Burns Nursing Management Reviewer

Burns. A burn is an injury that results from direct exposure to any thermal,
electrical, chemical, or radiation source. It occurs when energy from a heat
source is transferred into body tissues beyond what the body could hold,
leading to tissue injury. It is characterized by severe skin damage that
causes the affected skin cells to die.

Types of Burns

There are many other causes of burns aside from open flames. They
include:

 Thermal burns. A thermal burn is a burn to the skin caused by any

external heat source like a flame, hot liquids, or hot metals.
 Chemical burns. A chemical burn can be caused by many
substances, such as strong acids, drain cleaners (lye), paint thinner,
and gasoline that touches your skin can cause it to burn.
 Radiation burns. A radiation burn is the least common type.
Sunburn is a type of radiation burn and other exposure to nuclear
radiation, like X-rays or radiation therapy to treat cancer, can also
cause these.
 Electrical burns. An electrical burn occurs when the skin comes into
contact with an electrical current and it passes through the body
from faulty electrical wiring.
 Friction burns. A friction burn occurs when a hard object rubs off
some of the skin. It’s both an abrasion or scrape and a heat burn just
like motorcycle and bike accidents and a carpet burn.
 Cold burns. A cold burn also called “frostbite” occurs when the skin
comes into direct contact with something very cold for a prolonged
period of time.
 Inhalation injury. An inhalation injury is caused by smoke associated
with flame injury or inhaled carbon monoxide which is a by-product
of incomplete combustion.
Signs and Symptoms of Burn Injury

Local Response

The three zones of a burn were described by Jackson in 1947. These three
zones of a burn are three-dimensional, and loss of tissue in the zone of
stasis will lead to the wound deepening and widening. (National Center for
Biotechnology Information, U.S. National Library of Medicine)

 Zone of coagulation. This occurs at the point of maximum damage

to the area of the burn tissue. In this zone, there is irreversible tissue
loss due to the coagulation of the constituent proteins.
 Zone of stasis. The surrounding zone of stasis is characterized by
decreased tissue perfusion. The tissue in this zone is potentially
salvageable. The main aim of burns resuscitation is to increase tissue
perfusion here and prevent any damage from becoming irreversible.
Additional insults—such as prolonged hypotension, infection,
or edema—can convert this zone into an area of complete tissue loss.
 Zone of hyperemia. In this outermost zone tissue perfusion is
increased. The tissue here will invariably recover unless there is
severe sepsis or prolonged hypoperfusion.
Systemic response

The release of cytokines and other inflammatory mediators at the injury

site has a systemic effect once the burn reaches 30% of the total body
surface area.

 Cardiovascular changes. Due to fluid loss from the burn wound, it

results in systemic hypotension, increased heart rate, and end organ
hypoperfusion.
 Respiratory changes. Hyperventilation and increased respiratory
rate occur. Inflammatory mediators cause bronchoconstriction, and in
severe burns adult respiratory distress syndrome can occur.
 Metabolic changes. The basal metabolic rate increases up to three
times its original rate. For severely burned patients, the resting
metabolic rate at thermal neutral temperature (30°C) tops 140% of
predicted basal rate on admission, reduces to 130% once the wounds
are fully healed, then to 120% at 6 months after injury.
 Immunological changes. Non-specific down regulation of the
immune response occurs, affecting both cell mediated and humoral
pathways.
 Electrolyte imbalances. Hyponatremia and hyperkalemia occur.
Hyponatraemia is frequent, and the restoration of sodium losses in
the burn tissue is therefore essential. Hyperkalemia is also
characteristic during this time because of the massive tissue necrosis.
Hyponatraemia (Na) (< 135 mEq/L) is due to
extracellular sodium depletion following changes in cellular
permeability.
  Psychological responses. Effects on psychological health includes
shock, numbness, disbelief, depression, denial, mourning, perceived
losses.
Management of Burn Injury

Management of burn injury is categorized into three phases of care:

emergent phase, acute phase, and rehabilitation.

Emergent Phase

The emergent phase starts from the time of burn injury and ends when
the patient is hemodynamically stable, capillary permeability has been
restored, and fluid resuscitation has been completed. Usually 48-72 hours
from the time of injury. The emergent phase is also known as the
resuscitative phase, and the goals of this phase include prevention
of hypovolemic shock and preservation of vital organ functioning.

Asses for the burn depth.

Burn depth is assessed 24 hours after injury as blisters and other injuries
may evolve.

First Degree Burn (Superficial Partial Thickness Burn). In first-degree

burn injuries, the skin function remains intact, and transfer to a burn center
is not required. They do NOT count towards total body surface area (TBSA)
burned. This classification of burn depth affects the epidermis leading to
the following signs and symptoms:

 Erythema
 Edema
 Pain but without blisters
 Fluid loss is MILD
Second Degree Burn (Deep Partial Thickness Burn). In second-degree
burn injuries, the skin function is lost. Deep partial-thickness injuries can
easily convert to or require the same management as full-thickness.
An MCI (mass casualty incident) aims to treat as many 2nd degree injuries
as possible in an outpatient setting. This classification of burn depth affects
the dermis and epidermis, leading to the following signs and symptoms:

 Erythema
 Edema
 Pain with blisters
  Pink to reddish skin
 Fluid loss is MODERATE
Third-Degree Burn (Full Thickness Burn). In third-degree burn injuries,
skin function is lost, and grafting is required for functional healing. Third-
degree burns will almost always require hospital admission. This
classification of burn depth affects the subcutaneous tissues, epidermis,
and dermis leading to:

 Pearly white or charred appearance of the skin

 Mottled brown, black, or red burn site
 Pain is absent
 Fluid loss is SEVERE
Fourth-Degree Burn (Deep Fullness Thickness Burn). In fourth-degree
burn injuries, the affected areas go through both layers of the skin and
underlying tissue as well as deeper tissue. This classification of burn depth
involves muscle and bone.

 Burned part is black/charred

 Fluid loss is VERY SEVERE
Assess the burn size and extent.

The size of the burn is expressed through percentage according to the

total body surface area (TBSA), Rule of Nines.

 Small Burns (<25%). Response of the body is localized.

 Large Burns (>25%). Response of the body is systemic.
Assess for the burn location.

The area of a burn injury usually directs treatment. Burns on the face,
hands, feet, and genitalia, as well as large burns in other areas of the body
and those associated with inhalation injury, are often referred to burn
centers for specialized expertise.

 Head, Neck, and Chest. Respiratory

 Face. Corneal ulceration
 Perineum. Contaminated with urine and feces
 Circumferential Burns of Extremities. Compromis circulation
Airway Management

Airway Management is vital to maintain the airway and provide

supplemental oxygen in patients with major burns. Airway management is
crucial for types of burns related to inhalation injury.
  Oxygenation: CO2 poisoning. 100% of oxygen is delivered via a
tight-fitting non-rebreather mask until carbon monoxide falls to 15%.
 Mechanical ventilator as indicated.
 Endotracheal suctioning.
 Head of the bed is elevated to facilitate maximum expansion of
the lungs.
Fluid Resuscitation

Fluid Resuscitation refers to replacing fluids in burn patients to

prevent hypovolemia and hypoperfusion that can result from the body’s
systemic response to burn injury.

 Initiate fluid administration. Peripheral IV access may initially be

used though in larger and more severe cases of burns, a central
venous access is recommended as a large volume of fluid is required.
 Use American Burn Association (ABA) guidelines for fluid
resuscitation. The formula for the total fluid requirement in 24 hours
is as follows: 4ml x TBSA (%) x body weight (kg). [Example: Patient
weighs 80 kg with TSBA of 20% = 4mL x 80 kg = 320 x 20 = 6,400
mL]
 First half of the solution is given in the first 8 hours (3,200 mL)
 One quarter of the solution is given in the second 8 hours (1,600 mL)
 Another quarter of the solution is given in the third 8 hours (1,600
mL)
 Avoid colloid-containing solution for the first 24 hours because it
may aggravate edema due to an increase in capillary permeability.
 The amount of fluid in the second 24 hours will depend on the
patient’s urine output and hemodynamic studies (Hct, CVP, and
BUN/Crea)
 Colloid-containing solutions may be given with D5W with glucose.
 Monitor urine output. A urine output of 0.5 to 1 mL/kg/h is used as
an indication of appropriate resuscitation in thermal and chemical
injuries. In electrical injuries, a urine output of 75 to 100 mL/h is the
goal.
Diet

The larger the burn size, the more nutrients are needed for healing.

 Provide additional calories. Patients need more calories than

normal when they’re recovering from a burn injury. That’s
why nutrition is a major component of burn treatment. A diet high in
calories and protein supports the immune system to decrease risk of
 infection; helps wounds heal faster; maintains muscle mass; and
minimizes weight loss to support rehabilitation.
Pain Management

Pain due to burns can range from mild to severe to excruciating. Pain
management, which includes pharmacologic and nonpharmacologic
approaches, is a central component of the complex issues involved in
treating patients with burns.

NO intramuscular or subcutaneous administration because the

patient is hypovolemic.
 Intravenous analgesics: Morphine, Demerol
 Oral administration is NOT considered due to GI dysfunction.
 Minor burns: per orem
 Nonpharmacological: Deep breathing exercises, guided imagery
Wound Care

Prescribed topical agents are administered before the wound is covered

with layers of dry dressings.

 Use ointments. Antibiotic ointments or creams are frequently used

to fight or treat infections in patients with second-degree burns.
Using these ointments may require the use of bandages.
 Regularly change dressings. Dressings may need to be changed
regularly. The skin and the burn wound should be washed gently with
mild soap and rinsed well with tap water. Use a soft wash cloth or
piece of gauze to gently remove old medications.
Acute Phase

The acute phase of burn management starts 48-72 hours from the burn
injury when the patient is hemodynamically stable with completed fluid
resuscitation and restored capillary permeability and ends upon wound
closure.

Prevent infection. Patients with burns are at the highest risk for
healthcare-associated infections (HAIs). The loss of the skin’s barrier
function, combined with necrotic tissue, produces an environment
conducive to bacterial growth. Nursing interventions to prevent infection
includes:

 Watch out for signs of infection. Erythema, warmth, malodorous

exudates, and tenderness.
  Initiate universal precaution. Use of gowns, gloves,
and eye protection. Including frequent hand hygiene.
 Wound culture and antimicrobial therapy. Culture and sensitivity is
usually ordered on admission for patients with burns to test for
presence of MRSA.
 Wound care. Early excision and closure of the burn wound helps in
preventing infection.
 Control of hyperglycemia. Insulin is indicated (even
without diabetes) for severely burned patients to improve protein
synthesis, attenuate lean body mass loss, decrease hypermetabolism,
and accelerate donor healing time.
Provide nutritional support. Nutritional support through total parenteral
nutrition or enteral tube feeding for patients with burns is aggressive.
There should be an increase in calories, proteins, and fats.

Provide proper wound care. Wound cleansing should be done through

hydrotherapy and maybe submerged in a Hubbard tank.

Wound Cleansing

 Wound cleansing through hydrotherapy

 Patient is submerged in Hubbard Tank
 Involves immersion, spray, or showering 30 minutes or less.
 More than 30 minutes can cause heat loss, pain, and stress.
 Analgesics before the procedure.
Debridement

Debridement is the removal of necrotic tissues to prevent bacterial

growth-promoting wound healing.

 Mechanical Debridement. Involves the use of forceps and scissors

to trim away loose necrotic tissues.
 Enzymatic Debridement. Involves the use of proteolytic or fibriolytic
enzymes to digest necrotic tissues.
 Surgical Debridement. Involves excision of loose necrotic tissues.
Antimicrobial Agents or Ointments

 Silver Sulfadiazine. Once or twice daily.

 Open Method. The wound is left exposed to air after application.
 Close method. Sterile gauze is impregnated.
Surgical Management
Autografting. Autografting is the surgical removal of a superficial layer of
the patient’s own unburned skin (donor site) which is subsequently grafted
to the patient’s excised open wound.

Post Op Considerations:

 Promote graft adherence through immobilization

 Bed rest for 10 days
 Keep graft site free from pressure
 Avoid weight-bearing activities
 To remove exudate, roll a cotton tip applicator
 Watch out for foul smelling discharge. It may indicate infection.
As prescriBurns Nursing Management Reviewer
Burns. A burn is an injury that results from direct exposure to any thermal,
electrical, chemical, or radiation source. It occurs when energy from a heat
source is transferred into body tissues beyond what the body could hold,
leading to tissue injury. It is characterized by severe skin damage that
causes the affected skin cells to die.

Types of Burns

There are many other causes of burns aside from open flames. They
include:

 Thermal burns. A thermal burn is a burn to the skin caused by any

external heat source like a flame, hot liquids, or hot metals.
 Chemical burns. A chemical burn can be caused by many
substances, such as strong acids, drain cleaners (lye), paint thinner,
and gasoline that touches your skin can cause it to burn.
 Radiation burns. A radiation burn is the least common type.
Sunburn is a type of radiation burn and other exposure to nuclear
radiation, like X-rays or radiation therapy to treat cancer, can also
cause these.
 Electrical burns. An electrical burn occurs when the skin comes into
contact with an electrical current and it passes through the body
from faulty electrical wiring.
 Friction burns. A friction burn occurs when a hard object rubs off
some of the skin. It’s both an abrasion or scrape and a heat burn just
like motorcycle and bike accidents and a carpet burn.
  Cold burns. A cold burn also called “frostbite” occurs when the skin
comes into direct contact with something very cold for a prolonged
period of time.
 Inhalation injury. An inhalation injury is caused by smoke associated
with flame injury or inhaled carbon monoxide which is a by-product
of incomplete combustion.
Signs and Symptoms of Burn Injury

Local Response

The three zones of a burn were described by Jackson in 1947. These three
zones of a burn are three-dimensional, and loss of tissue in the zone of
stasis will lead to the wound deepening and widening. (National Center for
Biotechnology Information, U.S. National Library of Medicine)

 Zone of coagulation. This occurs at the point of maximum damage

to the area of the burn tissue. In this zone, there is irreversible tissue
loss due to the coagulation of the constituent proteins.
 Zone of stasis. The surrounding zone of stasis is characterized by
decreased tissue perfusion. The tissue in this zone is potentially
salvageable. The main aim of burns resuscitation is to increase tissue
perfusion here and prevent any damage from becoming irreversible.
Additional insults—such as prolonged hypotension, infection,
or edema—can convert this zone into an area of complete tissue loss.
 Zone of hyperemia. In this outermost zone tissue perfusion is
increased. The tissue here will invariably recover unless there is
severe sepsis or prolonged hypoperfusion.
Systemic response

The release of cytokines and other inflammatory mediators at the injury

site has a systemic effect once the burn reaches 30% of the total body
surface area.

 Cardiovascular changes. Due to fluid loss from the burn wound, it

results in systemic hypotension, increased heart rate, and end organ
hypoperfusion.
 Respiratory changes. Hyperventilation and increased respiratory
rate occur. Inflammatory mediators cause bronchoconstriction, and in
severe burns adult respiratory distress syndrome can occur.
 Metabolic changes. The basal metabolic rate increases up to three
times its original rate. For severely burned patients, the resting
metabolic rate at thermal neutral temperature (30°C) tops 140% of
 predicted basal rate on admission, reduces to 130% once the wounds
are fully healed, then to 120% at 6 months after injury.
 Immunological changes. Non-specific down regulation of the
immune response occurs, affecting both cell mediated and humoral
pathways.
 Electrolyte imbalances. Hyponatremia and hyperkalemia occur.
Hyponatraemia is frequent, and the restoration of sodium losses in
the burn tissue is therefore essential. Hyperkalemia is also
characteristic during this time because of the massive tissue necrosis.
Hyponatraemia (Na) (< 135 mEq/L) is due to
extracellular sodium depletion following changes in cellular
permeability.
 Psychological responses. Effects on psychological health includes
shock, numbness, disbelief, depression, denial, mourning, perceived
losses.
Management of Burn Injury

Management of burn injury is categorized into three phases of care:

emergent phase, acute phase, and rehabilitation.

Emergent Phase

The emergent phase starts from the time of burn injury and ends when
the patient is hemodynamically stable, capillary permeability has been
restored, and fluid resuscitation has been completed. Usually 48-72 hours
from the time of injury. The emergent phase is also known as the
resuscitative phase, and the goals of this phase include prevention
of hypovolemic shock and preservation of vital organ functioning.

Asses for the burn depth.

Burn depth is assessed 24 hours after injury as blisters and other injuries
may evolve.

First Degree Burn (Superficial Partial Thickness Burn). In first-degree

burn injuries, the skin function remains intact, and transfer to a burn center
is not required. They do NOT count towards total body surface area (TBSA)
burned. This classification of burn depth affects the epidermis leading to
the following signs and symptoms:

 Erythema
 Edema
  Pain but without blisters
 Fluid loss is MILD
Second Degree Burn (Deep Partial Thickness Burn). In second-degree
burn injuries, the skin function is lost. Deep partial-thickness injuries can
easily convert to or require the same management as full-thickness.
An MCI (mass casualty incident) aims to treat as many 2nd degree injuries
as possible in an outpatient setting. This classification of burn depth affects
the dermis and epidermis, leading to the following signs and symptoms:

 Erythema
 Edema
 Pain with blisters
 Pink to reddish skin
 Fluid loss is MODERATE
Third-Degree Burn (Full Thickness Burn). In third-degree burn injuries,
skin function is lost, and grafting is required for functional healing. Third-
degree burns will almost always require hospital admission. This
classification of burn depth affects the subcutaneous tissues, epidermis,
and dermis leading to:

 Pearly white or charred appearance of the skin

 Mottled brown, black, or red burn site
 Pain is absent
 Fluid loss is SEVERE
Fourth-Degree Burn (Deep Fullness Thickness Burn). In fourth-degree
burn injuries, the affected areas go through both layers of the skin and
underlying tissue as well as deeper tissue. This classification of burn depth
involves muscle and bone.

 Burned part is black/charred

 Fluid loss is VERY SEVERE
Assess the burn size and extent.

The size of the burn is expressed through percentage according to the

total body surface area (TBSA), Rule of Nines.

 Small Burns (<25%). Response of the body is localized.

 Large Burns (>25%). Response of the body is systemic.
Assess for the burn location.

The area of a burn injury usually directs treatment. Burns on the face,
hands, feet, and genitalia, as well as large burns in other areas of the body
and those associated with inhalation injury, are often referred to burn
centers for specialized expertise.

 Head, Neck, and Chest. Respiratory

 Face. Corneal ulceration
 Perineum. Contaminated with urine and feces
 Circumferential Burns of Extremities. Compromis circulation
Airway Management

Airway Management is vital to maintain the airway and provide

supplemental oxygen in patients with major burns. Airway management is
crucial for types of burns related to inhalation injury.

 Oxygenation: CO2 poisoning. 100% of oxygen is delivered via a

tight-fitting non-rebreather mask until carbon monoxide falls to 15%.
 Mechanical ventilator as indicated.
 Endotracheal suctioning.
 Head of the bed is elevated to facilitate maximum expansion of
the lungs.
Fluid Resuscitation

Fluid Resuscitation refers to replacing fluids in burn patients to

prevent hypovolemia and hypoperfusion that can result from the body’s
systemic response to burn injury.

 Initiate fluid administration. Peripheral IV access may initially be

used though in larger and more severe cases of burns, a central
venous access is recommended as a large volume of fluid is required.
 Use American Burn Association (ABA) guidelines for fluid
resuscitation. The formula for the total fluid requirement in 24 hours
is as follows: 4ml x TBSA (%) x body weight (kg). [Example: Patient
weighs 80 kg with TSBA of 20% = 4mL x 80 kg = 320 x 20 = 6,400
mL]
 First half of the solution is given in the first 8 hours (3,200 mL)
 One quarter of the solution is given in the second 8 hours (1,600 mL)
 Another quarter of the solution is given in the third 8 hours (1,600
mL)
 Avoid colloid-containing solution for the first 24 hours because it
may aggravate edema due to an increase in capillary permeability.
 The amount of fluid in the second 24 hours will depend on the
patient’s urine output and hemodynamic studies (Hct, CVP, and
BUN/Crea)
  Colloid-containing solutions may be given with D5W with glucose.
 Monitor urine output. A urine output of 0.5 to 1 mL/kg/h is used as
an indication of appropriate resuscitation in thermal and chemical
injuries. In electrical injuries, a urine output of 75 to 100 mL/h is the
goal.
Diet

The larger the burn size, the more nutrients are needed for healing.

 Provide additional calories. Patients need more calories than

normal when they’re recovering from a burn injury. That’s
why nutrition is a major component of burn treatment. A diet high in
calories and protein supports the immune system to decrease risk of
infection; helps wounds heal faster; maintains muscle mass; and
minimizes weight loss to support rehabilitation.
Pain Management

Pain due to burns can range from mild to severe to excruciating. Pain
management, which includes pharmacologic and nonpharmacologic
approaches, is a central component of the complex issues involved in
treating patients with burns.

NO intramuscular or subcutaneous administration because the

patient is hypovolemic.
 Intravenous analgesics: Morphine, Demerol
 Oral administration is NOT considered due to GI dysfunction.
 Minor burns: per orem
 Nonpharmacological: Deep breathing exercises, guided imagery
Wound Care

Prescribed topical agents are administered before the wound is covered

with layers of dry dressings.

 Use ointments. Antibiotic ointments or creams are frequently used

to fight or treat infections in patients with second-degree burns.
Using these ointments may require the use of bandages.
 Regularly change dressings. Dressings may need to be changed
regularly. The skin and the burn wound should be washed gently with
mild soap and rinsed well with tap water. Use a soft wash cloth or
piece of gauze to gently remove old medications.
Acute Phase
The acute phase of burn management starts 48-72 hours from the burn
injury when the patient is hemodynamically stable with completed fluid
resuscitation and restored capillary permeability and ends upon wound
closure.

Prevent infection. Patients with burns are at the highest risk for
healthcare-associated infections (HAIs). The loss of the skin’s barrier
function, combined with necrotic tissue, produces an environment
conducive to bacterial growth. Nursing interventions to prevent infection
includes:

 Watch out for signs of infection. Erythema, warmth, malodorous

exudates, and tenderness.
 Initiate universal precaution. Use of gowns, gloves,
and eye protection. Including frequent hand hygiene.
 Wound culture and antimicrobial therapy. Culture and sensitivity is
usually ordered on admission for patients with burns to test for
presence of MRSA.
 Wound care. Early excision and closure of the burn wound helps in
preventing infection.
 Control of hyperglycemia. Insulin is indicated (even
without diabetes) for severely burned patients to improve protein
synthesis, attenuate lean body mass loss, decrease hypermetabolism,
and accelerate donor healing time.
Provide nutritional support. Nutritional support through total parenteral
nutrition or enteral tube feeding for patients with burns is aggressive.
There should be an increase in calories, proteins, and fats.

Provide proper wound care. Wound cleansing should be done through

hydrotherapy and maybe submerged in a Hubbard tank.

Wound Cleansing

 Wound cleansing through hydrotherapy

 Patient is submerged in Hubbard Tank
 Involves immersion, spray, or showering 30 minutes or less.
 More than 30 minutes can cause heat loss, pain, and stress.
 Analgesics before the procedure.
Debridement

Debridement is the removal of necrotic tissues to prevent bacterial

growth-promoting wound healing.
  Mechanical Debridement. Involves the use of forceps and scissors
to trim away loose necrotic tissues.
 Enzymatic Debridement. Involves the use of proteolytic or fibriolytic
enzymes to digest necrotic tissues.
 Surgical Debridement. Involves excision of loose necrotic tissues.
Antimicrobial Agents or Ointments

 Silver Sulfadiazine. Once or twice daily.

 Open Method. The wound is left exposed to air after application.
 Close method. Sterile gauze is impregnated.
Surgical Management

Autografting. Autografting is the surgical removal of a superficial layer of

the patient’s own unburned skin (donor site) which is subsequently grafted
to the patient’s excised open wound.

Post Op Considerations:

 Promote graft adherence through immobilization

 Bed rest for 10 days
 Keep graft site free from pressure
 Avoid weight-bearing activities
 To remove exudate, roll a cotton tip applicator
 Watch out for foul smelling discharge. It may indicate infection.
 As prescribed, small amount of blood may be removed beneath the
grafted skin by rolling gauze from the center to the periphery where
the blood can be absorbed by the sterile gauze.
 Aspirate if with large amount of blood using a small gauge needle as
prescribed by the physician.
 Apply cocoa butter to prevent dryness.
Rehabilitation Phase

The rehabilitation phase occurs immediately after the burn has occurred
and can extend for years after the initial injury.

 Minimize functional loss. Burn rehabilitation includes rehabilitation

programs to help return the patients to their highest level of function
within the content of their injuries.
 Provide psychosocial support. Includes counseling, patient teaching,
and help the patient reintegrate with society through various
programs aimed at burn survivors.
  bed, small amount of blood may be removed beneath the grafted
skin by rolling gauze from the center to the periphery where the
blood can be absorbed by the sterile gauze.
 Aspirate if with large amount of blood using a small gauge needle as
prescribed by the physician.
 Apply cocoa butter to prevent dryness.
Rehabilitation Phase

The rehabilitation phase occurs immediately after the burn has occurred
and can extend for years after the initial injury.

 Minimize functional loss. Burn rehabilitation includes rehabilitation

programs to help return the patients to their highest level of function
within the content of their injuries.
 Provide psychosocial support. Includes counseling, patient teaching,
and help the patient reintegrate with society through various
programs aimed at burn survivors.