Nursing Management of patient

with Burns
Nutrition for Nursing
(NRS 411)
Level:7
Dr. Azza Ismail
By:
1.‫محمد س''حمانا''لشراري‬
2.‫ض''اريس''ع'د ا''لشمري‬
3.‫ا'صيل محمد ا''لشراري‬
 Outline
1. INTRODUCTION
2. Burns
3. TYPES OF BURNS
4. Assessment
5. Depth of burn
6. Nutrition therapy
7. NUTRITIONAL MANAGEMENT
8. Management of major burns
9. electrolyte balance
10. References
 INTRODUCTION
Nutrition support is the provision of nutrients and any necessary adjunctive therapeutic agents to improve or
maintain nutritional status. Nutrition support is fundamental in the management of patients with a moderate-to-
severe burn injury.
The primary goal of nutrition support following severe burn injury is to meet the distinctive demands placed
upon the body by hypermetabolism. The adverse effects of the hypermetabolic response can result in life-
threatening protein-calorie malnutrition. While management of nutritional needs in burn patients has many
features in common with the nutritional management of other critically ill surgical patients, the severity,
magnitude, and duration of the hypermetabolic response and the ensuing energy requirements for the severe
burn patient are far greater.
Definition of Burns
A burn is an injury caused by thermal, chemical,
electrical, or radiation energy. A scald is a burn caused by
contact with a hot liquid or steam but the term 'burn' is often
used to include scalds.
 Burns

Most burns heal without any problems but complete healing in terms of cosmetic outcome is often
dependent on appropriate care, especially within the first few days after the burn. Most simple burns can be
managed in primary care but complex burns and all major burns warrant a specialist and skilled
multidisciplinary approach for a successful clinical outcome.
 TYPES OF
BURNS

• Thermal

exposure to flame or a hot object.

• Chemical

exposure to acid, alkali or organic substances.

• Electrical

result from the conversion of electrical energy into heat.

• Radiation

result from radiant energy being transferred to the body resulting in production of cellular toxins
 Assessment

 Assess airway, breathing, circulation, disability, exposure (prevent hypothermia) and the need for fluid
resuscitation. Also, assess severity of burns and conscious level.

 Establish the cause: consider non-accidental injury.

 Assess for associated injuries: associated injuries may be sustained while the victim attempts to escape the
fire. Explosions may throw the patient some distance and result in internal injures or fractures.
 Assessment

 It is essential that the time of the burn injury be established.

 Burns sustained within an enclosed space suggest possible inhalation injury.

 Pre-existing illnesses, drug therapy, allergies and drug sensitivities are also important.

 Establish the patient's tetanus immunization status.

 Body surface area - Rule of Nines:

 The adult body is divided into anatomical regions that represent 9%, or multiples of 9%, of the
total body surface. Therefore 9% each for the head and each upper limb; 18% each for each lower
limb, front of trunk and back of trunk.

 The palmar surface of the patient's hand, including the fingers, represents approximately 1% of the
patient's body surface.
Rule of Nines
 Depth of burn

Depth of burn (as first- degree, second-degree and

Burns can be superficial in some areas but deeper in other areas:

 Epidermal (superficial partial-thickness): red, glistening, pain, absence of blisters and brisk
capillary refill. Not life-threatening and normally heal within a week, without scarring.

 Superficial dermal: pale pink or mottled appearance with associated swelling and small blisters. The
surface may have a weeping, wet appearance and is extremely hypersensitive. Brisk capillary refill.
Heal in 2-3 weeks with minimal scarring and full functional recovery.
 Deep dermal: blistering, dry, blotchy cherry red, doesn't blanch, no capillary refill and reduced or
absent sensation. 3-8 weeks to heal with scarring; may require surgical treatment for best
functional recovery.

 Full-thickness (third-degree): dry, white or black, no blisters, absent capillary refill and absent
sensation. Requires surgical repair and grafting.
 Fourth-degree: includes subcutaneous fat, muscle, and perhaps bone. Requires reconstruction and,
often, amputation.
 electrolyte balance

One of the many aspects of the care of the burn patient that must be monitored is the electrolyte balance.
1. the initial resuscitation period (between 0 and 36 h). characterized by hyponatraernia and hyperkalaemia;
2. the early post-resuscitation period (between days and 6). in which we consider hypernatraemia. hypokalaemia,
hypocalcaemia, hypomagnesaemia. and hypophosphataetnia:
3. the inflammation-infection period (also known as the hypermetabolic period). which is most evident after the
first week. when several imbalances may coexist, depending whether correction was performed. and. if so, how.
 Nutrition therapy

The primary goal of nutrition support following severe burn injury is to meet the distinctive demands placed upon the
body by hypermetabolism. The adverse effects of the hypermetabolic response can result in life-threatening protein-
calorie malnutrition. While management of nutritional needs in burn patients has many features in common with the
nutritional management of other critically ill surgical patients, the severity, magnitude, and duration of the
hypermetabolic response and the ensuing energy requirements for the severe burn patient are far greater.
NUTRITIONAL MANAGEMENT

❖ Enteral Feeding Should Be Commenced Early

❖Aggressive Nutritional Support is Often Required

❖Energy Requirements are Elevated by the Burn Injury

❖Protein Requirements are Substantially Increased

❖An Increased Requirement Exists for Nutrients Associated with Healing and Immune Function
Management of minor
burns
 Management of minor burns

• Clean burns with soap and water, or a dilute water-based disinfectant to remove loose skin.

• All blisters should be left intact to minimise the risk of infection.

• Larger blisters or those in an awkward position (in danger of bursting) should be aspirated under aseptic
technique.
 Management of minor burns

• Non-adhesive dressing, with gauze padding is usually effective, but biological dressings are better,
especially for children.

• Dressings should be examined at 48 hours to reassess the burn, including depth.

• Dressings should be examined at 48 hours to reassess the burn, including depth.

• Dressings on superficial partial-thickness burns can be changed after 3-5 days in the absence of infection.
Management of major burns
 Management of major burns

The initial treatment of burns needs to include the following possible injuries:

• Direct thermal injury producing upper airway oedema and/or obstruction.

• Inhalation of products of combustion (carbon particles) and toxic fumes, leading to chemical
tracheobronchitis, oedema, and pneumonia.

• Carbon monoxide (CO) poisoning.

• Airway:

The airway above the glottis is very susceptible to obstruction because of exposure to heat. The clinical
presentation of inhalation injury may be subtle and often does not appear in the first 24 hours.
 Immediate management

Clinical indications of inhalation injury include:

• Face and/or neck burns.

• Singeing of the eyebrows and around the nose.

• Carbon deposits and acute inflammatory changes in the oropharynx.

• Carbon particles seen in sputum.

• Hoarseness.

• History of impaired awareness, eg alcohol or head injury, and/or confinement in a burning

• Explosion, with burns to head and torso.

• Carboxyhaemoglobin level greater than 10% if the patient is involved in a fire.

1. Porter C, Tompkins RG, Finnerty CC, Sidossis LS, Suman OE, Herndon DN. The
metabolic stress response to burn trauma: current understanding and therapies.
Lancet. 2016;388(10052):1417–26
2. Dickerson RN, Gervasio JM, Riley ML, Murrell JE, Hickerson WL, Kudsk KA,
et al. Accuracy of predictive methods to estimate resting energy expenditure of
thermally-injured patients. J Parenter Enteral Nutr. 2002;26(1):17–29.
3. Rousseau A-F, Losser M-R, Ichai C, Berger MM. ESPEN endorsed
recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32(4):497–
502.
4. Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the Provision and
Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:
Society of Critical Care Medicine (SCCM) and American Society for Parenteral
and Enteral Nutrition (A.S.P.E.N.). Crit Care Med 2016; 44:390.