adults.

PATHOPHYSIOLOGY OF BURNS

When a body surface is burnt, it is characterized by inflammatory reaction leading to increase in capillary
permeability as early as past 20 minutes past burn. Water, sodium and plasma proteins (especially
albumin) move into the interstitial spaces and other surrounding tissues. The colloidal osmotic pressure
decreases progressive loss of proteins from the vascular space and more fluids shifts into the interstitial
space known as second spacing, fluids also move to areas that normally have minimal to no fluids, a
phenomenon termed as third spacing e.g. exudate and blister formation edema in non-burned areas.

Fluids is also lost through insensible losses by evaporation from large body surface and the respiratory
system. The net result of fluid shift and losses in intravascular volume depletion. Hemolysis of red blood
cells also occur due to action of circulating factors and direct insult of the burn injury. Thrombosis in the
capillaries of burned tissues causes an additional loss of circulatory RBCs. An elevated hematocrit is
commonly caused by hemoconcentration resulting from fluid loss. Shift of Na and K also occur. Sodium
rapidly moves into the interstitial space and remains there until edema ceases. Capillary membrane
permeability is restored towards the end of the emergent phase, if fluid replacement is adequate.

CLASSIFICATION

Burns are classified on the basis of four criteria:

[Link] of injury

[Link] of body surface involved

[Link] of the burn

[Link] of the burn

CAUSES

Thermal-mostly from flames

Electrical

Chemical

Radiation

Classification by depth

Categories of burns based on depth of tissue destruction

[Link] (1ist degree); Epidermis, painful red heals easily in 5-10 days, no systemic effect, no
scarring.

[Link] thickness burns (2nd degree) upper layers of the dermis, bright red, moist, painful extremities,
sensitive to cold air blistered, heals in 14-21 days with some scarring if deep dermal layer involved.

[Link] thickness (3rd degree) Epidermis and dermis and subcutaneous issue, form eschar (thick leather-
like dead skin)

4.4th degree -tendons, bones, and muscles involved. Usually electrical burns. Requires skin grafting, skin
flaps, possible amputation.

BURN EXTENT

How much surface is burnt is determined by one of the following methods:

Rules of Nines

An estimation of the total body surface area burned by dividing the body into multiples of 9

Totals: Anterior and posterior head and neck-9%

Anterior and posterior upper limbs -18%

Anterior and posterior trunk-36%

Perinium-1%

Anterior and posterior lower limbs -36%

Lund and Browder Method

A more precise method of estimating tee extent of [Link] takes account that the percentage of the
surface area represented by various anatomic parts (head and legs)changes with growth

Palm method
Used to estimate the percentage of scattered burns using the size of the patients palm (about 1% of
body surface) to assess the extent of burns.

ASSESMENT OF BURNS

The severity of burns depend on the following:

 Time of contact with burn material-the longer the contact the more severe the burn
 Temperature of burn material
 Type of burn material
 Part of body part involved
 Age of patient
 Surface area of the skin involved

People with the following burns should be transferred to a specialist burn unit:

10% burns or more partial thickness burns

5% or more full thickness burns

Burns to delicate areas such as the eyes, face or hands, perineal area.

Burns involving the airway

LABORATORY AND IMAGING STUDIES

COPLETE BLOOD COUNT

To check the levels of hemoglobin , if 7-10g/dl give hematinic if less than 7g/dl transfuse. Check for levels
of white blood cells.

COAGULATION PROFILE

Platelets are destructed by the burns and also tissue destruction

ARTERIAL BLOOD GASES

Inhalation of gases increase amount of carbon monoxide hence patient may go into metabolic acidosis

UREA, ELECTROLYTE AND CREATININE

To check if kidneys have failed if high kidneys are not able to excrete hence causes tubular necrosis.

ECG

Electric burns has effect on heart muscles.

ESR

To determine inflammatory rate.

TREATMENT
Therapeutic management: The aim of the treatment targets:

ABC management in case of head and neck urns to management of respiratory distress.

Fluid resuscitation and respiratory management, pain management, wound care, nutritional support
psychological support.

Oxygen if needed especially in upper body burns facial bruises and smoke inhalation burns.

Fluid resuscitation -especially in first treatment -prevent hypovolemic shock due to increased capillary
permeability .Ringers lactate usually used. The patients body weight and % of burns area determine fluid
volume and rate of administration.

Using Parklands formula for calculating resuscitation needs : 4mills of Ringers lactate solution x Kg of
body weight x total body surface area burnt divided into one half of total 1st 8 hours post-burn ; quarter
next 8 hours and then quarter the next 8 hours.

Use ringers lactate or normal saline with 5% glucose for maintenance ,use Ringers lactate with
5%glucose of half-norm.

Consensus formula-2-4mlxkg bod weight x TBSA burned half to be given in the first 8 hours ,remaining
half given over 16 hours.

The first 24 hours means since time of burn not since admission

 Elevate head of bed and burned extremities

 Monitor serum electrolyte levels
 Recognize developing electrolyte imbalances

Maintaining normal body temperature by providing a warm blanket and work quickly when wounds
must be cleaned.

Minimize pain and anxiety through administering analgesics and assessing response, assess patient and
family understanding of burn injury coping strategies, family dynamics and anxiety levels.

Provide pain relief and anxiolytics if the patient remains highly anxious and agitated after psychological
interventions.

WOUND CARE

After stabilization, aseptic technique cleaned and debrided – removal of dead skin. Wound soaked for
ten minutes and then washed from inner to outer surface using firm, circular motion(cut dead skin with
forceps).Apply antibacterial cream e.g. silver sulfadimidine , silver nitrate magnetite acetate ,
hydrotherapy can be used to soften dead tissue.

PREVENTION OF IMPAIRED MOTILITY

Increased risk to impaired motility, contractures due to increased bed rest ,muscular atrophy and
shortening, sit fining of burned tissue, exercise prevent the above e.g. range of motion exercises .

NUTRITIONAL SUPPORT
Burns induced hyper metabolic state occurs as soon as after injury. Its vital to provide early nutritional
support for wound healing and to reduce stress ulcers.

Burn healing requires increased glucose intake but fat principally used for anaerobic metabolism. There
is relative carbohydrate intolerance with hyperglycemia and abnormal glucose intolerance.

Zinc supplement with vitamin C and folic acid in wound healing.

Protein at least 255 caloric energy and the rest carbohydrate and fat.

COMPLICATIONS OF BURNS

[Link]

Burn patients are at increased risk for hypothermia due to unprotected and prolonged body surface
exposure and loss of protective thermoregulatory provided by normally intact skin.

[Link] failure

Renal failure occurring immediately mostly after burns is mostly due to reduced cardiac output , which is
mainly caused by fluid loss. There is also decreased blood flow to the kidneys and cause kidney damage.

[Link]

Loss of the skin barrier as well as immunosuppression experienced because of a systemic inflammatory
response triggered by the injured tissue.

[Link]

Due to destruction of red blood cells and due to surgery.

[Link]

Burn patients receiving long term immobilization of their extremities by positioning, pain management
and splinting wire easily to have joint contractures. Contractures occur due to burn scars maturing,
thickening and tightens, this can prevent movement.

[Link]

The patient must be monitored for early signs of hypovolemic shock or fluid overload secondary to
adequate fluid resuscitation. Most commonly fluid deficit occurs, which may develop into distributive
shock.

TREATMENT
 DRUG NAME CLASS MODE OF INDICATIONS SIDE NURSING
ACTION EFFECTS IMPLICATIONS
OMEPRAZOLE Protein It inhibits the Gastric and Headache Advise patient
pump secretion of duodenal ulcers Nausea to avoid
inhibitor gastric acid by Erosive Constipation alcohol and
irreversibly esophagitis Stomach foods that’s
blocking the Gastroesophageal pain can increase
enzyme reflux disease GI irritation
system of
hydrogen
/potassium
adenosine
triphosphate

flucloxacillin Beta It works by Osteomyelitis Skin rash Assess site

lactam breaking endocarditis Wheezing carefully
antibiotic down the and trouble before and
bacteria cell breathing during
wall .It Swelling of injection for
inhibits cross- the face, extravasation
linkage lips, tongue Observe for
between the signs of super
linear infection
peptidoglycan
polymer
chains that
make up a
major
component of
the cell wall

mebocream Antibiotic Soothes the Burns Rash Observe for

and wound by the Scalds Itching any adverse
wound action of sunburns Peeling of side effects of
healing moisture - skin the drug on
cream retaining oil Chest the patient
tightness
Difficulty in
breathing

Amino guard granules

MOA; it works by promoting wound healing and slowing down the process that damage cells.

Side effects; metabolic imbalances, hyperammonemia, coma, stupor, high nitrogen in blood, aluminum
poisoning.

Tetanus toxoid

MOA: It creates immunity to the parts of the germ that cause a disease instead of the germ itself.

Side effects; soreness, redness, nausea, vomiting, diarrhea, loss of appetite, headache or body aches and
fatigue.

NURSING CARE PLAN

NURSING NURSING GOAL/ INTERVE RATIONALE IMPLEMENTATI EVALUATI

ASSESME DIAGNOSIS OUTCOME NTION ON ON
NT
Patient Acute pain Goal Ensure Ensuring Linen was Patient
verbalizes related to To provide that patient is changed and verbalized
feeling of tissue pain relief by patient is comfortable dressings reduced
pain on a injury the end of 30 comforta by changing changed by pain at
score of 8 secondary minutes. ble when linen helps nurse Gloria at 10:15am.
on a scale to burns Outcome changing relax the 9am.
of 0-10. evidenced Patient will bed linen patient. Morphine
On by the express pain and wet Morphine 10mls in 5%
observati patient relief by the dressings. binds to dextrose was
on, verbalizing end of thirty Administr opiate administered
patient feeling of minutes. ation of receptors and by nurse
screams pain and analgesic alters Winnie.
of pain screaming morphine perception Psychological
during during 10mls and response reassurance
wound wound TDS. to painful was given to
dressing dressing Provide stimuli the patient by
and psycholog resulting in nurse Gloria.
shows ical decreased
facial reassuran severity of
grimace. ce to the pain.
patient. Psychological
reassurance
calm the
patient hence
decreased
response to
pain.
Patient Fluid By the end of Give iv To increase Iv fluids, ringers By the end
complains volume 24 hours of fluids for fluid volume lactate 3200mls of 24
of deficit IVF infusion the first in the body. were hours,
dizziness. related to patient fluid 24 hours. administered to patient
On fluid loss volume will the patient. fluid
examinati secondary increase. volume
on the to fluid had
patient shift from increased,
has a poor the urine
skin intravascul output of
turgor. ar space to 50mls per
Urine extravascul hour.
output of ar space Skin
20ml/hour evidenced returned
. by patient to normal.
having a
poor skin
turgor and
urine
output of
20ml/hour.
Patient Hypother Goal Use of a Heater helps Electric heater After 24
verbalizes mia To restore heater to to generate was placed hours of
feeling related normal generate heat by next to the nursing
cold. On poor thermoregula heat. creating patient and interventio
observati thermoreg tion by patient Covering warmth to the switched on by n patient
on, ulation verbalizing the patient. nurse Gloria. will
patient is secondary feeling warm patient Covering Patient was verbalize
shivering. to skin loss after thirty with patient with covered with feeling
Temperat due to minutes. extra blankets extra blankets warm.
ure of burns as Outcome blankets. decreases by nurse Gloria
35.3 when evidenced Patient will Closing rate of heat at 10am.
measured by patient express signs windows loss from the Windows next
using a verbalizing of effective next the patient’s to the patient
thermogu feeling thermoregula patients body. were closed by
n. cold and tion by bed. Closing nurse Gloria.
shivering verbalizing windows next
on feeling of to the patient
observatio warmth. helps reduce
n. heat loss.

Maintain The
Subjective strict wound is
data aseptic Aseptic free from
Patient technique technique was infection,
verbalizes while To minimize maintained no sepsis.
having Risk for Patient will be dressing infection to while dressing
wound on infection free from the the wounds. the wounds.
the lower related to infection. wounds.
and upper open
extremitie wounds on Use Sterile gauzes
s. the skin appropria To promote and wound
Objective secondary te wound faster wound creams were
data to burns. dressings. healing and used to dress
On minimize the wounds.
observati Administ infection to
on, er the wounds.
patients antibiotic Mebocream
has 2nd s, amino and amino
degree granules Amino granules were
superficial and granules and used to dress
and deep mebocre mebocream the wound to
burns on am was promote promote faster
the face, used to wound healing.
upper and dress the healing and
lower wound. slows down
extremitie the process
s. that damage
the cells.
Patient Fluid Goal Encourag Taking fluids Patient was After 24
complains volume To increase e patient orally given 450mls of hours of
feeling of deficit fluid input by to take increases fluid water by nurse nursing
thirst. related to the end of 4 fluids intake and Gloria at 9am. interventio
Dry failed fluid hours. orally. improves Patient was n, patient
mucous resuscitati Outcome Monitor rehydration also has
membran on Patient will vital signs status of the encouraged on moisturize
e of the secondary express signs to check patient. taking fluids d lips .
mouth on to failure of fluid on the Monitoring e.g. water and
observati of access volume progress vital signs of milk.
on. to restoration by of the the patient Patient vitals
Failure to intravenou verbalizing patient helps in were
access s line as absence of every 4 identifying monitored by
intraveno evidenced feeling thirst. hours. impending nurse Gloria at
us line by dry complications 9:30 am.
due to mucous such as
burns on membrane hypovolemic
upper and s of the shock.
lower mouth.
limbs.
Subjective Impaired By the end of Provide To reduce risk Wound was By the end
data skin two weeks, appropria for infection dressed in an of two
Burns on integrity skin tissue will te burn and promote aseptic weeks of
the face, related to start care and wound techniques nursing
lower and destructed generating. infection healing. using NS interventio
upper skin layer control. dermazine n, patients
extremitie as Dress cream to skin had
s. evidenced with promote started
Objective by patient dermazin wound healing. degenerati
data having e and ng.
2nd burn scars wash the
degree on the face wounds
deep and and lower with NS.
superficial and upper
burns. extremitie
Burns of s.
approxim
ately 38%.
Patient Disturbed By the end of Give Giving Nurse talked to By the end
verbalize body 24hours of emotiona emotional the patient on of a week
he is no image Nursing l support support to the the importance patient
longer related to intervention, to the patient of self had
cute due destructio patient is able patient so reassures him acceptance to accepted
to burns n of skin to accept that he that he is still boost his self himself
on the tissue due himself the can be acceptable esteem. the way he
 face and to burns as way he is. able to the way he is. is.
the evidenced accept
extremitie by patient himself
s. verbalizing the way
Patient he is no he is.
hides the longer
burns so cute and
that hiding the
people burns
cannot during
see during wound
wound dressing.
dressing.
Subjective Impaired Patient will be Early To minimize Patient was Patient is
data mobility able to move mobilizati the risk for advised to under the
Patient related to freely. on. contracture move out of nursing
verbalize pain, related to bed atleast interventio
feeling of wound Perform burns. twice in a day. ns upto
pain when dressings range of Nurse Gloria now.
trying to and motion To facilitate performed a
move. contractur exercises. movement of range of
Objective e joints and motion
data secondary Safe promote exercises on
Patient to burns, client mobility of the patient's
has as handling. the extremities.
limited evidenced extremities. Patient was
range of by patient handled with
motion verbalizing To reduce care when
feeling of further dressing the
pain and injuries. wounds to
having a minimize pain
limited and discomfort.
range of
motion.

CRITIQUE

Patient was being nursed in the male surgical ward instead of the burn unit for infection prevention and
proper observation of patient.

Patient was covered with non-sterile sheets.

Clean gloves used when dressing the wound and if sterile used for more than one patient.

One sterile pack can be used to dress more than two patients and thus sterility is not maintained.

Painful scrubbing of wounds during wound cleaning and dressing.

RECOMMENDATION
I would recommend that patients with severe burns should be nursed in the burn unit for infection
prevention.

I recommend that patients with open burn wounds should be covered with sterile sheets as burns are
easily susceptible to infection.

I recommend that a dressing pack should be used only on one patient for proper infection prevention.

Sterile gloves should be used only on one patient to ensure that there is n cross-contamination on the
wounds.

I would recommend that analgesic drugs should be administered 15 minutes prior to dressing the
wounds.

C0NCLUSION

This study concluded that burns is a surgical condition of considerable importance which requires
extensive surgical intervention and multidisciplinary care. Majority of burns can be managed with simple
outpatient wound care and ambulatory clinic to ensure that all involved areas heal and do so without
debilitating scarring.

Severe burn patients and those that meet specific criteria should be nursed in burn units.

For major burns, intravenous access should be obtained and a urinary catheter inserted.

Adequate fluid resuscitation is the most critically important aspect of early major burn care and aims to
maintain tissue and organ perfusion and minimize systemic sequelae, especially renail failure.

Burn patients and their families should receive emotional support from the health care team members.

REFERENCE
Allorto NL,Rogers AD, Rode H. ‘Getting under our skin’; Introducing allograft skin to burn surgery in South
Africa. S Afr Med J 2016; 106 (9):865-866.