The Integumentary System: 1st and 2nd Degree Burns

In this part of our integumentary system discussion, we’ll be paying particular attention to 1st and 2nd-degree burns – what they are, how they happen, how they appear, and the different nursing interventions for each degree.

Before, the staging of the degree of burns is stage one, stage two, and stage three. Today, there are updates in the nursing field regarding the new way to classify the degree of burn, namely:

  • Superficial
  • Superficial partial thickness
  • Deep partial thickness
  • Full thickness
  • Deep full thickness

Even so, there are still a lot of hospitals, veteran doctors, and nurses who are more comfortable in using the old method of staging. However, this will still depend on your school, instructor, and the institution where you’ll do your clinical rotation; some might opt for using the conventional method of staging burns, while some will go for the updated version. Right now, we’ll be focusing on the staging.

Stage 1: Superficial Burn

Stage 1 is classified as a superficial burn or like a sunburn; this means that the affected area is just the epidermis. As a quick recap of your skin’s physiology, there are three primary layers – epidermis, dermis, and subcutaneous (fatty portion). Staying out in the sun and getting exposed for too long due to outdoor activities such as playing sports or you just want a nice tan, you’re bound to get a sunburn.

Since the burn is just superficial, it will present the following:

  1. Pinkish skin
  2. Very painful

Nursing care for 1st-degree burn would be:

  1. Apply aloe vera to soothe the burnt area and promote faster healing
  2. Stay out of the sun
  3. Increase fluid intake
  4. Avoid harsh lotions that can further irritate the skin
  5. Application of skin products should be at a minimum

Stage 2:  Superficial Partial and Deep Partial Thickness

Going deeper into the dermis is stage 2 degree burn. So, there are two types of stage 2 degree burn – superficial partial thickness and deep partial thickness.

Superficial Partial Thickness

Since the burn has now reached way past the epidermis, it will present the following:

  1. Blisters
  2. Hot to touch
  3. Edema
  4. Pain

Going back to its pathophysiology, stage 2 degree burns present as such because once you get burned, your epithelial cells will get affected resulting to triggering the mast cells that are connected to the blood vessels. This reaction will lead to a massive flow of blood to the burned area so that the white blood cells and nutrients can do their job; thus the presence of edema. The blisters are due to the fluid shifting into the superficial epithelial cells.

The appearance of a deep partial thickness burn would be a red and white skin. Healing time would be less than two weeks; sometimes, it’s a lot quicker, depending on the client’s age, nutritional and hydration status, and medical history. A young, healthy person is expected to heal up a lot faster than an elderly who is taking a series of medications like Solu-Medrol, and with multiple diagnoses that compromises the immune system.

Deep Partial Thickness

In this type of stage 2 degree burn, the damage has now affected the entire epidermis and has reached deep into the dermis. By the way, “epi” means surface. So, whenever you hear deep partial thickness burn, it’s deep but only around the dermis and has not gotten all the way into the subcutaneous.

The appearance of a deep partial thickness burn would be a red and white skin. The manifestations would be quite similar to superficial partial thickness but the appearance is different, and the pain is much more severe.

What causes deep partial thickness burn?

  1. Exposure to flames
  2. Scalding surfaces or water
  3. Grease or tar
  4. Chemicals
  5. Hot oils

Healing time for deep partial thickness burns would be around 14 to 36 days; also depending on the client.

That’s it for 1st and 2nd-degree burns. Let’s go to 3rd-degree burn which is the full thickness and deep thickness burns in our next article.

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