MARKING KEY BURNS

NURSING CARE/MANAGEMENT:

Objectives:
 To prevent shock
 To improve tissue perfusion
 To relieve pain
 To prevent infection
 To allay anxiety
 To prevent complication e.g. contractures
 To promote wound healing

(i) PSYCHOLOGICAL CARE:

(ii)
Explain procedures and educate the patient to understand the on going treatment and
 Relieve anxiety to promote mental health
 future plans.
 Allow the patient to express his feelings to maintain sense of hope and positive body
image
 Help patient to focus on positive aspect of self
 Any other related

(ii) PREVENTION OF INFECTION:

 Prevention of infection starts at the time of admission hence, put patient in a clean bed.
 Injury to the skin destroys the body’s first line of defence thus infection sets in easily.
Important to clean wound on regular basis.
 Use aseptic technique and sterile gloves during wound care.
 Care for the patient in a special burns unit
 Give high protein foods to boost immunity
 Identify and monitor signs of infection: fever, Tachycardia, change in mental state.
 Prevent exogenous infection by not allowing any one with infectious disease near the
patient (Mr. Mayeso) (give 1% each for any 5 points-Max-5%

(iii) PROMOTING SKIN INTERGRITY:

 Daily inspection and cleaning of the wound

 Remove the Escher (slough) to support healthy tissue regeneration because slough
contains dead tissue, moisture and warmth that are conducive media for microbe’s
growth.
 Saline bath is more comfortable method of removal of dressing.

WOUND CARE

(iv) Methods of Treatment: Depending on the location of burn, its size and depth.

a) OPEN OR EXPOSED METHOD

 Isolation technique is essential

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  When nursing the patient, wear sterile gown, mask and apron, sterile linen may
also be put on the bed.
 Patient may experience a lot of pain give controlled administration of morphine
sulphate.
 Minimise discomfort-patients loose more heat from burned surfaces than normal
skin.
 Humidity of the room should be controlled.

b) SEMI OPEN METHOD:
 Covering the wound with topical antimicrobial agents.
 A thin layer of gauze is used to cover the wound
 Clean the wound once or twice daily

(c) CLOSED OR OCCLUSIVE METHOD

 Wounds are cleaned and dressings changed at least once or twice daily.
 Promote mobility by 2nd day of injury-Any delay may result in contractures.
 Topical agents applied to the wound, help decrease infection and fasten wound
healing. The agents include: Silverdene, Silver, Nitrate, Povidone, Furacin,
Geramycin, Neomycin.

(v) THERAPEUTIC POSITIONING:

 Place the body parts correctly in anatomical position to prevent deformities.

 Apply splint currently if indicated
 Assess always the splinted limbs for adequate circulation, or cyanosis.
 Complaints of pain and pressure must not be ignored

(vi) EXERCISES AND AMBULATION

 Exercises of the arm when condition allows, to prevent and correct contracture
 Involve physical and occupational therapist

(vii) NUTRITION

 Give high protein diet, vitamins and vegetables for tissue repair.
 Ensure adequate nutritious fluids.

(viii) HYGIENE

 Daily bath-to prevent infection and promote self-esteem

 Oral care-to promote appetite and prevent oral infection
 Hair care-for self-esteem
 Nail care-to prevent injury
 Hygiene care necessary for maintaining body integrity.

(ix) OBSERVATIONS

 Temperature
 Pulse
 B/P
 Respiration
 Observe for any complaint (s) about pain or pressure on the limbs,

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  Observe for cyanosis.
 Assess the wound healing process
 Observe whether patient is having good sleep and rest
 Assess for appetite and nutritional status.

(x) ELIMINATION PATTERN

 Monitor the intake and output and record the findings on the appropriate chart.
 Any deviation (e.g. constipation), in the normal bowel motion should be
reported.

(xi) REST AND SLEEP

 Time your procedures in order to minimise disturbance

 Give prescribed pain reliever.

(c ) COMPLICATIONS OF BURNS

 Hypovolaemic shock
 Neurological shock
1. Infection
 Contractures
 Loss of body image
 Damage to organs
 Anaemia
 Anuria
 Renal failure
 Paralytic ileus
 Dehydration

(d) OUTLINE SEVEN (7) POINTS TO BE INCLUDED IN THE LESSON TO BE GIVEN

TO THE COOKS AT LUANGWA LODGE ON BURNS

(i) CAUSES OF BURNS

 Electrical burns-Heat generated from an electric current.

 Thermal burns-Contact with hot objects, flame, scald, hot cooking oil.
 Chemical burns-contact with chemicals that are noxious.
 Smoke/inhalation burns-as a result of inhalation of hot air, smoke (from burnt
food) or noxious chemical thus burning the respiratory tract.

(ii) CLASIFICATIONS OF BURNS

 Superficial
 Deep
(iii) FIRST AID TREATMENT

 For flames- stop the flame by covering with a blanket

 For hot liquid-pour cold water on the spot
 For fumes-place outside for oxygenation

(ix) PREVENTION OF BURNS

 Do not leave cooking oil burning on the stove or frying meat with a lot of fat in
thatched house

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  Do not hold hot pans with bare hands
 Switch off electrical appliances when not used and when closing the hotel
kitchen
 Use first Aid measures to put off fire e.g. use of sand, blanket.
 Ensure that extinguishers are always functioning
 The hotel kitchen must have a fire point.

1. PREVENTIVE MEASURE OF BURNS (TO THE COMMUNITY)

1. Avoid sleeping with fire on – candle, brazier

2. Switch off electrical appliances when not used
3. When bathing a baby put cold water first before hot water and test the water.
4. Do not leave boiling pots and a small child alone
5. Do not sleep in the same room with tins of petrol or diesel
6. Do not smoke in bed
7. Use first aid measures to put off fire-use of sand, blanket switch off.
8. Do not leave children playing with fire near a thatched house.
9. Do not leave cooking oil burning on the stove-or drying meat with a lot of fat in a
thatched house.
10. do not hold hot pans with bare hands.

2. COMPLICATIONS OF BURNS

1. Hypovolaemic shock
2. Infection
3. Contractures
4. Loss of body image
5. Damage to the organs
6. Dehydration
7. Anaemia
8. Anuria
9. Neurological shock