Burns

Introduction:

Burns are damage to the skin and body tissues caused by flames, heat, cold, fric-
tion, radiation (sunburn), chemicals, or electricity. Burns are generally divided into
three categories, depending on the damage. First-degree burns are those with
injury to the outer layer of skin called the epidermis. They will be red, and painful,
with some swelling. Asecond-degree burn is when the epidermis is burned, as well
as the next layer, the dermis. Severe pain, white and reddened areas, swelling, blis-
ters, and perhaps drainage will be seen. A third-degree burn goes through all the
layers of the skin and could involve underlying tissues. It is often painless due to
destruction of the nerves in the area. The area will look black (termed eschar)
and/or reddened. Many drugs may make the skin more sensitive to the sun, pro-
ducing the effect of a sunburn with little exposure. Common medications with this
effect include: amiodorone, carbamazepine, furosemide, naproxen, oral contra-
ceptives, piroxicam, quinidine, quinolones, sulfonamides, sulfonulureas, tetracy-
clines, and thiazides, among others.

PROGNOSIS
Prognosis depends on the severity of the burn plus the amount of surface area
involved. When large portions of the face, chest, hands, feet, genitalia, or joints
have sustained a large second- or third-degree burn, prompt medical attention is
necessary. Serious burns can lead to death. If smoke inhalation has occurred, or if
the nasal hairs are singed, or if quantities of soot are present around the face, assess
for adequacy of breathing and damage to the respiratory tract. CPR may need to be
started. Infants and elderly patients with burns require prompt medical attention.

SIGNS AND SYMPTOMS

• Redness, no break in skin—indicates a first-degree burn from damage to the
epidermis
• Deeper red, with clear fluid blisters—indicates a second-degree burn as the
epidermis and dermis are burned
• Charred black or dry white—indicates death of the tissue from the burn (third-
degree burn)

TREATMENT
The objective of burn treatment is to prevent infection, decrease inflammation and
pain, and promote healing of the areas. Treatment choices depend on the degree of
burn and the amount of body surface area that was burned. Any second-degree burn
greater than 5 to 10 percent of surface area and all third-degree burns belong in a
hospital, preferably within a specialized burn unit. All electrical burns and burns
of the ears, eyes, face, hands, feet, and perineum require hospital care, as do chem-
ical burns and burns in infants or the elderly.
• Check the area for any exposed electrical wires, if you are present on the scene.
• Use cold water to decrease the temperature of the area for a first-degree burn
or a small second-degree burn and to stop the burning.
• For chemical burns, ensure that all the chemical has been flushed away.
• For electrical burns, look for entrance and exit wounds.
• Cover the area with dry gauze.
• If the skin is broken (second-degree burn), use a topical antibiotic ointment such
as silvadene to prevent a secondary bacterial infection before applying the gauze.
• Administer pain medications (ibuprofen, acetaminophen) as needed.
• For third-degree burns, the eschar needs to be debrided (cut away) to allow
new tissue to grow.
• These wounds are often covered in moist sterile saline gauze, as new tissue
grows best in this environment. When the gauze dries; it adheres to the dead
tissue. The area is mechanically debrided when the gauze is removed.
• Oral antibiotics may be necessary.
• Administer pain medications (oxycodone, morphine) as needed, especially
before dressing changes that may be painful.
• Prevent heat loss due to large areas of tissue exposed from lack of skin
coverage.
• Maintain fluid levels since fluid loss is common from evaporation and
wound drainage.

NURSING DIAGNOSES

• Risk of fluid volume deficit
• Pain, discomfort
• Risk of altered body temperature

NURSING INTERVENTION

• Anticipate pain medication needs to make the patient more comfortable.
• Assist in range of motion to avoid contracture development due to pain with
movement.
• Encourage family visitation.
• Assist with activities of daily living.
• Isolation may be needed to protect the patient from bacteria, especially if a
large amount of skin is not intact.
• Teach the patient to look for signs and symptoms of infection: fever, increased
redness, increase in drainage, or change in color of drainage.