Introduction to Burns Nursing Care
Burns come in all shapes, sizes, and levels of pain. The severity of the burn often depends on how deep the burn goes. If it only affects the top layers of skin (first degree), it is less intense than if it damages the tissue deeper (second or third degree).
Assessment of burns is the first step in the nursing process. Inspection of the burn can determine the severity of the damage. In first-degree burns the tissue is pink, second-degree burns are red (sometimes with blisters), and third-degree burns look black or charred.
The size and severity of the burn damage can be determined by using the rule of nines. This assessment tool guides nurses to estimate the area of a burn, which can help them determine the plan of care.
The rule of nines is based on the idea that humans have nine areas of equal size, which you can use to estimate the percentage of body surface area burned by any given burn injury. It tells us how much of the body’s total body surface area (TBSA). This helps us calculate wound size by weighing each client’s TBSA (depending on age).
Pathophysiology of Burns
Burns are tissue damage that results from heat, overexposure to the sun, radiation, chemical or electrical contact, and even extreme cold can cause frostbite burns.
The skin is made of three layers: epidermis, dermis, and subcutaneous tissue (that fatty bubble-looking tissue). A burn causes damage to the cells in the epidermis (outer layer of skin) and dermis (inner layer of skin). If a burn is severe enough, it can damage all layers of the skin, including subcutaneous tissue (the fat layer) and underlying muscle or bone.
The depth of the burn is assessed by the amount of layers affected. A full-thickness burn has damaged all layers of skin (epidermis, dermis, subcutaneous tissue, and muscles). An incomplete-depth burn affects only part of these layers.
Superficial burns affect only the epidermis and superficial areas of the dermis, while partial-thickness burns affect only deeper regions such as the deep dermis or muscle.
In general, most burns heal with no complications. However; multiple conditions can occur as the result of a burn such as, infection, sepsis, fluid volume deficit, shock, acute renal failure and pulmonary complications due to inhalation.
Types and Causes of Burns
Burns can be classified in different ways: first, second, and third-degree burns.
Burn injuries are caused by direct tissue damage from exposure to:
- Thermal (boiling liquids)
First-degree burns are the most common, and appear dry with blanchable redness. They are superficial (only affecting the outer layer of your skin), and are caused by heat or the cold.
Second-degree burns are more serious because they affect the outer and inner layers of the skin. They can be caused by heat or chemicals, and result in painful blisters or red, moist, shiny fluid-filled vesicles.
Third-degree burns are the most serious because they penetrate all layers of the skin, exposing the muscle tissue to the air. They result in dry, waxy white, leathery, non-blanchable, and/or charred black color skin.
A minor burn occurs when the skin is exposed to heat or steam. When a minor burn occurs, immediately immerse the burn in cool tap water or apply cold, wet compresses. This should be done for about 10 minutes or until the pain subsides.
When treating minor burns, make sure not to apply creams or ointments – they could make things worse. After cooling down the area for fifteen to twenty minutes, cover it loosely with sterile gauze and bandage it up securely to protect the burn from the air.
Memory trick: Care for Minor Burns
- Cool water
- Cover the area
- Clothing removal
Major burns can be described as massive tissue damage and cellular destruction, leading to widespread systemic inflammation. This increases vascular permeability (leaky blood vessels that fill up the body like a water balloon), and results in low fluid volume within the blood vessels.
Without urgent and appropriate nursing interventions, this could lead to Hypovolemic Shock (or even death).
Signs and Symptoms (in the first 24 hours)
- High Potassium (Hyperkalemia) Over 5.0
- High potassium = high pumps
- Potassium priority pumps heart
- Tall, Peaked T Waves on ECG
- Low Sodium (hyponatremia) – Below 135
- Elevated H/H
- Hemoglobin: 12 – 18 = normal
- Hematocrit: 36 – 54% = normal]
- Provide IV Lactated Ringer’s (LR) solution
- IV Normal Saline (0.9% sodium Chloride)
- Administer enteral feedings once bowel sounds return
- Assess fluid resuscitation:
- Urine output – 30 mL/hr or more
- Blood pressure (90/systolic or more)
- Heart rate less than 120/min
to take the
Rule of Nines Burns
The Rule of nines is used to quickly estimate the percentage of the body affected by a burn, called total body surface area (TBSA). It’s also used to calculate the necessary fluid resuscitation needed.
If you imagine the body as nine sections (head, trunk, arms, legs), then each section represents 10% of the body surface area (BSA).
So if a client has a two-inch diameter burn on their forearm, that’s 20% BSA. This means it’s probably considered a second-degree burn since it’s greater than 10%, but less than 30%.
Once the total body surface area is calculated, then the volume needed for emergency fluid resuscitation within the first twenty-four hours can be calculated using the Parkland Formula.
The Parkland Formula is an equation that helps nurses determine the amount of fluid to administer to burn victims. It’s named after Parkland Hospital in Dallas, Texas, where a team of nurses in the 1960s invented it.
4 mL x kg of body weight x TBSA %
To use this formula, you need to know what percentage of the body is burned. If someone has burns on both hands and legs (but not on their torso or head), then you would use 100% for their TBSA. If they had burns on their arms and legs but not their torso or head, then you would use 66% for their TBSA.
During my exam, I could literally see and hear him going over different areas as I was answering my questions.
This past Friday I retook my Maternity Hesi and this time, I decided for my last week of Holiday break to just watch all of his OB videos. I am proud to say that with Mike’s help I received a score of 928 on my Maternity Hesi!
Burns in Nursing Conclusion
Burns are a type of skin damage that are classified into first, second, and third degrees. They can be brought on by heat sources like fire, steam, electricity, radiation, chemicals, and extremely cold temperatures (such as frostbite).
The epidermis, dermis, and subcutaneous tissue are the three layers that make up the skin (that fatty bubble-looking tissue). The cells in the dermis and epidermis (the skin’s outer layer) are harmed by a burn (inner layer of skin). All layers of skin, including subcutaneous tissue (the fat layer) and underlying muscle or bone, can be harmed by a burn if it is severe enough.
Total body surface area, or the Rule of Nines, is used to quickly calculate the percentage of the body that has been burned (TBSA). It is also used to determine how much fluid resuscitation is required.