The document discusses burn injuries, including their definition, types, causes, symptoms, assessment, management, and reconstructive treatments. It covers: 1. Burns are classified by degree of skin damage, from superficial first-degree burns to full-thickness third-degree burns. Thermal burns from heat are most common but burns can also be caused by chemicals, electricity, radiation, or sunlight. 2. Burn assessment involves estimating the total body surface area affected using methods like the Rule of Nines. Management involves fluid resuscitation, wound care, pain management, and rehabilitation. 3. Later treatments may include skin grafts or other reconstructive surgeries to repair damage and improve function and appearance.

1. Burn
Presented by
Sanjeev soni

2. Introduction
• Burn injury of the skin is characterized by the damage to skin tissue from hot (scald,
flash, flame, contact), cold, electrical, chemical, radiation, sunlight, or other sources.
• Burns constitute one of the most common causes of morbidity and mortality worldwide.
• They can result in significant disfigurement, physical impairment, work loss,
psychological problems, and considerable economic burden
• A burn injury can affect people of all age groups, in all socioeconomic groups. An
estimated 500,000 people are treated for minor burn injury annually

3. Definition
• Burns are tissue damage brought on by heat, chemicals, electricity, radiation or the sun
• A burn occurs when heat, chemicals, sunlight, electricity or radiation damages skin tissue
• A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation,
radioactivity, electricity, friction or contact with chemicals.

4. Types
• Burns are classified by degree depending on how deeply and severely they penetrate the skin
1. First degree burn
2. Second degree burn
3. Third degree burn and
4. Fourth degree burn

5. • First-degree (superficial) burns.First-degree burns affect only the outer layer of skin, the epidermis. The
burn site is red, painful, dry, and has no blisters
Types

6. Types
• Second-Degree Burns: They damage both the skin’s outer layer and the layer
beneath it.
• Second-Degree Burns go through the epidermis and reach the dermis, which
layer of skin.
• Second-Degree Burns tend to form blisters and are more painful and swollen

7. • Third-Degree Burns: They destroy or damage the deepest layer of skin and
tissues underneath.
• They tend to reach the third and lowest level of the skin, the hypodermis.
• The affected area from the Third-Degree Burns appears white
Types

8. • Fourth-Degree Burns: These burns penetrate through all the three layers of the
skin and damage the muscle, bones, nerves and fat lying underneath them.
• There is no pain in fourth-degree burns, as the nerves get damaged
the pain.
Types

9. Skin anatomy & physiology
• The skin is the largest organ of the body, with a total area of about 20 square
feet.The skin protects us from microbes and the elements, helps regulate body
temperature, and permits the sensations of touch, heat, and cold.

10. • Basically, the skin is comprised of two layers that cover a third fatty layer.These three layers
differ in function, thickness, and strength.
• The outer layer is called the epidermis; it is a tough protective layer that contains the melanin-
producing melanocytes.
• The second layer (located under the epidermis) is called the dermis; it
contains nerve endings, sweat glands, oil glands, and hair follicles.
• Under these two skin layers is a fatty layer of subcutaneous tissue, known as
the subcutis or hypodermis.The skin contains many specialized cells and structures:
Skin anatomy & physiology

11. Skin anatomy & Physiology
• Skin has variety of the function
• Protection
• The skin covers the body and acts as a physical barrier that protects underlying tissues
from physical damage, ultraviolet rays, and pathogenic invasion. By containing fluids in
the body, the skin also protects again dehydration.
• Body Temperature Maintenance
• The skin contains sweat glands that secrete fluid in the form of perspiration. This
process helps regulate the body's internal temperature.

12. • Excretion
• During perspiration, the sweat glands flush small amounts of waste
products composed of water, salt, and organic compounds out of the body.
(Organic compounds are the chemical compounds that make up living
organisms).
Physiology of the skin

13. • Nursing assessment done by following manner
• History taking and physical assessment
• History taking – Nurses should be take comprehensive history from
patient or their attender regarding burn condition
Nursing assessment

14. Nursing assessment
• Various methods are used to estimate the TBSA affected by
• burns; among them are the
• Rule of nines
• the Lund and
• Browder method, and the palmer method.

15. • A common method, the rule of nines is a quick
• way to estimate the extent of burns in adults.
• The system di-vides the body into multiples of nine.
• The sum total of thes partss equals the total body surface area and is an important
Measurement in the severity of injury
Nursing assessment
(Rule of nine)

16. Nursing assessment
(Rule of nine)

17. Etiology of the burn
1. Thermal burns
2. Chemical burns
3. Electrical burns
4. Radiation burns
5. Sunburns
Etiology of burn

18. • Thermal burns- It develops in two different ways as hot water and flame
burns.
• Thermal burns are skin injuries caused by excessive heat, typically from
contact with hot surfaces, hot liquids, steam, or flame.
• Thermal damage to skin results in cellular death as a function of
temperature and length of contact time.
• Thermal burns are the most common type of burn injuries, making up
about 86% of the burned patients requiring burn center admission.
• About 70% of the burns in children develop due to hot water. It is most
often caused by hot drinks or hot bath water.
Etiology of the burn

19. • Chemical burns- It is the cause of burns caused by cleaning materials
that are used in daily life at home or by work accidents.
• While 3–6% of all burns constitute chemical burns, they constitute 14–30%
of burn-related mortalities
• Generally, it is developed due to contact with strong acid or alkaline
substances. Unlike thermal burns, there is longer contact with the agent.
• Inhalation or ingestion of the chemical material may result in systemic
symptoms and injuries in the mouth, esophagus, and stomach
Etiology of the burn

20. • Electrical burns- Electric burns, which are most common in men between
20 and 40 years of age, constitute 20% of burn-related mortalities
• It occurs by electric current or lightning strike
• In low-voltage accidents, burns are limited on the skin, however, go down
into deeper tissues. In high-voltage accidents, there are traces just like
stapler pierce, ulceration, and scarring.
Etiology of the burn

21. • A radiation burn is a damage to the skin or other biological tissue and
organs as an effect of radiation
• The radiation types of greatest concern are thermal radiation, radio
frequency energy, ultraviolet light and ionizing radiation
Etiology of the burn

22. • Sunburns-It develops due to uncontrolled and prolonged exposure to sun
or light sources containing UVB. Sunburn is the contact dermatitis due to
ultraviolet B rays (295–315 nm), which is the most erythematous
wavelength.
Etiology of the burn

23. • Cold burn (frostbite)
• It is developed with cooling of the body.
• The skin is frozen at −2 to −10°C and irreversible changes occur under
−22°C. Cold burn is different from thermal burns; trauma occurs at the
cellular level and extracellular fluid directly, at the organ functions indirectly
• Electrolytee concentration increases with development of ice crystals in
the intracellular and extracellular fluid, enzyme systems do not work and
tissue destruction begins
Etiology of the burn

24. Pathophysiology of burn

25. Pathophysiology of burn

26. Clinical manifestation
• Burn symptoms vary depending on the severity or degree of the burn.
Symptoms are often worse during the first few hours or days after the burn.
Burn symptoms include:
• Blisters
• Extremly Pain.
• Swelling.
• White or charred (black) skin.
• Peeling skin
• OOZING

27. Management of burn
• Burn care is typically categorized into three phases of care:
1. EMERGENT/RESUSCITATIVE PHASE
2. ACUTE/INTERMEDIATE PHASE
3. Rehabilitation phase

28. • EMERGENT/RESUSCITATIVE PHASE- Preventing injury to the rescuer is the
first priority of on-the-scene care. If needed, fire and emergency
medical services should be requested at the first opportunity
• Duration - From onset of injury to completion of fluid Resuscitation
• Priority needs-
1. First aid
2. • Prevention of shock
3. • Prevention of respiratory distress
4. • Detection and treatment of concomitan injuriess
Management of burn

29. • First aid for burn
1. Protect the burned person from further harm.
2. Make certain that the person burned is breathing.
3. Remove jewelry, belts and other tight items,
4. Cool the burn.
5. Cover the burn
6. Raise the burned area
7. Watch for signs of shock
Management of burn

30. • Prevention of shock- the most urgent need is preventing irreversible shock by
replacing lost fluid and electrolytes. As stated previously, survival of the patien
with burn injury depends on adequate fluid resuscitation
• fluid changes that occur in the emergent/resuscitative phase of care. Baseline
weight an laboratory test results are obtained, and these parameter must be
monitored closely in the immediate postburn (re-suscitation) period.
Management of burn

31. • Fluid Replacement Therapy- The total volume and rate of IV fluid
replacement are gauged by the patient’s response and guided by the
resusci-tation formula.
• The adequacy of fluid resuscitation is deter-mined by monitoring urine
output totals, an index of renal perfusion. Urine output totals of 0.5 to
1.0 mL/kg/h fo adults have been used as resuscitation goals
Management of burn

32. • The projected fluid requirements for the first 24 hours ar calculated by
the clinician based on the extent of the bur injury
• Some combination of fluid categories may be used,including colloids
(whole blood, plasma, and plasma ex-panders) and
crystalloids/electrolytes (physiologic sodiu hloride or lactated Ringer’s
solution).
• Adequate fluid re-suscitation results in slightly decreased blood volume
level during the first 24 postburn hours and restoration of plasm levels to
normal by the end of 48 hours.
Management of burn

33. •Iv infusion therapy via park land formula- Parkland formula especially
designed for burn patient
•First 24 hours of resuscitation at approximately 4ml per kilogram of body
weight per percentage burn of TBSA. Half the volume is given in the first eight
hours post burn, with the remaining volume delivered over 16 hours
•The formula
The Parkland formula for the total fluid requirement in 24 hours is as follows:
• 4ml x TBSA (%) x body weight (kg)
Management of burn

34. •Mr. Sunil (60kg) admitted in burn ward with 40% electric burn.
•How we can administer iv infusion therapy through park land formula
• Parkland formula - 4ml x TBSA (%) x body weight (kg)
• Parkland formula 4×40×60
•9600 ml
•4800 ml fluid will given first 8 hours and remaining 4800 ml will be given in
16 hours
Management of burn

35. • Acute/intermediate phase
• Duration -From beginning of diuresis to near
• completion of wound closure
1. Wound care and closure
2. Prevention or treatment of complications including infection
Management of burn

36. • Wound Cleaning
• Wash Your Hands Clean
• Stop the Bleeding
• Clean the Wound
• Apply Antibacterial Ointment
• Protect the Wound
• Change the Dressing
• Observe Symptoms
Management of burn

37. • Prevention or treatment of complications including infection
• Topical antimicrobials for the prevention and treatment of burn wound infection
include mafenide acetate, silver sulfadiazine, silver nitrate solution, and silver-
impregnated dressings.
• These various therapies differ in their ability to penetrate eschars, antimicrobial activities,
and adverse-event profiles
Management of burn

38. • Rehabilitation
• Duration-From major wound closure to return to individua optimal level
of physical and psychosocial adjustment
1. Physical, occupational, and vocational rehabilitation
2. Psychosocial counseling
Management of burn

39. • Promoting physical mobility
• An early priority is to prevent complications of immobility.
• Deep breathing, turning, and proper positioning are essen-tial nursing practices that
prevent atelectasis and pneumo-nia, control edema, and prevent pressure ulcers and
con-tractures.
• These interventions are modified to meet the patient’s needs.
• Low-air-loss and rotation beds may be use-ful, and early sitting and ambulation are
encouraged.
• If th lower extremities are burned, elastic pressure bandage should be applied
before the patient is placed in an uprigh position
• These bandages promote venous return and mini-mize edema formation.
Management of burn

40. • Psychological Support
• A patient’s outlook, motivation, and support system ar important to his
or her overall well-being and ability t progress through the rehabilitation
phase.
Management of burn

41. Medical management
• Silver sulfadiazine 1%
• (Silvadene) water-soluble cream
• Indication- • Most bactericidal agent Minimal penetration of eschar
• Application- Apply 1⁄16-inch layer of cream with a sterile glove 1–3 times daily.
• Mafenide acetate 5% to 10% (Sulfamylon hydrophilic-baseded cream
• Indication- • Effective against gram-negative and gram-positive organisms
• Application- Apply thin layer with sterile glove twice a day and leave open as
prescribedd; if the wound Is Dressedd, change the dressing every 6 hours as
prescribed.

42. Nursing management
• Assessment
• The nurse obtains information about the patient’s educa-tion level,
occupation, leisure activities, cultural back-ground, religion, and family
interactions early.
• The pa-tient’s self-concept, mental status, emotional response to the
injury and hospitalization, level of intellectual function-ing, previous
hospitalizations, response to pain and pain relie measures, and sleep
pattern are also essential components of a comprehensive assessment.
• Information about the patient’s general self-concept, self-esteem, and
coping strategies in the past are valuable in addressing emotional needs.

43. • Priority needs of the burn patient
• To prevent hypovolemic shock
• - Administer iv infusion therapy to the patient
• To prevention from infection
• - check his/ her vital sign
• - administer antibiotics to the patient
• To relieve from severe pain
• - Administer analgesic to the patient
• Improve nutritional status
• To give balance diet to the patient
Nursing management

44. • Nursing diagnosis
1. Activity intolerance related to pain
2. Altered body temperature related to infection
3. Fluid volume deficit related to evaporative losses fluid from burn wound
4. Altered nutritional status related to less than body requirements
5. Anxiety related to lack of knowledge about condition
6. Impaired skin integrity related to burn
Nursing management

45. Reconstructive surgery
• The word plastic comes from a Greek word meaning to formPlasticc or reconstructive
procedures are performed to recon-struct or alter congenital or acquired defects to
restore or improve the body’s form and function.
• Often the terms“plastic” and “reconstructive” are used interchangeably.
• This type of surgery includes closure of wounds, removal of skin tumors, repair of
soft tissue injuries or burns, correction of deformities, and repair of cosmetic defects

46. • Skin Grafts
• Skin grafting is a technique in which a section of skin is de-tached from
its own blood supply and transferred as free tissue to a distant
(recipient) site. Skin grafting can be used torepair almost any type of
wound and is the most common form of reconstructive surgery.
Reconstructive surgery

47. • Skin grafts are commonly used to repair surgical defect suchh as those
that result from excision of skin tumors, cover areas denuded of skin (eg,
burns), and to coverwounds in which insufficient skin is available to
permitwound closure.
• They are also used when primary closure ofthe wound increases the risk
of complications or when pri-mary wound closure would interfere with
function.
Reconstructive surgery

48. • Site Selection -The site where the intact skin is harvested is called the
• donor site. Selection of the donor site is made to match the color and
texture of skin at the surgical site and to leave aslittle scarring as
possible.
Reconstructive surgery

49. • Graft application
• The skin graft is taken from the donor or host site and ap-plied to the desired site,
called the recipient site or graft bed.
• For a graft to survive and be effective, certain conditions
• must be met:
• The recipient site must have an adequate blood sup-ply so that normal physiologic
function can resume
• The graft must be in close contact with its bed toavoid accumulation of blood or
fluid between the graftand the recipient site.
• The graft must be fixed firmly (immobilized) so that itremains in place on the
recipient site.
• The area must be free of infection.
Reconstructive surgery

50. Types of reconstructive
surgery
• most common plastic surgery procedures?
• Breast augmentation or enlargement (augmentation mammoplasty)
• Breast implant removals.
• Breast lift (mastopexy) with or without the placement of an implant.
• Buttock lift.
• Chin, cheek, or jaw reshaping (facial implants or soft tissue augmentation)
• Dermabrasion.

51. Cosmetic procedure
• Chemical Face Peeling
• Chemical face peeling involves application of a chemical mix-ture to the face for
superficial destruction of the epidermis andthe upper layers of the dermis to treat
fine wrinkles, keratoses,and pigment problems.
• It is especially useful for wrinkles at the upper and lower lip, forehead, and
periorbital areas.
• The typeof chemical used depends on the planned depth of the peel.
• The conscious patient feels a burning sensation that continuesfor 12 to 24 hours.
Frequent small doses of analgesics and tran-
• quilizers are prescribed to keep the patient comfortable.

52. • Dermabrasion
• Dermabrasion is a form of skin abrasion used to treat acne
• scarring, aging, and sun-damaged skin.
• A special instrument(ie, motor-driven wire brush, diamond-impregnated disk, or
• serrated wheel) is used.
• The epidermis and some superficialdermis are removed by a sanding-like action, and
enough ofthe dermis is preserved to allow re-epithelization of thetreated areas.
Results are best in the face because it is richin intradermal epithelial elements.
Cosmetic procedure

53. • Facial Reconstructive Surgery
• Reconstructive procedures on the face are individualized tothe patient’s
needs and desired outcomes.
• They are per-formed to repair deformities or restore normal function.
• They may vary from closure of small defects to complicatedprocedures
involving implantation of prosthetic devices toconceal a large defect or
reconstruct a lost part of the face(eg, nose, ear, jaw).
Cosmetic procedure