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Slide 1:

welcome

Slide 2:

PRESENTED BY: KIRAN RANDHAWA BURNS

DEFINITION:

DEFINITION Injuries that result from direct contact with or exposure to any thermal , chemical or radiation source are termed burns.

ETIOLOGY:

ETIOLOGY Thermal burns Chemical burns Electrical burns Radiation burns Inhalation injury

THERMAL BURNS:

THERMAL BURNS Caused by exposure to or contact with flame , hot liquid , steam or hot objects. Depth of injury is related to the Temperature Duration of exposure

CHEMICAL BURNS:

CHEMICAL BURNS Caused by tissue contact with strong acids, alkali or organic compound. Severity is determined by Concentration Volume Type of chemical Duration of contact

ELECTRICAL BURNS :

ELECTRICAL BURNS Caused by heat that is generated by electrical energy as it passes through the body. Extent of injury influenced by Duration of contact type of current intensity of current

RADIATION BURNS :

RADIATION BURNS Caused by exposure to radioactive source . Extent of injury depends upon Strength Distance Duration Surface area

INHALATION INJURY:

INHALATION INJURY Caused by exposure to asphyxiants & smoke . Commonly occur with flame injuries.

WHO ALL ARE AT RISK:

WHO ALL ARE AT RISK Most of burn occur at home. Second most frequent place is work place. Young children, older people & people with mental and physical limitation. Flame injury is leading cause of accidents in adults. Smoking combined with alcohol intake Toddlers more suffers from scalds

Slide 11:

PATHOPHYSIOLOGY

DIRECT INJURY TO SKIN:

DIRECT INJURY TO SKIN With direct injury , heat from an external source is conducted to skin Denatures the cells Damage depends upon Length of exposure to heat Temperature

DIRECT INJURY TO SKIN:

DIRECT INJURY TO SKIN ZONES AT SITE OF TISSUE INJURY Zone of coagulation Zone of stasis Zone of hyperemia

PULMONARY RESPONSE:

PULMONARY RESPONSE Upper airway injury from direct heat and trauma. Results in erythema , edema & ulceration. Mechanical obstruction of the airway.

PULMONARY RESPONSE:

PULMONARY RESPONSE Lower airway injury results from inhalation of products of incomplete combustion and noxious gases. + Chemical irritation at alveolar level Loss of ciliary action, mucosal edema, reduced pulmonary surfactants

CONTD…:

CONTD… atelectasis

Upper airway injury from direct heat and trauma. Results in erythema , edema & ulceration. . CONTD…:

Upper airway injury from direct heat and trauma. Results in erythema , edema & ulceration. . CONTD… CO combine with Hb carboxyhemoglobin 0 2 deficiency in blood hypoxia

CONTD…:

CONTD… Pulmonary complication Respiratory acidosis ARDS Acute respiratory failure

FLUID SHIFT:

FLUID SHIFT Burn injury to tissue Release of vasoactive substances Change in capillary permeability Fluid shifts in interstitial space

CONTD…:

CONTD… Depletes intravascular fluid volume hypovolemia

URINARY RESPONSE:

URINARY RESPONSE Hypovolemia + destruction of RBC & muscle damage Free Hb and myoglobin occlude the renal tubule

CONTD…:

CONTD… Decrease GFR Renal failure

GI RESPONSE:

GI RESPONSE Low blood flow to gastric mucosa Ischemia to upper GI Slow production of mucosal lining Superficial erosion

CONTD…:

CONTD… Curling’s ulcers Coffee ground colored vomitus

BODY TEMPERATURE:

BODY TEMPERATURE Loss of skin Inability to regulate body temperature Low body temperature

IMMUNOSUPPRESSION:

IMMUNOSUPPRESSION First line of defence is destroyed Serious burn injury diminishes resistance to infection Altered level of immunoglobulins Impaired neutrophil function Reduction in T – helper lymphocyte Patient at high risk of infection

Slide 29:

CLINICAL MANIFESTATIONS

PULMONARY RESPONSE:

PULMONARY RESPONSE Impaired clearance of secretion Hypoxia Change in voice Bloody sputum Laboured breathing Tachypnea Bronchoconstriction

CARDIOVASCULAR RESPONSE:

CARDIOVASCULAR RESPONSE Decreased BP Decreased urine output Weak peripheral pulse Suppressed myocardial activity

PAIN RESPONSE :

PAIN RESPONSE CLIENT HAVE TWO TYPES OF PAIN BACKGROUND PAIN Continuous in nature Low in intensity Lasting for duration of clinical course PROCEDURAL PAIN Acute & high in intensity

EDEMA:

EDEMA Shift of fluid results in blister formation and edema Edema is maximal after 24 hrs

Slide 37:

MANAGEMENT

EMERGENT PHASE:

EMERGENT PHASE Consists of time between the initial injury and 36 to 48hrs after injury Ends when fluid resuscitation is complete Remember : A- airway B-breathing C-circulation

ASSESSMENT:

ASSESSMENT Burn depth Burn severity Burn size

CLASSIFICATION OF BURN INJURIES:

CLASSIFICATION OF BURN INJURIES MAJOR BURN INJURY Partial Thickness Burns >25% TBSA Full thickness burns>10% Any burn involving the eyes, ears ,face, hands ,feet,perineum Electrical injury Burn complicated with other injury Client has cardiac,pulmonary disorder

CONTD…:

CONTD… MODERATE BURN INJURY Deep Partial Thickness Burns 15%-25% TBSA Full thickness burns 2%-10%TBSA. Patient is under 60 & has no chronic cardiac disorder

CONTD…:

CONTD… MINOR BURN INJURY Deep Partial Thickness Burns< 15% TBSA Full thickness burns< 2% TBSA

DIAGNOSTIC FINDING:

DIAGNOSTIC FINDING LAB FINDING SHOWS: Elevated Hb Elevated hematocrit Elevated urea nitrogen Elevated blood glucose Elevated serum creatinine Decreased sodium Elevated potassium

CONTD…:

CONTD… ARTERIAL BLOOD GAS STUDY SHOWS Decreased PaO 2 Increased PaCO 2 Decreased PH Increased carboxyhemoglobin

CONTD…:

CONTD… Bronchoscopy Ventilation perfusion scan PFT Ophthalmic examination Ultrasonography X – ray ECG

MONITOR RESPIRATORY STATUS:

MONITOR RESPIRATORY STATUS For mild pulmonary injury, inspired air is humidified and patient is encouraged to cough For sever situation , remove secretion by bronchial suctioning and administer bronchodilater and mucolytic agents If edema of airway develops , intubate ET tube

CONTD…:

CONTD… Administer 100% oxygen in case of CO poisoning Provide ventilatory if needed

FLUID REPLACEMENT:

FLUID REPLACEMENT GOALS Output have been 30 to 50 ml / hr Systolic BP exceeds 100mmHg Pulse rate less than 110/ min

CONTD…:

CONTD… If TBSA > 15% , IV fluid resuscitation is necessary Use to minimize deleterious effects of hypovolemia Formula for fluid replacement : Parkland/ baxter formula- RL solution= 4ml * body wt. * % TBSA

CONTD…:

CONTD… Half to be in first 8 hrs Half to be given in next 16 hrs Then colloid is added

PREVENT ASPIRATION:

PREVENT ASPIRATION If TBSA more than 25% or patient is nauseated, a NG tube should be inserted to prevent emesis and reduce the risk of aspiration All oral fluid should be restricted

MINIMIZE PAIN:

MINIMIZE PAIN For moderate or major burn, administer IV opioids & non opioids, typically morphine sulphate, meperidine Anesthetic agents such as ketamine, pentobarbital sodium& nitrous oxide PCA can be used

Slide 54:

NURSING CARE

GENERAL MANAGEMENT:

GENERAL MANAGEMENT Asses for airway patency Administer oxygen as needed Cover the patient with a blanket Keep the client on NPO status Elevate the extremities if no fracture is obvious Initiate a IV line and begin fluid replacement

CONTD…:

CONTD… Administer tetanus toxoid Perform head to toe assesment

SPECIFIC MANAGEMENT:

SPECIFIC MANAGEMENT FLAME BURN smother the flames Remove the smoldering clothing and all metal objects

CONTD…:

CONTD… CHEMICAL BURN Brush of chemical remove the clients clothing Ascertain the type of chemical Do not attempt to neutralize the chemical unless chemical has been positively identified and use appropriate neutralizing agent

CONTD…:

CONTD… ELECTRICAL BURN Separate the clients from the electrical current Smother any flame Initiate cardiopulmonary resuscitation Obtain ECG

CONTD…:

CONTD… RADIATION BURN Remove the client from the radiation source If the client has radioactive particle on his skin send client to the nearest radiation decontamination center

SUMMARISATION:

SUMMARISATION Definition Etiology Thermal burn Chemical burn Electrical burn Radiation burn Inhalation injury

CONTD…:

CONTD… Risk factors Pathophysiology Clinical manifestations Assessment Diagnostic finding Medical management in emergent phase Nursing management

BIBLIOGRAPHY:

BIBLIOGRAPHY Black J. M. & hawks J. H., “Medical – Surgical nursing,”Vol- 2 , 7 th ed, Elsevier, Pg –1420-1440. Brunner & Suddarth, “Textbook of medical surgical nursing ,”10 th , Lippincott williams & wilkins, Pg-1704-1720

CONTD…:

CONTD… Lippincott, “Manual of nursing practice,” 8 th ed, Lippincott williams & wilkins, Pg 1121-1132 Ignatavicius D .Donna, Medical- Surgical nursing across the health care continum , Vol- 2, 3 rd ed, W. B. Sauders company , Pg-1750- 1760

CONTD…:

CONTD… Lewis S. M. &Dirksen S. R. , “Medical -Surgical Nursing,” 6 th ed , Mosby, Pg-515- 540 WWW. GOOGLE. COM

Slide 66:

THANK YOU

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