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Burns Nursing Overview | Rule of Nines, Types, Causes, Care



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Burns is an injury to the skin or other organic tissue primarily caused by a given energy source.
Causes of burns include
Thermal (heat) from hot liquids, steam or flames. Commonest.
Electrical-there is tissue damage and body dysfunction caused by electric current. Electrical burns lead to heart dysrhythmias, bone fractures, cervical spine, and acute tubular necrosis.
Chemical burns-results from toxic substances like powders via contact to the body
Cold- due to excessive prolonged exposure to extremely low temperatures like in frostbite.
Radiations such as prolonged exposure to x-rays, sun or during radiotherapy
Friction rubs like in road traffic accidents or falls.
The severity of burns depends on the degree of the burn, extent of body surface injured (rule of nine), location of burn on the body, patient's age, pre-burn medical history and complicating factors.
Burns can be classified into-
First Degree (superficial): damage of the skin limited to the epidermis. The skin remains intact but appears red or pink in the complexion, warm to touch and remains painful. There are usually no accompanying blisters. Capillary refill is less than 2 seconds.

Second degree (partial-thickness): Involves the epidermis and dermis. The wound is characteristically moist/wet and red with swelling. The pain is excruciating, and there can be accompanying blisters or sloughing of the skin.

Third degree (Full-thickness) burns- affect the dermis, epidermis and hypodermis. The burn can be yellow, red, and black. It is usually dry as opposed to being moist/wet. Pain sensation may be absent or, if present, reduced. It requires surgical intervention like skin grafting.

Fourth degree (deep full-thickness): The epidermis, dermis, and hypodermis/subcutaneous tissue are damaged; injury can penetrate deep into the muscles, tissues or underlying organs. The affected region resumes charred or black complexion. Pain sensation is absent.
Clinicians should be on the lookout for eschar (hard dead tissue restricting blood circulation and respiration) and acute tubular necrosis (due to myoglobin and hemoglobin release into the circulation) in patients having third to fourth-degree burns; these are usually the potential complications and can be fatal. Moreover, awareness of the location and the shape of the burns is critical. Circumferential burn circles around an area of the body and are most hazardous on the torso and extremities.

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