burns in children clinical presentation

3. BURNS IN
CHILDREN
PRESENTED BY:
Aswani.B
Final year Msc nursing.
Kongunadu college of nursing

4. Child profile
Name of child :Master. Yaswanth
Age : 2 years 11 months
Developmental age : Toddler.
Ward :III floor.
Room no :308
Diagnosis :Burn injury (30%)
Medical history : Burns over both
lower extremities
and external
genitalia.

5. Chief complaints:
 child had complaints of burns over
both lower extremities and external
genitalia.
Temperature 100°C.
Severe pain over burdened area.
Immunization history:
Child was receive all immunization of
his age.

6. On physical examination:
• child have 30% burns over lower
extremities and external genitalia
• Dry skin.
• coated tongue.
• Tiredness is present.
• Persistent crying during examination.
• Bowel and bladder pattern is normal.

7. Growth and development:
• weight : 12.5 kg
• Height : 86 cm
• Head circumference : 50 cm
• Chest circumference : 52 cm
• Temperature : 100° C
• Pulse : 112 beats/min
• Respiration : 24 breaths/ min
• Blood pressure : 90/60 mm/hg

8. cont..
• psycho social development :sense of
Autonomy Vs same and Doubt
• psychosexual development:
Anal stage
• Cognitive development: pre-
operational stage
• Spiritual development : initiative Vs
projective faith
• Moral development :pre conventional
morality.

9. INTRODUCTION
Burns are the common and serious
childhood injury causing prolonged
effects on growing child with various
complication and fetal prognosis.
Burns may result from exposure
to cold, chemicals, electricity or
radiation.

10. INCIDENCE
30% of burn injury occurring in
children less than 10 years of
age.
Burns are second leading cause of
injuries in age group between 1
and 4 years.
80% of burns injuries
occurs at home.

11. DEFINITION
A Burn is an injury to the skin or
other organic tissue primary caused
by heat or due to radiation,
radioactivity, electricity, friction or
conducts with chemicals.
(WHO)

12. Classification of burns
According
to type of
burns
• Scalds
• Electric burns
• Open flame
• Chemical burns
According to
severity of
burns
• Major burn injury
• Moderate burn injury
• Minor injury.
According
to degree
of the
burn
• Superficial (first degree)
• Partial thickness (second degree)
• Full thickness (third degree)
• Fourth degree burns.

13. TYPE OF BURNS
Scalds are
caused by hot
liquids or steam.
Electric burns
are caused by
electric outlet,
wires, electric
extension.
Open flame
burns are caused
by open flames.

14. TYPE OF BURNS
Chemical burns caused by handling
of household cleansing chemicals.

15. DEGREE OF BURNS
First Degree (Superficial)
Involves only epidermis
Minimal tissue damage.
Red
Painful
Tender
Blanches under pressure
Possible swelling, no blisters
Heal in ~7 days

16. Second Degree (Partial
Thickness)
Extends through epidermis into dermis
Salmon pink
Moist, shiny
Painful
Blisters may be present
Heal in ~7 to 21 days

17. Third Degree (Full Thickness)
Through epidermis, dermis into underlying
structures
Thick, dry
Pearly gray or charred black
May bleed from vessel damage
Painless
Require grafting
Nerve endings, hair follicles
and sweat glands are destroyed.

18. Fourth degree burns
Involve underlying muscles fascia and
bones.
Wound dull and dry.
Ligaments , tendons and bone may
exposed.

19. SEVEARITY OF BURNS
MINOR BURN
INJURY
MODERATE AND
MAJOR BURN
INJURY

20. PATHOPHYSIOLOGY
Change in hemodynamic, autonomic nervous
system, cardiopulmonary and renal
disturbances
Water and electrolyte imbalance
Shift of fluid from vascular to interstitial
compartment.
Decreased glomerular filtration and
increased anti diuretic hormone

21. oliguria
Edema
Decreased cardiac output
Decreased venous return
Increase myocardial contraction.

22. Minor burns
strap burning process
Apply cold water
don’t disturb blister
Don’t apply anything to
wound. Over with clean
cloth
Major burns
Strap burning process
Place horizontal position
Role the victim
Mouth to mouth
resuscitation
Cover with clean cloth
transport.

23. BODY SURFACE AREA
ESTIMATION
RULE OF
HAND
RULE OF
FIVE
RULE OF
NINE
LUND
AND
BROWDER
CHART

24. RULE OF HAND
One hand surface ‘’child’s own
hand’’ with closed fingers amounts to
1% of body's surface area of burns.

25. RULE OF FIVE
(Lynch & blocker)
AREA 0-5 YEARS 5-10 YEARS ABOVE 10 YEARS
HEAD & NECK 20% 15% 15%
TRUNK-front 20% 20% 20%
TRUNK- back 20% 20% 20%
Upper limbs 10× 2= 20% 10× 2= 20% 10× 2= 20%
Lower limbs 10× 2= 20% 15× 2= 30% 15× 2= 30%
100% 100% 100%

26. RULE OF NINE

29. Symptoms of shock
Pallor, poor muscle tone
Subnormal temperature
Low blood pressure
Cyanosis, Rapid pulse
prostration

30. INHALATION INJURIES
Inflammation of glottis, vocal cords
and upper trachea
Dyspnea
Stridor
Chest retractions
Nasal flaring
Cough
Drooling
Restlessness
Pulmonary edema

31. SMOKE INHALATION
Mild bronchial construction.
Within 48 hours, may develop
bronchial obstruction, severe airway
obstruction, pulmonary edema.

32. TOXEMIA
Develops after burns within 1- 2 days
It is manifested with fever
Vomiting
Edema
Decreased urinary output
Prostration
Rapid pulse
Glycosuria.
Unconsciousness.

33. MANAGEMENT
Minor burns
Managed at home it self
Maintenance of aseptic
technique
Specific home care
instructions

34. Moderate burns
Shift to district
hospital

35. Major burns
First aid measures
Transfer to specialized
unit/ burn care

36. MANAGEMENT
First aid measures
Assessment of child
Fluid replacement
Additional measures
Nutritional support
Wound management
Rehabilitation

38. First aid measures
Remove from heat source
Lie flat on ground and roll
Extinguishing fire.
Keep air way patent.
Not apply cotton and house hold
articles.

39. Cont…
Avoid pouring of water over burn
area.
Oral fluid/ ORS.
Wrap in clean cloth
Remove oro-pharangeal secretions.
Do not disturb blisters.

40. Cont…
Keep airway patent.
Turn child to one side.
Mouth to mouth breathing.
Transfer to hospital

41. ASSESSMENT
ABC.
Level of consciousness.
Vital signs.
Cause, duration, time of burn injury.
Life saving aids
Extent and depth of burn
injury.

42. Fluid replacement
Total
surface
area
burn
Body
weight
of the
child
TOTAL FLUID
REPLACEMENT

43. Park land formula
For next 16 hours
Remaining half of the fluid
For first 8 hours
One half of calculated fluid from time of injury
In first 24 hours
4 ml of RL× weight in kg ×% of TBSA

44. Cont…
Next 24 hours
2 ml of ringer lactate / kg /% of
burns.

45. For Master Yashwanth..
4ml RL × % of burns × body weight
4 × 30 × 12
1440 ml over 24.
750 ml of RL in 8 hours.
750 ml of RL in 16 hours.
Maintaince = ½ DNS 45ml/ hour
Target output is 1ml /kg/hr

46. Additional measures
Airway management
Oxygen therapy, ventilatory support
or tracheotomy
Tetanus prophylaxis.
Sedation and analgesics.
IM injections should be avoided.
Systemic antibiotics depends on
cultural report
urinary catheter if needed.

47. Nutritional support
Adequate nutrition for healing
initially kept child in NPO.
Start oral fluid if bowel sound heard.
Protein rich diet.

48. Davies formula
PROTEIN REQUIREMENT
• 3 gram of protein /kg
body weight+ 1 gram / %
of TBSA burned

49. Davies formula cont..
CALORIE REQUIREMENT
• 60 kcal / kg body
weight+ 35 kcal / % of
TBSA burned

50. Davies formula cont..
others
• Potassium and
vitamin supplements

51. Wound management
Starts after assessment &
resuscitation
Wound debriment
Sedation & analgesics.
Temp: > 28-30° c
Remove tights cloths & ornaments
Clean wound with saline or savlon

52. Cont..
Remove loose & dead tissue.
Open / close method depends on
nature of wound
Cover wound with antibacterial
cream/ ointment/ saline Vaseline
gauze.
Hydrotherapy; 32°c/ 90° f
Antibiotics.

53. Cont..
Application of tropical agents.
Such as..
silver sulfadiazine
silver nitrate
mefinidine acetate cream.
Isotonic saline for cleaning of wound.
Eshcarotomy:
Non viable tissue (eshcar) can removed
through mechanical or surgical
debridement.

54. MANAGEMENT
Electic burns
Faciotomy
Surgical wound debridement
Reconstructive surgery
amputation
Chemical burns
Initial washing of burnt
area with water and
buffer solution

55. GRAPHTING.
XENOGRAPHT
AUTOGRAPHTALLOGRAPHT

56. REHABILITATION
PHYSICAL
SOCIAL
PSYCHOLOGICALOCCUPATIONAL
ECONOMIC

57. COMPLICATIONS
Early complication
 UTI
 Hypovolemic shock
 Respiratory failure
 Renal failure
 Paralytic illus
 GI bleeding
 Wound sepsis
 Hypoplastic pneumonia
 Tonic shock syndrome
 Hypertension
 Depression
Late complcations
 Anemia
 Growth failure
 Marjolin’s ulcer
 Contracture
 Psychological trauma
 Cosmetic problems

58. NURSING DIAGNOSIS
• Decreased cardiac output related to
hypovolemea and increased metabolism
• Impaired oxygenation related to
inhalation injury.
• Pain related to burn wound
• Potential to infection
• Alteration of body image

59. NURSING INTERVENTIONS
Monitoring
Administering IV fluid therapy and
oxygen therapy
Warmth and humid environment
Provision of respiratory function
Relaxation therapy
Emotional support
Nutritional requirement
Prevention of infection.

60. Conclusion…