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BURNS

BURNS. PRESENTED BY SOUMYA SARA JOSEPH. DEMOGRAPHIC DATA. Name: Case No.3 MR No : 196537 Diagnosis: 15% Burn Age: 2 YRS Gender: Male. PHYSICAL ASSESSMENT. GENERAL ASSESSMENT :

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BURNS

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  1. BURNS PRESENTEDBY SOUMYA SARA JOSEPH

  2. DEMOGRAPHIC DATA Name: Case No.3 MR No : 196537 Diagnosis: 15% Burn Age: 2 YRS Gender: Male

  3. PHYSICAL ASSESSMENT GENERAL ASSESSMENT: Baby has fever, lethargic, dehydrated SKIN: Dry, No blisters, No edema, Right side upper chest , left elbow, right thigh 1st degree burn present, Dehydrated HEAD AND NECK: No Deformities Found

  4. THORAX:Normally symmetrical in size • CARDIOVASCULAR: normal • GENITOURINARY: Diminished urine output

  5. GASTROINTESTINAL : Abdomen is soft, not distended MUSCULO-SKELETAL : No deformities found NEUROLOGY : Growth and development is normal according to Erikson’s psycho social stage

  6. PATIENT HISTORY Past Medical History No past history of any medical illness Present Medical History Now baby is admitted with complaints of 20% Burns

  7. Topic Presentation BURNS

  8. BURNS Tissue damage from excessive heat, electricity, radioactivity, or corrosive chemicals that destroys(denatures) proteins in the exposed cells is called a burn. Generally, the systemic effects of a burn are a greater threat to life than are the local effects.

  9. FIRST-DEGREE – only epidermis (sunburn) SECOND-DEGREE BURN – destroys entire epidermis & part of dermis – fluid-filled blisters separate epidermis & dermis – epidermal derivatives are not damaged – heals without grafting in 3 to 4 weeks & may scar THIRD-DEGREE OR FULL-THICKNESS – destroy epidermis, dermis & epidermal derivatives – damaged area is numb due to loss of sensory nerves

  10. ANATOMY AND PHYSIOLOGY

  11. STRUCTURE OF THE SKIN EPIDERMIS – The superficial portion of the skin – Composed of epithelial tissue. DERMIS – The deeper layer of the skin – Primarily composed of connective tissue

  12. SUBCUTANEOUSOR HYPODERMIS – It consists of areolar and adipose tissue. – fat storage, an area for blood vessel passage, and an area of pressure sensing nerve endings.

  13. OVER VIEW OF EPIDERMIS

  14. EPIDERMIS Stratified squamous epithelium – Avascular (contains no blood vessels) – 4 types of cells – 5 distinct strata (layers) of cells

  15. CELLS OF EPIDERMIS Four Principle Cells of the Epidermis • KERATINOCYTES – produce the protein keratin, which helps protect the skin and underlying tissue from heat, microbes, and chemicals, and lamellar granules, which release a waterproof sealant • MELANOCYTES – produce the pigment melanin which contributes to skin color and absorbs damaging ultraviolet (UV) light

  16. LANGERHANS CELLS – derived from bone marrow – participate in immune response • MERKEL CELLS – contact a sensory structure called a tactile (Merkel) disc and function in the sensation of touch

  17. LAYERS OF THE EPIDERMIS From deepest to most superficial the layers of the epidermis are – STRATUM BASALE (stratum germinativum) – STRATUM SPINOSUM – STRATUM GRANULOSUM – STRATUM LUCIDUM (only in palms and soles) – STRATUM CORNEUM

  18. DERMIS • Connective tissue layer composed of collagen & elastic fibers, fibroblasts, macrophages & fat cells • Contains hair follicles, glands, nerves & blood vessels • Two major regions of dermis – papillary region – reticular region

  19. ETIOLOGY • (from steam, hot bath water, tipped-over coffee cups, hot foods, cooking fluids, etc.) • Contact with flames or hot objects (from the stove, fireplace, curling iron, etc.) • chemical burns (from swallowing things, like drain cleaner or watch batteries, or spilling chemicals, such as bleach, onto the skin) • Electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets, etc.) • overexposure to the sun

  20. PATHOPHYSIOLOGY When large part of the body burnt this will effect most systems of the body.

  21. SKELETAL SYSTEM Burn area is too large Destruction of red blood cells Blood transfusion Bone marrow replacement

  22. MUSCULAR SYSTEM In case of burn Body becomes hyper metabolic

  23. CARDIO-VASCULAR SYSTEM Burning of the skin Increase in capillary permeability Increase in blood vasculaturiture Decrease of Blood pressure Decreases blood flow and oxygenation to tissue Edema, shock and eventually death

  24. NERVOUS SYSTEM Partial thickness burn Full thickness burn Only pain Nerve cell destruction no feeling Abnormal levels of circulating potassiumions Such as Cellular destruction, outward flow of K+ fluid in burn  HYPERKALEMIA HYPOKALEMIA Transmission of messages in the nervous system work faster orSlower than normal or not at all

  25. RESPIRATORY SYSTEM Airway obstruction Gross edema of the throat Increased rate of respiratory rate Pulmonary edema

  26. ENDOCRINE SYSTEM Increased secretion of adrenaline and nor adrenaline Increased body temperature Increased cell metabolism

  27. LYMPHATIC SYSTEM Increased inflammation Grater strain on lymphatic system Pitting edema

  28. IMMUNE SYSTEM Excessive strain on Burns area removing the first Lymphatic system line of infection defense Decreased response Increased infection

  29. DIGESTIVE SYSTEM Potential hypovolemic state Decrease in blood availability in the intestinal lining and liver Increases nutrients requires to support metabolism Repair of damaged cells

  30. URINARY SYSETEM Increased fluid loss Decreased urine output Potential for kidney damage Poor perfusion

  31. SIGN AND SYMPTOMS BOOKED BASE 1ST DEGREE • Redness • Pain • Minor swelling 2nd DEGREE • Severe pain • Blister+ and if it breaks the area wet looking with a bright pink to cherry red color • Redness 3rd DEGREE • Little or No pain • Skin Dry, look waxy white, leathery, brown or charred

  32. PATIENT MANIFESTED • Fever • Pain • Redness • Minor swelling

  33. INTRVENTION • Promoting comfort • Promoting fluid intake and maintain nutrition • Promoting pain relief and psycho logic adjustment • Promoting family knowledge • Prevention of infection • Monitoring And Prevention Of Complication • Promoting home and community based care

  34. BOOK BASED 1ST & 2nd DEGREE BURNS • Sterile dressings • Preventive Antiseptics • Preventive Antibiotics • Analgesics • Hydration- 3RD DEGREE BURNS • Sterile dressing • Preventive Antibiotics • Preventive Antiseptics • Hydration • Transfusion • Skin grafting

  35. FLUID CALCULATION FOR BURN PATIENT ACCORDING TO PARKLAND FORMULA 4 X TBSA ( %OF BURN ) X WEIGHT ONE HALF OF THE REQUIREMENTS ARE GIVEN DURING THE FIRST 8 HRS THE REMINDER IS GIVEN OVER THE NEXT 16 HRS

  36. LUND AND BROWDER CHAT IS USED TO DETERMINE TO EXTENT OF BURNS IN CHILDREN BECAUSE IT IS BASED ON AGE, THUS COMPENSATING FOR CHANGES BASED ON GROWTH

  37. COMPLICATIONS ACUTE Infection Curling’s ulcer (Stress) { TBSA>20%} Acute gastric dilation { TBSA>20%} Renal failure Respiratory failure Post burn seizures

  38. Hypertension • Central Nervous system dysfunction • Vascular Ischemia • Anxiety and complex pain • Anemia and malnutrition • Constipation and fecal impaction • Alteration in mood secondary to hospitalization

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