TOPIC: BURNS

SUBJECT: PEDIATRIC NURSING

PRESENTED BY: PEER ZADA YAWAR ASHRAF
(Student of SMMCN & MT, IUST Awantipora)
ROLL NO: SMCB-17-08
DEFINITION:

Injuries that results from direct contact or exposure to any

thermal, chemical, electrical or radiation source are termed
as burns.

• Thermal injuries are the 3rd most common cause of

accidental deaths in children.
• Burns are second leading cause of injuries in age group
between 1 and 14 years.
• 80% of burn injuries occur within home.
CAUSES OF BURN:
a. Scald injury from moist heat:
• Common cause of burn injury in toddlers.
• Scald occurs in home.
b. Flame:
• 2nd most common cause of burns and leading cause of
mortality in burn children.
• Occurs due to contact with stove, heater, smoking in bed
etc.
c. Electrical injury:
• Devastating injury caused by high voltage electrical
contact.
d. Chemical injury and contact injury:
• Chemical burns in toddlers often result from ingestion of
acids or alkalies, caustic soda, etc.
• Contact burns may occur due to heated liquids, [Link].
e. Radiation injury:
• Occurs due to over exposure to UV rays from sun.
PATHOPHYSIOLOGY
ASSESSMENT OF BURN DEPTH AND SEVERITY:
The physiologic responses, therapy and prognosis are
releated to:

a. Extent of injury
b. Depth of injury
c. Severity
a. EXTENT OF INJURY:
Percentage of total body surface area(TBSA).
 Modified rule of nine: Childs body parts are
proportionately different from those of an adult.
• Head and neck - 19%
• Anterior trunk - 18%
• Posterior trunk - 18%
• Upper extremities - 9% each
• Lower extremities - 13% each
• Perineum - 1%
RULE OF ‘5’(Lynch and Blocker) :

AREA INFANT CHILD

Head and neck 20% 15%

Hands 10% 10%

Anterior trunk 20% 20%

Posterior trunk 20% 20%

Legs 10% 15%

TBSA of burn according to age:

AREA Newborn 3 years 6 years 12 years

Head and 18% 15% 12% 6%

neck

Trunk 40% 40% 40% 38%

Arms 16% 16% 16% 18%

Legs 26% 29% 32% 38%

b. DEPTH OF
INJURY:
c. BURN SEVERITY:
¡) Minor burns:- It includes_
• Partial thickness burns of less than 15%0of TBSA.
• Full thickness burns less than 2%0TBSA.
¡¡) Moderate burns:- includes
• Partial thickness burns of 15-25% TBSA.
• Full thickness burns less than 10% TBSA.
¡¡¡) Major burns:- includes
• Partial thickness burns of 25% TBSA or greater.
• Burns involving respiratory tract injury.
• Full thickness burns of 10% TBSA.
• Electric burns that penetrate.
• Deep chemical burns and third degree burns.
ASSESSMENT:
• Thorough patient history should be obtained.
• Estimate extent of injury according to TBSA involved.
• Estimate depth of injury—partial thickness burn or full
thickness burn.
• Estimate burn severity.(minor, moderate, major)
• Find out age of child.
• Take past medical history.
• Look for associated trauma.
• DIAGNOSTIC EVALUATION:
• Blood for serum electrolytes, blood urea nitrogen, serum
protein, serum albumin, ABG analysis.
• Urine specific gravity and hemochromogens are
monitored.
• X-ray is taken if there is evidence of smoke inhalation or
trauma.
• Wound cultures for starting antibiotic therapy.
EMERGENCY FIRST AID:
1. Stop burning
2. Protect the burn area
3. Transportation to a medical facility
4. Emotional support of the family members.
IMMEDIATE MANAGEMENT:
A. 𝙼𝙸𝙽𝙾𝚁 𝙱𝚄𝚁𝙽 𝙸𝙽𝙹𝚄𝚁𝚈:
 Minor wound care
 Tetanus immunization
 Prophylactic antibiotics
B. 𝙼𝙰𝙹𝙾𝚁 𝙱𝚄𝚁𝙽 𝙸𝙽𝙹𝚄𝚁𝚈:
1. Emergency care:
Begins at the time of injury and continues until child's
condition stabilizes in about 48-72 hours.
• Assess ABC and initiate CPR, if needed.
• Provide IV sedation if necessary.
• Complete trauma assessment should be performed.
• Insert IV line to deliver fluids at rapid rate.
• Weigh the child to calculate fluid requirement.
• Insert an indwelling Foley's catheter.
• Empty stomach through NG tube to pret aspiration.
• Examine burn wound and evaluate extent and depth of
injury.
• Fluid replacement therapy.
• Administration of medications—(TT prophylaxis, penicillin
prophy, analgesics.)
• Wound care—three methods
a. Open exposure method
b. Closed occlusive method
c. Semi-open method
• Monitor physiologic response to treatment.
• Initiating measures to prevent complications.
• Providing emotional support.
2. Care during acute phase:
Acute phase begins with stabilization of child's condition,
approximately 48-72 hours after injury and continues until
wound healing is complete.
NURSING MANAGEMENT INCLUDES:

Managing Burn wound:

• Changing the dressing daily.
• Recognizing early signs of infection.
• Recognizing burnburn wound progress.
• Documentation of burn wound changes.
Providing pain relief:
• Narcotic analgesics should be given regularly as
prescribed.
• Effectiveness of pain relief should be monitoret.
• Simple non pharmacologic supportive techniques like
distraction, imagery or relaxation may be effective in
decreasing the perception of pain.
Providing nutritional support:
• Monitor nutritional status.
• Maintain intake/output chart.
• Supplemental enteral feedings are generally indicated to
provide proper protein and calorie intake.
• NG feeds should be continued till oral feeds are allowed.
Monitor for complications:
Burn patients particularly younger than 2 years are prone to
infectious complications like bacterial invasion of wound,
pneumonia and sepsis.

Provide emotional support v

• Age appropriate activities should be incorporated into the
child's day.
• Allow parents to spend time with child.
• Parents should be encouraged to participate in care of child.
Planning for rehabilitation and discharge:
• Active ROM exercises, burn scar management, pressure
garments and orthoplastic splints should be introduced.
• If parents remain unable to meet child's rehabilitative
needs, temporary placement in a pediatric rehabilitation
facility may be necessary.
[Link] Burn care:
Rehabilitative phase begins with closure of the burn wound
and anticipation of return to home environment. This phase
aims to bring back the discharged patient to pre-burn
activity level.
Nsg Management:-
• Providing skin care and wound management
• Providing a physical exercise program
• Scar management
• Providing for social re-entry.
PREVENTION:
Almost all thermal injuries are preventable. Prevention is
the best cure for this problem:
• Programs aimed at informing the public of this
healthhazard, provided by fire department.
• Use of smoke detectors.
• Practice of exit drills at home.
• Use of escape routes and fire ladders.
• ‘Stop-drop-roll-cool’method of extinguishing clothing fire is
taught to people.
• Children should be taught about preventive measures from
pre-school age.
• Children should be taught to stay away from fire.
𝓣𝓱𝓪𝓷𝓴 𝔂𝓸𝓾