definition, types, degree of burn, phases, fluid calculation, nursing diagnosis

1. BURNS

2. Definition
• Burns are a result of the effects of thermal
injury on the skin and other tissues
• Human skin can tolerate temperatures up to
42-440 C (107-1110 F) but above these, the
higher the temperature the more severe the
tissue destruction
• Below 450 C (1130 F), resulting changes are
reversible but >450 C, protein damage
exceeds the capacity of the cell to repair

3. INCIDENCE
• 450,000 people are treated annually
• 68% injuries occurs at home
• 10% injuries are industries annually
• 5% injuries occurs recreational related
• 17% injuries are from other related

4. Kinds of Burns
• Scald Burn: most frequent in home injuries; hot
water, liquids and foods are most common causes;
above 65o C, cell death
• Flame Burn: due to gasoline, kerosene, liquified
petroleum gas (LPG) or burning houses
• Chemical Burn: common in industries and
laboratories but may also occur at home; acid is
more common than alkali
• Electrical Burn: worse than the other types; with
entrance and exit wounds; may stop the heart and
depress the respiratory center; may cause
thrombosis and cataracts
• Radiation Burn: from X-ray, radioactive radiation
and nuclear bomb explosions

5. Classification According to Depth
(information about body surface affected by degree)
• First-degree Burns (superficial): epidermis
 Pain, erythema & slight swelling, no blisters
 Tissue damage usually minimal, no scarring
 Pain resolves in 48-72 hours
 Oral pain medication, cold compression or lotions
can be used(eg: exposure to sun, flash)
• Second-degree Burns(partial thickness): entire
epidermis & variable dermis
 Vesicles and blisters characteristic
 Extremely painful due to exposed nerve endings
 Heal in 7-14 days if without infection
 Some scarring and depigmentation
 Grafting may be required( flame. Flash, scald, hot
object)

6. Cont..• Third degree Burns(Full-thickness):
 Epidermis, dermis, some
subcutaneoustissue, may involve
connective or muscles
 Dry, pale white, red brown, leathery,
edema,
 Eschar may be slough, grafting needed,
scarring and loss of function.(flame,
electric flash, prolong contact with hot
object)
• Fourth-Degree(full thickness includes fat,
muscles, fascia or bone) : entire epidermis
and dermis, subcutaneous, deep tissue,
muscles and bone.
 Painless, extensive fluid & metabolic
deficits
 Amputation, grafting of no benefit given
depth and severity of wounds.(same as 3
degree example)

7. Burn Photos
Mild Burn
2nd degree Burn 1 hr
2nd degree Burn 1 day
2nd degree Burn 2 days

8. Extent of body surface area injury
(to know the severity of burns)
• RULE OF NINE
• LUND AND BROWDER METHOD
• PALMER METHOD

11. Extent of Burns

12. Rule of nine

13. Classification According to Extent
• Mild: 10%
• Moderate:
10-30%
• Severe: > 30%
Anatomic
structure
Surface
area
Head 18%
Anterior Torso 18%
Posterior Torso 18%
Each Leg 14%
Each Arm 9%
Perineum 1%
Infant Rule of Nines
(for quick assessment
of total body surface
area affected by burns)

14. Thermal trauma for hospitalization
Major
burn(hospital
required)
Moderate
(hospital recommended)
Minor
(outpatient)
Adult 25% 2º 15-25% 2º <15% 2º
10% 3º <10% 3º
Child 20% 2º 10-20% 2º <10% 2º
The people over sixty years of age and less than 2yrs of age has higher
mortality rate. And children are generally admitted to hospital when their
injury is less extensive than adult.

15. Burn Photos
Scald Burns Flame Burns

16. Burn Photos
Chemical (Acid) Burns
Radiation (Flash) Burns

17. Burn Photos
Electrical Burns
Entrance Wounds
Electrical Burns
Exit Wounds
Entrance wound of electrical
burns from an overheated tool
Severe swelling
peaks 24-72 hrs after
Electrical burns mummified
1st 2 fingers later removed

18. • Assuming that all of the patient's injuries can be seen in
the picture above, roughly what percentage of the
patient's total body surface area is burned?
A) 22.50%
B) 27%
C) 31.50%
D) 18%
ans : D

19. The burns on this patient's hand are
A) fourth degree.
B) third degree.
C) second degree.
D) first degree
ans: B

20. TBSA??
• POSTERIOR part
only burned?

21. TBSA??
• ANTERIOR
AND POSTERIOR
burned?

22. Pathologic Features

23. Zones of injury
• Zone of coagulation (necrosis): Superficial area of coagulation
necrosis and cell death on exposure to temperatures >450 (primary
injury). Most damaged
• Zone of stasis (vascular thrombosis): Local capillary circulation is
sluggish, depending on the adequacy of the resuscitation, can
either remain viable or proceed to cell death (secondary injury)
• Zone of hyperemia (increased capillary permeability):minimal
injury , fully recover overtime.

24. Effect of burns
• Local
• Regional
• Systemic

25. Local effect of burns
• Causes tissue damage and inflammation ,
infection
• Can be colonized by microorganism within 24-
48hrs
• Can lead to local wound to regional infection

26. Regional effect in burns
• Severe burns
• Gross edema in the affected region and
swelling and tissue tension increased
• Circulation may be compromised
• Leads to venous obstruction
• Possibility of compartment syndrom at
affected part

27. Pathophysiology
Heat causes coagulation necrosis of skin and
subcutaneous
tissue
↓
Release of vasoactive peptides
↓
Altered capillary permeability
↓
Loss of fluid → Severe hypovolemia
↓

28. Decreased cardiac → Decreased myocardial
output function
↓
Decreased renal blood → Oliguria
flow (Renal failure)
Altered pulmonary resistance causing
pulmonary edema
↓
Infection
↓
Systemic inflammatory response syndrome (SIRS)
↓
Multiorgan dysfunction syndrome (MODS).

30. Burn Pathophysiology: Edema
• Injured tissue  Increased permeability of entire
vascular tree  loss of water, electrolytes and
proteins from the vascular compartment  severe
hemoconcentration
• Protein leakage  resultant hypoproteinemia,
increased osmotic pressure in the interstitial space
• Decreased cell membrane potential cause inward
shift of Na+ and H2O  cellular swelling
• In the injured skin, effect maximal 30 min after the
burn but capillary integrity not restored until 8-12
hours after, usually resolved by 3-5 days
• In non-injured tissues, only mild and transient
leaks even for burns >40% BSA

31. Burn Pathophysiology: Cardiac
• Cardiac output decreases due to:
1) Decreased preload induced by fluid shifts
2) Increased systemic vascular resistance caused
by both hypovolemia and systemic
catecholamine release
3) A myocardial depressant factor has been
described that impairs cardiac function
• Cardiac output normal within 12-18 hours, with
successful resuscitation
• After 24 hours, it may increase up to 2 ½
times the normal and remain elevated until
several months after the burn is closed

32. Burn Pathophysiology: Blood
• The red-cell mass decreases due to direct losses
• Immediate, 1-2 hours after, and delayed, 2-7 days
postburn, hemolysis occurs due to damaged cells
and increased fragility
• Anemia within 4-7 days is common and expected,
typically, will persist until wound healing occur;
depressed erythropoietin levels documented
• Early mild thrombocytopenia (sequestration)
followed by thrombocytosis (2-4x normal) and
elevated fibrinogen, factor V and factor VIII levels
commonly by end of the 1st week
• A “normal” platelet or fibrinogen level may be an
early sign of disseminated intravascular coagulation
• Persistent thrombocytopenia is associated with
poor prognosis -- suspect sepsis

33. Burn Pathophysiology: Metabolic
• Severe catabolism with breakdown of muscle
protein for gluconeogenesis as acute response
• Prostaglandins and cytokines implicated in
increased core temperature of 1-20 C and in
initiating acceleration of nitrogen catabolism
• Plasma levels of catecholamines, glucagon and
cortisol all increase, maximal in patients with 50-
60% TBSAB, while insulin and thyroid hormone
levels decrease
• Hypermetabolic response may approach 200% of
BMR remaining elevated for months after burn
closed
• Early enteral feeding associated with lessening of
the hypermetabolic response

34. Burn Pathophysiology: Renal
• Renal blood flow and GFR decrease soon after
due to hypovolemia, decreased cardiac output,
and elevated systemic vascular  oliguria and
antidiuresis develops during 1st 12-24 hours
• Followed by a usually modest diuresis as the
capillary leaks seal, plasma volume normalizes,
and cardiac output increases after successful
resuscitation and coinciding with onset of the
postburn hypermetabolic state, and
hyperdynamic circulation

35. Burn Pathophysiology: Immunologic
• Mechanical barrier to infection is impaired because
of skin destruction
• Immunoglobulin levels decreased as part of general
leak and leukocyte chemotaxis, phagocytosis, and
cytotoxic activity impaired
• The reticuloendothelial system's depressed
bacterial clearance is due to decreases in opsonic
function
• These changes, together with a non-perfused,
bacterially-colonized eschar overlying a wound full
of proteinaceous fluid, put the patient in a
significant risk for infection

36. GIT
• burnsmucosal atrophy
decreased absorption & increased
intestinal permeability
increased bacterial translocation
septicemia

37. GIT
Acute gastric dilatation which occurs in 2-4 days.
 Paralytic ileus.
 Curling’s ulcer.
 Acute acalculous cholecystitis, acute
pancreatitis
 Abdominal Compartment syndrome

38. Pulmonary system
• Minute ventilation often normal or slightly
decreased
• Pulmonary vascular resistance may increase
• Inhalation injury: in inhalation injury oxygen
molecules are displaced, CO binds to
haemoglobin to form oxyhemoglobin.
• Direct heat injury to the upper airway result in
edema, erythema and ulceration.

39. CLINICAL MANIFISTATION
• DEGREE OF INJURY
1.First degree injury: painful, appear red
• Eg : sun burn
2.Second degree injury: blister and painful
3.Third degree injury: dry moltted and colored black,
red, brown, white.
• Eschar=denatured skin
• Scarring
4. Fourth degree injury :charred or competely burned

40. Cont..
• Hypothermia
• Fluid and electrolyte imbalance
- Decrease urine output
- Poor skin integrity
- Hyponatermia and hypernatermia
- Hyperkalemia
- Hematocrit level increase in 1st 24hr
- Elevated BUN
- Oligouria
- Decreased GI motility
- (Later weeks diuresis starts after fluid resuscitation)

41. • In respiration
- Tachypnea, dyspnea
- Clinical mainifestation of CO poisioning
CO level %
5-10 impaired visual acuity
11- 20 flushing, headache
21-30 nausea, impaired dexterity
31-40 vomitting,dizziness, syncope
41-50 tachypnea, tachycardia
>50 coma, death
• In cardiac
- HR and peripheral vascular resistance increases
- Decreased blood pressure
- Weak peripheral pulses
• Altered level of consciousness

42. First Aid Measures in Burns
1. Extinguish flames by rolling in the ground, cover
child with blanket, coat or carpet
2. After determining airway is patent, remove
smoldering clothes and constricting accessories
during edema phase in the 1st 24-72 hours after
3. Brush off remaining chemical if powdered or solid
then wash or irrigate abundantly with water
4. Cover burn wounds with clean, dry sheet and
apply cold (not iced) wet compresses to small
injuries; significant burns (>15-20% BSA)
decreases body temperature which
contraindicates use of cold compress dressings
5. If burn caused by hot tar, mineral oil to remove it

43. Outpatient Management
• For 1st and 2nd degree burns less
than 10% BSA
• Blisters should be left intact and
dressed with silver sulfadiazine
cream
• Dressings should be changed daily
washing with lukewarm water to
remove any cream left

44. Recommendations for Hospitalization
1. Total burns
2. Hands, face, feet or genitalia involved
3. Evidence or suspicion of inhalation injury
4. Associated injuries present
5. Suspicion that burn inflicted
6. Burn is infected
7. Burn circumferential
8. History of prior medical illness
9. Patient is comatose
10.Patient or family unable to cope with
situation

45. Hospital Management
1. General assessment and
cardiopulmonary stabilization
2. Resuscitation
3. Establishment of IV lines and blood
studies
4. Wound care and infection control
5. Pain relief and psychological support
6. Nutritional support
7. Physical Therapy/Occupational
Therapy

46. Burns management
• RESUSCITATIVE PHASE
• ACUTE PHASE
• REHABILITATION PHASE

47. RESUCSCITATIVE PHASE
• Phase between initial injury and 36 to 48hr
• End once fluid resuscitation is done
1. Assess burn severity
depth, size, location, age, general health, mechanism of
injury
2. Monitor airway and breathing
3. Prevent burn hypovolemic shock
4. Prevent aspiration
5. Minimize pain and anxiety
6. Wound care
stop burning process, immediate care, prevent tetanus,
prevent tissue ischemia, transport to burns facilities.

48. Fluid and electrolyte changes RP
• General dehydration
• Reduction of blood volume
• Decrease urinary output
• Excess potassium
• Sodium deficit

49. On the scene care
• Circulation, airway , Breathing, to be
maintained
• Neurological assessment is to be done
• Maintain client vitals till the medical help
arrives

50. Initial Procedures
• Administer oxygen and maintain airway
• Fluid infusion must be started immediately
• NGT insertion to prevent gastric dilatation,
vomiting and aspiration, suction to be done
• Urinary catheter to measure urine output
• Weight important and has to be taken daily
• Local treatment delayed till respiratory
distress and shock controlled
• Hematocrit and bacterial cultures
necessary

51. Fluid Resuscitation
• For most, Parkland/Baxter formula a suitable starting guide
= 4 ml Ringer’s Lactate × kg body weight × % BSA burned,
½ to be given over 1st 8 hr from time of onset, while remaining over the next
16 hr
• During 2nd 24 hr, ½ of 1st day fluid requirement to be infused as D5LR
• Oral supplementation may start 48 hr after as homogenized milk or soy-
based products given by bolus or constant infusion via NGT
• Albumin 5% may be used to maintain serum albumin levels at 2 g/dl
• Packed RBC recommended if hematocrit falls below 24% (Hgb <8 g/dl)
• Sodium supplementation may be needed if burns greater than 20% BSA

52. Other formulas
• Consensus formula
RL sol: 2-4ml x kg bd wt x %TBSA
Half in first 8hr, remaining in 16rs
• Brooke army formula
Colloids : 0.5ml x kg bd wt x %TBSA
RL: 1.5ml x kg bd wt x %TBSA
Glucose(5% water): 2000ml for insensible water loss
Day 1 : 8hr half of fluid, remaining in next 16 hr
Day 2 : half of colloid, electrolyte and insensible water
loss

53. Goals of fluid replacement therapy
• Monitor urine output an index of renal
perfusion
• 30 to 50 ml/hr
• Systolic blood pressure exceed 100mmhg
• PR= 110b/m
• Within 24hr hematocrit and Hb level decreases
• Sodium level is maintained
• Serum lactate levels is decreased

54. NURSING MANAGEMENT
• Impaired gas exchange r/t carbon monoxide
poisoning
-Provide humidified oxygen
-assess the breath sound,rate and sign of
hypoxia
- Monitor ABG values
- Be prepared for intubation

55. Fluid volume deficit r/t evaporation
from the burn wound
• Observe the vital sign , cvp, urine output
and sign for fluid volume overload
• Monitor and chart urine hourly
• Maintain i/v line and administer fluid as
prescribed
• Elevate the burn extrimities
• Notify the physician if abnormality is
observed

56. • Hypothermia r/t open wound and loss of skin
microcirculation
• Pain r/t tissue and nerve injury
• Anxiety r/t fear and emotional impact of burn
injury
• Risk for infection r/t decrease immune system

57. Acute phase management
• Begins when client is hemodynamically stable
• Capillary integrity is restored and diuresis has begun
• Begins appox. 48 to 72 hr after injury
• Continues till the wound closure
1. Prevent infection
2. Provide metabolic support
3. Minimize pain
4. Provide wound care( wound cleaning, debridement, topical
antimicrobial treatment, maximize functioning,
5. Provide psychological support
6. Provide surgical management
for full thickness burns- autografting is done( split thickness,
meshed, sheet)

58. Fluid and electrolyte changes in acute
phase
• Hemodilution (decrease hematocrite)
fluid enters the intravascular compartment loss of blood
cell at destroyed burn site
• Increase urinary output
fluid shift increases the renal blood flow and causes urine
formation
• Sodium deficit
with diuresis sodium is lost and serum is diluted by water
influx

59. Cont..
• Potassium deficit
on 4 or 5 day potassium shift from extracellular fluid into cells
• Metabolic acidosis
loss of sodium depletes fixed base, relative carbon dioxide
content increases

60. • X-ray and ABG analysis is to be done to see the
effect in ling tissue
• Assessment of the respiratory system
• Continuation of fluid with caution(overload fluid)
• Acetaminophne for fever and provide
hypothermic blanket to maintain temperature
• Avoidance of invasive i/v catheter unless
essential

61. Infection prevention
• Topical antimicrobial agent
• Systemic antibiotic to be administer only after
c/s of specific organism and systemic sepsis is
• Infection control of the surrounding
• Dressing via sterile or clean technique
• Start early eternal feeding to decrease
intestinal permeability and prevent endotoxin
intestinal translocation

62. Wound cleaning
• Hydrotherapy
• Water temp 37.8 degree
• For 20-30min
• Gently pat with towel
• Prevents pathogens from overwhelming proliferation and
invasion in the deeper tissue
• Before hydrotherapy pt is assessed for vitals, hemodynamic
stability, pain unrelieved by analgesic

63. Topical antibacterial therapy
• Reduces the number of bacteria
• Penetrate Escher and effective
• Cost effective
• Silver is bactericidal and bacterstatic properties
• Silver sulfadiazin, silver nitrate, mafenide acetate
• Silver dressing can also be used silverlon, acticoat
• Bacterial culture is to be done
• Before reapplying clean the previous application

64. Wound dressing
• Topical application is applied and covered with several layer
of dressing
• Light dressing is used over the joints
• Functional body alignment position maintained using splint
• In face leave the area for mouth, nose and eye
• Exercise regimen to be followed before reapplying of
dressing
• Done after hydrotherapy, administration of analgesic 20min
before the dressing
• Universal precaution is used during dressing
• Loose eschar are removed

65. Escharotomy
• In extensive full thickness burn a hard thick
eschar can combine with massive edema
cause torniquet effect
• Leads to impair circulation , impairment, loss
of sensation and motor function
• Relieved by a surgical incision through
constriction eschar = escharotomy
• Fasciotomy is an incisional through a fascia to
relieve pressure that would otherwise
compromise circulation

67. Wound debridement
• Debris delays the epithelization process
• Its done remove contaminated tissue,
protecting from invasion of infection and
remove eschar and prepare for grafting
• Types
1. Natural debridement
2. Mechanical debridement
3. Surgical debridement

68. Natural debridement
• Death tissue separate spontaneously
• Bacteria present on interface liquefy the fibrils
of collagen underneath the burned tissue
post burn week 2-3
• Antibacterial agent slows this process
• Other method of debridement can be used

69. Mechanical debridement
• Use of surgical instrument to remove debrides
• Done by skilled person
• Cleaning and dressing is done daily
• Hemostatic agent are used
• Topical debridement agent are used(no
antimicrobial properties)
• Silver metal agent deactivate topical
debridement agent so separate dressing used

70. Surgical debridement
• Surgical removal of devitalized tissue and wound closure
• Surgical removal of the tissue or full thickness of the skin down
the fascia or shaving of burned skin layer gradually down to
free bleeding , viable tissue
• Its done once the pt is hemodynamically
stable and edema has decreases
• Covered immediately with graft or occlusive dressing is done
• Risk of extensive blood loss, if done timely and in effective
manner shorten the hospital stay and risk of sepsis

71. Wound grafting
• Done in deep or full thickness burns where
reepithelialization is not possible
• Purpose :
decrease infection risk
prevent loss of protein, fluid and electrolyte
minimize fluid loss through evaporation
• Mainly done in face, functional area and joints
• If not ready for skin grafting , Burn wound is
excised and allowed for granulation

72. Types of wound grafting
• Biological dressing(homo and hetero graft)
• Biosynthetic and synthetic dressing
• Auto graft
• Dermal substitutes

73. Biological dressing
• Commonly used in extensive burns where normal skin is less and
provides coverage till granulation
• Used to debride wound after eschar separation
• Speed up healing
• Stay for varying length till cases of infection or rejection
• Homograft(allograft)= same species living or deceased(amniotic
membrane)= good vascularization
• Heterograft(xenograft)= different species(eg:pig)= dnt vascularize,
remain adhere provide pain control

75. Biosynthetic and synthetic dressing
• Widely used synthetic dressing
• Biobrane is composed of nylon, silastic
membrane combined with collage derivative
• Its semi transparent and sterile
• Protect the wound from fluid loss and
bacterial invasion
• Biobrane adhere to wound with in 5 days and
remain for 3-4 week
• It can be removed once epithelialization and
healing occurs

76. • BCG matrix is temporary wound covering
combines beta gulcan, complex carbohydrate
with collagen in mesh
• Stimulate macrophages
• Partial thickness burn and at donor site(use)
• Polyurethane elastic flim is also used which is
waterproof but permeable to water vapour
and air

77. Dermal substitues
• Product for wound covering
• Enhances the healing of open wound where
autologous skin is limited
• Integra artifical skin and alloderma are two
product
• Artificial skin integra= two layer
• Epidermis= silicon
• Dermis = animal collagen

78. • Allow migration of fibroblast and capillaries
into material
• It becomes permanent structure , epidermis
silicon removed after 2 week
• Replaced with pt skin epidermal skin graft
• It quickens healing and prevents contracture
formation and cosmetic qulaities

79. Alloderm
• Processed form dermis of human cadaver skin
• Used for dermal layer of skin graft
• Its used in the donor site as replacement of
dermal layer
• Epithelial graft of patient is only done to cover
dermal layer
• Resulted in less scarring and contracture
formation

80. Autograft
• Preferred material for burn wound closure
• Graft can be taken as split thickness, full
thickness, pedicle flap or epithelial graft
•

81. Pedicle flap

82. Cultured epithelial autograft
• Biopsy of unburned area
• Keratocytes isolated and cultured
• Provides coverage for large wound and
autografting is not option
• The grafts are thin, fragile and shear easily
• Use is very limited only used when donor sites
are limited

83. Care of graft site
• Occlusive dressing for immobilization of graft
• Clean with sterile saline and assess in first
dressing i.e. 2-5 days
• Avoid pressure on graft
• Elevate the grafted site to decrease edema
• Start exercise the grafted area after 5 to 7
days under the supervision of physiotherapist

84. Donor site care
• Moist guaze application
• Stop oozing
• Thrombostatic agent can be applied
• Dressing material such as biobrane, BCG
matrix can be used
• No pressure on donor site
• Heals spontaneously

85. Pain management
• Pain is inevitable during recovery from any
burn
• 3 types of pain repoted by pt
• Background pain: 24 hr pain
• Procedural pain : manipulation of wound
• Breakthrough out pain: blood level of
analgesic agents decrease below required
level

86. Medication
• Opoid I/v administration
• Morphin
• Fentanyl
• Patient controlled analgesic
• Anxolytic : medazolam, lorazepam

87. Nutritional support
• Goal of nutrition is to promote sate of positive
nitrogen balance by optimum nutrient
utilization
• protein requirement= 1.5 to 4gm/kg of bdy
wt every 24 hr
• Carbohydrate = 5000calories/ day
• Lipids to be included
• Indirect calorimeter can be used to assess
nutritional requirement

88. • Enternal feeding can be started as soon as possible
• If oral high calorie and high protein meals and
supplement are given
• Additional vitamin supplements
and minerals can be given
• Hypermetabolic effect= oxandrolone
An anabolic steroids, can be used
• Assess for Risk of infection via
parentral route and curling ulcer is present in
acute phase

89. Nutritional Support
• Shriners Burn Institute at Galveston,
Texas Guidelines for Caloric Intake
Infants
1000 kcal/m2 BSA burned +
2100 kcal/m2 total BSA
2-15 years
1300 kcal/m2 BSA burned +
1800 kcal/m2 total BSA
Adolescents
1500 kcal/m2 BSA burned +
1500 kcal/m2 total BSA

90. Disorder of wound healing
• Hypertrophic scar
• Hypertrophic keloid
• Failure to heal
• Contracture formation

91. Nursing diagnosis
• Excessive fluid volume r/t resumption of capillary integrity
and fluid shift from interstitial compartment to intravascular
compartment
• Risk of infection r/t loss of skin barrier
• Imbalanced nutrition less than body required r/t hyper
metabolism and wound healing need
• Acute pain r/t exposed nerves
• Ineffective coping r/t fear of dependency on health care
providers
• Deficient knowledge r/t course of burn injury

92. Rehabilitation phase management
• Final phase of recovery
• Encompass from the time from wound closure to
discharge and beyond
• Over laps the acute phase
1. Minimizes the function loss
2. Provide psychological and psychosocial support

93. Complication
1.Neuropathies
2. Heterotrophic
ossificatio
1. Assess peripheral pulse and
sensation, prevent edema
pressure by elevation, postioning
and constritictive dressing, splint
can be used, OT or PT can be
consulted
2. Gentle range of motion exercise

94. Cont..
3. Hypertrophic
scarring
4. Contracture
5. Wound
breakdown
3. Keep skin pliable and soft,
massage and pressure garment as
prescribed
4. Maintain Position of alignment
of joints, range of motion
exercise, consult to
physiotherapist
5. Teach about importance of
good nutrition
Protect wound from pressure and
shearing forces

95. Cont..
• Gait deviation
• Complex regional pain
• Joint stability
• Provide adequate pain
management, consult OT
and PT, ambulatory and
mobility training
• pain management,
Consult OT PT, gental
motion of affected region
• Appropriate pin fixing,
and splinting, consult OT
and PT

96. Nursing diagnosis
• Activity intolerance r/t pain on exercise, joint
immobility and limited endurance
• Disturbed body image r/t altered physical
appearance and self concept
• Deficit knowledge r/t post discharge home
care and follow up

97. B - Breathing
Body image
U - Urine output
R - Rule of nines
Resuscitation - Fluid
N - Nutrition
S - Shock
Silver sulfa diazene

98. Only those who will risk
going too far, can possibly
find out how far one can go.
-- T. S. Elliott