Arianne Bernardo

BSN-3B1

BURNS

A burn is a type of injury to the skin caused

by heat, electricity, chemicals, light, radiation or friction. Most burns only affect the skin
(epidermal tissue and dermis). Rarely deeper tissues, such as muscle, bone, and blood
vessels can also be injured. Managing burns is important because they are common,
painful and can result in disfiguring and disabling scarring. Burns can be complicated
by shock, infection, multiple organ dysfunction syndrome, electrolyte
imbalance and respiratory distress. Large burns can be fatal, but modern treatments,
developed in the last 60 years, have significantly improved the prognosis of such burns,
especially in children and young adults

Classification of Burns:

By degree

 First-degree burns are usually limited to redness (erythema), a white plaque

and minor pain at the site of injury. These burns involve only the epidermis.
Most sunburns can be included as first-degree burns.
 Second-degree burns manifest as erythema with superficial blistering of the
skin, and can involve more or less pain depending on the level of nerve involvement.
Second-degree burns involve the superficial (papillary) dermis and may also involve
the deep (reticular) dermis layer. Deep dermal burns usually take more than three
weeks to heal and should be seen by a surgeon familiar with burn care, because in
some people very bad hypertrophic scarring can result. Burns that require more than
three weeks to heal are often excised and skin grafted for best result.
 Third-degree burns occur when the epidermis is lost with damage to
the subcutaneous tissue. Burn victims will exhibit charring and extreme damage of
 the epidermis, and sometimes hard eschar will be present. Third-degree burns result
in scarring and victims will also exhibit the loss of hair shafts and keratin. These
burns may require grafting. These burns are not painful, as all the nerves have been
damaged by the burn and are not sending pain signals; however, all third-degree
burns are surrounded by first and second-degree burns.


Other classifications

A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided

into superficial and deep categories) and "Full Thickness" relates more precisely to the
epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and
predict outcome.

A description of the traditional and current classifications of burns.

Traditional
Nomenclature Depth Clinical findings Example
nomenclature

Erythema,
Superficial
first degree Epidermis involvement significant pain,
thickness
lack of blisters

Partial
Superficial Blisters, clear
thickness – second degree
(papillary) dermis fluid, and pain
superficial

Partial third degree Deep (reticular) dermis Whiter

thickness – appearance or
deep fixed red staining
(no blanching),
 reduced
sensation

Epidermis, Dermis, and Charred or

complete destruction to leathery,
Full thickness fourth degree* subcutaneous fat, eschar thrombosed
formation and minimal blood vessels,
pain, requires skin grafts insensate

* It should however be noted that although fourth-degree is not a technical term, it is

often used to describe burns that reach muscle and bone. Third-degree sufficiently
describes all burns of this nature.

An even simpler, more accurate and more descriptive classification is epidermal, dermal
and full thickness. Dermal injuries are subdivided into superficial, mid and deep.

It is most common for high percentage burns to only be classified as Superficial, Partial
thickness and Full Thickness. The reasoning behind this is that in an emergency setting
such as a burn trauma room or ambulance it is more important to protect the patient
from dehydration, hypothermia and infection rather than calculating the exact depth of a
burn.

Signs and Symptoms:

The symptoms of burns could be summed up in two parts. Minor and severe burns.
Minor burns are painful and cause reddening and blistering of the skin while severe
burns are painless causes white or charred area.

First-degree burns are mild and injure only the outer layer of skin. The skin becomes
red, but will turn white when touched. The area may also be painful to the touch.

Second-degree burns are deeper, more severe, and very painful. Blisters may form on
the burned area. This type of burn takes about 2 weeks to heal.
Third-degree burns are the deepest and most serious kind. The skin becomes white
and leathery, but it does not feel very tender when touched.

Burns with a "sock" or "glove-like" appearance on hands or feet and "doughnut" shaped
burns on the buttocks. These types of burns are usually caused by either dipping or
forcing the child to sit in scalding liquid.

Burns which leave a pattern outlining the object which was used to make the burn such
as an iron, electric burner, heater or fireplace tool;
Burns caused by rope friction, usually found on legs, arms, neck or torso as the result of
having been tied up.

Nursing Diagnosis

Actual

- Disturbed body image related to traumatic event

- Impaired Skin integrity related to burns

Risk

Diagnostic Procedure
When diagnosing a burn, a doctor evaluates the depth and extent of the damage, the
degree of pain, the amount of swelling, and signs of infection. Doctors classify the burn
based on the depth and extent of the injury. Burns that cover a significant portion of the
body, burns associated with smoke inhalation, burns from electrical injuries, and burns
associated with suspected physical abuse require immediate emergency medical
attention. In the emergency room, all wounds are wrapped with sterile cloths. Patients
may receive oxygen (either through a mask or tube) and fluids. Patients are also
evaluated for associated injuries (such as from physical abuse). Doctors may also
conduct tests to determine whether the wound is infected.