Burns

There are three levels of burns:

First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling. Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.

Causes
Burns can be caused by dry heat (example is fire), wet heat (such as steam or hot liquids), radiation, friction, heated objects, the sun, electricity, or chemicals. Thermal burns are the most common type. Thermal burns occur when hot metals, scalding liquids, steam, or flames come in contact with your skin. These are frequently the result of fires, automobile accidents, playing with matches, improperly stored gasoline, space heaters, and electrical malfunctions. Other causes include unsafe handling of firecrackers and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns to your airways can be caused by inhaling smoke, steam, superheated air, or toxic fumes, often in a poorly ventilated space. Burns in children are sometimes traced to parental abuse.

Symptoms include:

Blisters Pain (the degree of pain is not related to the severity of the burn -- the most serious burns can be painless) Peeling skin Red skin Shock (watch out for pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness) Swelling White or charred skin

Symptoms of an airways burn:

Charred mouth; burned lips Burns on the head, face, or neck Wheezing Change in voice Difficulty breathing; coughing Singed nose hairs or eyebrows Dark, carbon-stained mucus

First Aid
FOR MINOR BURNS
1. If the skin is unbroken, run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area submerged for at least 5 minutes. A clean, cold, wet towel will also help reduce pain. 2. Calm and reassure the person. 3. After flushing or soaking, cover the burn with a dry, sterile bandage or clean dressing. 4. Protect the burn from pressure and friction. 5. Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling. Do NOT give children under 12 years of age aspirin. Once the skin has cooled, moisturizing lotion also can help. 6. Minor burns will usually heal without further treatment. However, if a second-degree burn covers an area more than 2 to 3 inches in diameter, or if it is located on the hands, feet, face, groin, buttocks, or a major joint, treat the burn as a major burn. 7. Make sure the person is up to date on tetanus immunization.

FOR MAJOR BURNS

1. If someone is on fire, tell the person to stop, drop, and roll. Wrap the person in thick material to smother the flames (such as wool or cotton coat, rug, or blanket). Douse the person with water. 2. Call 911. 3. Make sure that the person is no longer in contact with smoldering materials. However, Do NOT remove burned clothing that is stuck to the skin. 4. Make sure the person is breathing. If breathing has stopped, or if the person's airways are blocked, open the airways. If necessary, begin rescue breathing and CPR. 5. Cover the burn area with a dry sterile bandage (if available) or clean cloth. A sheet will do if the burned area is large. Do NOT apply any ointments. Avoid breaking burn blisters. 6. If fingers or toes have been burned, separate them with dry, sterile, non-adhesive dressings. 7. Elevate the body part that is burned above the level of the heart. Protect the burn area from pressure and friction. 8. Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches, and cover the person with a coat or blanket. However, do NOT place the person in this shock position if a head, neck, back, or leg injury is suspected or if it makes the person uncomfortable. 9. Continue to monitor the person's vital signs until medical help arrives. This means pulse, rate of breathing, and blood pressure.

DO NOT:

Do NOT apply ointment, butter, ice, medications, cream, oil spray, or any household remedy to a severe burn. Do NOT breathe, blow, or cough on the burn. Do NOT disturb blistered or dead skin. Do NOT remove clothing that is stuck to the skin. Do NOT give the person anything by mouth, if there is a severe burn. Do NOT immerse a severe burn in cold water. This can cause shock. Do NOT place a pillow under the person's head if there is an airways burn. This can close the airways.

When to Contact a Medical Professional

Call 911 if:

The burn is extensive (the size of your palm or larger). The burn is severe (third degree). You aren't sure how serious it is. The burn is caused by chemicals or electricity. The person shows signs of shock. The person inhaled smoke. Physical abuse is the known or suspected cause of the burn. There are other symptoms associated with the burns Call a doctor if your pain is still present after 48 hours. Call immediately if signs of infection develop. These signs include increased pain, redness, swelling, drainage or pus from the burn, swollen lymph nodes, red streaks spreading from the burn, or fever. Also call immediately if there are signs of dehydration: thirst, dry skin, dizziness, lightheadedness, or decreased urination. Children, elderly, and anyone with a weakened immune system should be seen right away.

Considerations:
Before giving first aid, evaluate how extensively burned the person is and try to determine the depth of the most serious part of the burn. Then treat the entire burn accordingly. If in doubt, treat it as a severe burn. By giving immediate first aid before professional medical help arrives, you can help lessen the severity of the burn. Prompt medical attention to serious burns can help prevent scarring, disability, and deformity. Burns on the face, hands, feet, and genitals can be particularly serious. Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns. In case of a fire, you and the others there are at risk for carbon monoxide poisoning. Anyone with symptoms of headache, numbness, weakness, or chest pain should be tested.

Prevention
Tips on how to prevent burns:

Install smoke alarms in your home. Check and change batteries regularly. Teach children about fire safety and the hazards of matches and fireworks. Keep children from climbing on top of a stove or grabbing hot items like irons and oven doors. Turn pot handles toward the back of the stove so that children can't grab them and they can't be accidentally knocked over. Place fire extinguishers in key locations at home, work, and school. Remove electrical cords from floors and keep them out of reach. Know about and practice fire escape routes at home, work, and school. Set temperature of water heater at 120 degrees or less.

Learning Feedback Diary

General Objectives: To be able to acquire new learning To familiarize myself to a new hospital set- up To familiarize myself with the different ward staffs Specific Objectives: To build rapport with my patient/s and SO To provide a complete bedside care to my patient/s To apply the knowledge and skills learned in real life situation To appreciate the importance of hospital duty experience in providing better care for the patients

LEARNINGS For our 2 day exposure at Surgery Ward, I was able to improve my nursing skills. I was able to do complete bedside care to my patients. Also being assigned as the team leader, I was in charge that my group mates are doing their assigned task efficiently. Also being a team leader, I learned that being a nurse in the future, one must help her co- worker in finishing her task for them to endorse their patients properly for the next shift. In some instances, being a team leader, one must not confine herself from doing only those assigned tasks to her, but also ensuring the safety of the patients even those in other wards. I also learned that medication cards vary from one ward to another. This exposure also served as a review of the things I have learned from the past. We were also corrected by some of our mistakes during the shift. Mistakes in the sense that, there were some inconsistencies about the skills they thought to us during our skills lab. days.

FASCILITATING FACTORS One facilitating factor in my part is that, being the team leader for one day, I was able to converse with my clinical instructor well. One more thing is that, my group mates and I are in very good terms that is why we have unity among our group. So, when one of us is unsure about what he/ she is doing; we can ask over our team mates without any hesitations. Also, our clinical instructor is so approachable. During our entire shift, I did not hear her scold even one of us. Another is that, most of the staffs during our shift are nice and approachable. Also, most of the patient/s and their SOs are so good to us, and in my part, I can talk to them without difficulty using the dialect we both know.

HINDERING FACTORS I think that one hindering factor in my part is the time we have to report when we have our AM duty. Waking up very early in the morning is so difficult to do, thus when we are on the area, I feel sleepy. Also some of the patients in which I was able to handle are speaking Itawes and only knows little Tagalog and Ilocano, so I find difficulty when talking to them and to their SO. Since we were exposed in a ward, particularly the Trauma Ward, the smell of the room is not that good. I even visited the Burn Room to get the vital signs of a client there, and like the smell in the trauma ward, it is also smelly. Smelly in the sense that, these patients are having injuries and having blood loss like those who are have met vehicular accidents.

Report On BURNS
Submitted to:
Mrs. JaninaCruz- Abad Clinical Instructor

Submitted by:
Genevieve Kryzlei N. Alviar BSN- III Set- 2 Group- F