Burns- Final Copy

8/4/2019 Burns- Final Copy

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MINDANAO SANITARIUM AND HOSPITAL COLLEGEBrgy., San Miguel, Iligan City, 9200

SCHOOL OF NURSING

AY 2009-2010

BURNS

Submitted by:

Suello, Harleyquin G. BSN 2C

Siglos, Justerine Jade T. BSN 2BTaneo, Abigaile T. BSN 2D

Submitted to:

Karla B. Orbeta, RN


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Introduction

INTRODUCTION:

Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals. It is

usually caused by heat (thermal burns), such as fire, steam, tar, or hot liquids. Burns

caused by chemicals are similar to thermal burns, whereas burns caused by radiation,

sunlight and electricity tend to differ significantly.

Thermal and chemical burns usually occur because heat or chemicals contact part of the

bodys surface, most often the skin. Thus, the skin usually sustains most of the damaged.

However, severe surface burns may penetrate to deeper body structures, such as fat,

muscle, or bone. When tissues are burned, fluid leaks into them from the blood vessels,

causing swelling and pain.In addition, damaged skin and other body surfaces are easily

infected because they can no longer act as a barrier against invading organisms.

Classification:

Doctors classify burns according to strict, widely accepted definitions. These definitions

may not correspond to a persons understanding of those terms.

The depth of injury from a burn is described as first, second, or third degree. First degree

burns are the most shallow (superficial). They affect only the top layer of the skin

(epidermis). Second degree burns extend into the middle layer of the skin (dermis). Third

degree burns involve all three layers of skin (epidermis, dermis and fat layers), usually

destroying the sweat glands, hair follicles and nerve endings as well.

Burns are classified as minor, moderate, or severe. The severity determines how they

are predicted to heal and whether complications are likely. Doctors determine the severity

of the burn by estimating the percentage of the body surface that has been burned. Special

charts are used to show what percentage of the body surface various body parts comprise.

Symptoms and Diagnosis:

First degree burns are red, moist, swollen, and painful. The burned area whitens

(blanches) when lightly touched but does not develop blisters. Second degree burns are

red, swollen, and painful, and they develop blisters that may blanch when touched. Third

degree burns usually are not painful because the nerves have been destroyed. The skin

becomes leathery and may be white, black, or bright red. The burned area does not blanch

when touched, and hairs can easily be pulled from their roots without pain. No blisters

develop. The appearance and symptoms of deep burns can worsen during the first hours or

even days after the burn.

Treatment:

Before burns are treated, the burning agent must be stopped from inflicting further


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damage. For example, fires are extinguished. Clothing- especially any that is smoldering

(such as melted synthetic shirts), covered with hot tar, or soaked with chemicals is

immediately removed. Hospitalization is sometimes necessary for optimal care of burn

injuries.

Superficial Minor Burns are immersed immediately in cool water if possible. The burn is

carefully cleaned to prevent infection. If dirt is deeply embedded, a doctor can give

analgesics or numb the area by injecting a local anesthetic and then scrub the burn with a

brush. Often, the only treatment required is application of an antibiotic cream, such as silver

sulfadiazine. The cream prevents infection and forms a seal to prevent further bacteria from

entering the wound. A sterile bandage is then applied to protect the burned area from dirt

and further injury. A tetanus vaccination is given if needed. Care at home includes keeping

the burn clean to prevent infection. In addition, many people are given analgesics, often

opoiod analgesics, for at least a few days. The burn can be covered with a nonstick

bandage or with sterile gauze. The gauze can be removed without sticking by first being

soaked in water.

Deep Minor Burns - As with more superficial burns, deep minor burns are treated with

antibiotic cream. However, any dead skin and broken blisters must be removed before the

antibiotic cream is applied. In addition, keeping a deeply burned arm or leg elevated above

the heart for the first few days reduces swelling and pain. The burn may require frequentre-examination at a hospital or doctors office, possibly as often as daily for the first few

days.

A skin graft may be needed. Most skin grafts replace the burned skin. Other skin grafts

help by temporarily covering and protecting the skin as it heals on its own. In a skin grafting

procedure, a piece of healthy skin is taken from unburned area of the persons body

(autograft), from another living or dead persons body (allograft), or from other species

(xenograft) usually pigs because their skin is most similar to human skin. The skin graft is

surgically sewn over the burned area after removing any dead tissue and ensuring that the

wound is clean. Autografts are permanent. Allografts and xenografts, however, are rejected

after 10 to 14 days by the persons immune system. Physical and occupational therapy

usually are needed to prevent immobility caused by scarring around the joints. Stretching

exercises are started within the first few days after the burn. Splints are applied to ensure

that joints are likely to be immobile rest in positions that are least likely to lead to

contractures. The splints are left in place except when the joints are moved.

Severe Burns. Severe, life threatening burns require immediate care. Dehydration is

treated with large amounts of fluids given intravenously. A person who has gone into shock

as a result of dehydration is also given oxygen through a face mask. Destruction of muscle

tissue is also treated with large amounts of fluids given intravenously. The fluids dilute the

myoglobin in the blood, preventing extensive damage to the kidneys. Sometimes a

chemical, sodium bicarbonate, is given intravenously to help dissolve myoglobin and thus

also prevent further damage to the kidneys. Eschars that cut off blood supply to an


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extremity or that impair breathing are cut open in a surgical procedure called escharotomy.

Escharotomy usually causes some bleeding, but because the burn causing the eschar has

destroyed the nerve endings in the skin, there is a little pain. Keeping the burned area

clean is important, because the damaged skin is easily infected. Cleaning may be

accomplished by gently running water over the burns periodically. Wounds are cleaned and

bandages changed 1 to 3 times per day.

RULE OF NINES:

FLUID RESUSCITATION

Parkland Formula:

Total fluid requirement for 24 hours = 4 ml of LR solution x % of total body surface area


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burned x body weight in kilograms

NOTE: First 8 hours: half of the total

2nd 8 hours: of the total

3rd 8 hours: of the total

ASSESSMENT FORMAT

Physical Assessment

Systems Inspection Auscultation Percussion Palpation

CNS pain painIntegumentary Eschar formation

Dry skin

Poor skin turgor

Cool, clammy skin

Presence of edema

Swelling

Poor skin

turgor

Cool,

clammy skin

Respiratory Difficulty of

breathingUse of accessory

muscles

Increased effort in

breathing

Tachypnea

Adventitiousbreath sounds

Cardiovascular Prolonged capillary

refill

Hypotension

Tachycardia

Dysrhythmia

Strong

pulses

Metabolic Hyperglycemia

Hyponatremia

hyperkalemia

GUT Oliguria

musculoskeletal Limited ROM

Deeply charredsubcutaneous

tissue, muscle and

bone tissue

Limited motion of

the neck

Muscle weakness


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mouth Dry oral mucousa

Dry lips

NORMAL ANATOMY AND PHYSIOLOGY

NORMAL ANATOMY AND PHYSIOLOGY

Our skin is the largest organ of the human body. The integument or skin makes up

15% to 20% of the bodys weight. Intact skin is the bodys primary defense system. It


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protects us from invasion by organisms, helps to regulate body temperature, manufactures

vitamins and provides our external appearance. skin has three primary layers (i.e.,

epidermis or outer layer; the dermis or inner layer and the hypodermis or subcutaneous

layer) as well as epidermal appendages (i.e., eccrine glands, apocrine glands, sebaceous

glands, hair follicles and nails).

The skin is the most prominent organ containing epithelium, which is composed of

cells that provide a continuous barrier between the body contents and the outside the

environment. Epithelial cells also cover the Gastrointestinal tract, pulmonary airways and

alveoli, renal tubules and the urinary system, and the ducts that empty onto the surface of

the skin of the GI and respiratory systems. Epithelial cells allow the selective transport of

ions, nutrients, and metabolic wastes and have a permeability to water that is partially

regulated.

Structure of the Integumentary System

EPIDERMIS

The epidermis consists of four distinct layers: the stratum corneum, the stratum

granulosum, the stratum spinosum and the stratum basale. The stratum corneum is the

outermost covering and consists of 15-20 layers. Stratum granulosum consists of flattenednucleated cells containing distinctive cytoplasmic inclusions called keratohyalin granules.

Stratum spinosum is comprised of several layers of a polyhedral type cell that lie above the

germinal layer of cells.stratum basale is germinative layer of the epidermis.

The epidermis is the thin, stratified layer that is in direct contact with the external

environment. The thickness of the epidermis ranges from 0.04mm on the eyelids to 1.6mm

on the palms and soles. Desmosomes (point of intracellular attachment that are vital for


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cell-to-cell adhesion) are found in the epidermis. Keratinocytes, the principal cells of

epidermis, produce keratin in a complex process. The cells begin in the basal layer and

change constantly, moving upward through the epidermis. On the surface, they are

sloughed off or lost by abrasion. Thus the epidermis constantly regenerates itself, providing

a tough keratinized barrier.

Epidermal appendages

Epidermal appendages are down growths of epidermis into the dermis. They consist

of eccrine glands, apocrine glands, sebaceous glands, hair and nails.

Eccrine glands- produce sweat and play an important role in the thermoregulation. They

are more numerous on the palms, soles, forehead and axillae. These are stimulated by

heat as well as by exercise and emotional stress. The eccrine gland also responds to

sympathetic and parasympathetic stimulation.

Apocrine glands- occur primarily in the axillae, breast, areolae, anogenital area, ear canals,

and eyelids. Mediated by adrenergic innervations, secrete a milky substance that becomes

odoriferous when altered by skin surface bacteria.

Sebaceous glands- are found throughout the skin except on the palms and soles and are

most abundant on the face, scalp, upper back, and chest. Androgen is responsible for

sebaceous gland development.

Hair- is a nonviable protein end product found on all skin surfaces except the palms andsoles. About 50-100 hairs are lost each day.

Nails- are horny scales of epidermis. The nail matrix is the source of specialized,

nonkeratinized cells. They differentiate into keratinized cells, which make up the nail

protein. A damaged nail matrix, which may result from trauma or aggressive maincuring,

produces distorted nail.

DERMIS

The dermis, a dense layer of tissue beneath the epidermis, gives the skin most of its

substance and structure. The dermis contains fibroblasts, macrophages, mast cells and

lymphocytes. The skins lymphatic, vascular, and nerve supplies, which maintain

equilibrium in the skin, are in the dermis.

The dermis is divided into two parts: papillary and reticular. The papillary dermis,

which contains increased amounts of collagen, blood vessels, sweat glands, and elastin, is

in contact with the epidermis. The reticular dermis also contains collagen but with increased

amounts of mature elastic tissue. The dermis houses many specialized cells, blood

vessels, and nerves.

Dermis - Specialized Structures

Nerve endings

Blood vessels

Sweat glands


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Oil glands - keep skin waterproof, usually discharges around hair shafts

Hair follicles - produce hair from hair root or papilla

Each follicle has a small muscle (arrectus pillorum) which can pull the hair upright and

cause goose flesh

HYPODERMIS

The subcutaneous layer is a specialized layer of connective tissue. It is sometimes

called the adipose layer because of its fat content. This layer is absent in some sites, such

as eyelids, scrotum, areola and tibia. Subcutaneous fat is generally thickest on the back

and buttocks, giving shape and contour over the bone. This layer functions as insulation

from extremes of hot and cold, as a cushion to trauma, and as a source of energy and

hormone metabolism.

FUNCTION OF THE INTEGUMENTARY SYSTEM

PROTECTION

The skin protects the bodys against many forms of trauma. The intact tough

epidermal layer is a mechanical barrier. Bacteria, foreign matter, other organisms and

chemicals penetrate it with difficulty. The oily and slightly acid secretions of its sebaceous

glands protect the body further by limiting the growth of many organisms.

HOMEASTASIS

Skin forms a barrier that prevents excessive loss of water and electrolytes from the

internal environment and also prevents the subcutaneous tissues from drying out. The

effectiveness of this impermeable membrane is readily recognized when one observes the

extreme loss of fluids that occurs with damage to the skin, as with burns and other injuries.

Insensible loss of water and electrolytes occurs only though pores in this effective barrier.

THERMOREGULATION

Body temperature represents the balance between heat regeneration and heat loss

processes. The skin, with its ability to alter the rate of heat loss, is the major point of

regulation of body temperature. The rate of heat loss depends primarily on the surface

temperature of the skin, which is in turn a function of the skins blood flow.

The flow of blood to the skin is derived in two processes. Direct perfusion is from

capillary beds entering in lateral directions. Skin is also perfused vertically from vessels that

enter from the muscle and fascia supporting it.

In general, the vessels dilate during warm temperatures and constrict during cold.The hypothalamus is partly responsible for regulating skin blood flow, particularly to the

extremities, the face, ears, and the tip of the nose. Maintenance of the thermal balance

allows the internal temperature of the body to remain at approximately 37 degree Celsius.

SENSORY PERCEPTION

Apart from sight and hearing, the major human sensory apparatus is in the skin.

Sensory fibers responsible for pain, touch and temperature form a complex network in the


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dermis. The skin contains specialized receptors to detect discriminative touch and

pressure. Touch is sensed by Meissners corpuscles; pressure by Merkel cells and Ruffini

endings; vibration by Pacinian corpuscles; and hair movement by hair follicle endings.

A second grouping of nerves communicates information about temperature and pain

to the somatosensory cortex via the anterolateral pathways. Temperature is sensed by

specific thermoreceptors in the edpidermis, and pian is sensed by free nerve endings

throughout the edpidermal, dermal, and hypodermal layers.

VITAMIN D REPRODUCTION

The epidermis is involved in synthesis of vitamin D. In the presence of sunlight or

ultraviolet radiation, a sterol found on the malpighian cells is converted to form

cholecalciferol (Vitamin D3). It assists in the absorption of calcium and phosphate from

ingested foods.

PROCESSING OF ANTIGENIC SUBSTANCES

Langerhans cells are scattered among the keratinocytes located primarily in the

epidermis; however, they can also be seen in the dermis. These cells originate in the bone

marrow and migrate to the epidermis. Langerhans cells play a role in the cell-mediated

immune responses of the skin through antigen presentation.

Cells in both the epidermis and dermis of the skin are important in the immune

function. Skin is now recognized not only as a physical barrier but also as a participant inimmunologically mediated defense against various antigens.

TYPES OF BURNS

A. Thermal Burns

- caused by exposure to flames, hot liquids, steam or surfaces

B. Chemical Burns

- caused by tissue contact with strong acids, alkalis and organic compounds

- systemic toxicity from cutaneous absorption can occur

C. Electrical Burns

- caused by great heat generated by an electrical energy as it passes through

the body

- cutaneous burns cause muscle and soft tissue damage that may be

extensive,

particularly in high-voltage electrical injuries

D. Radiation Burns

- caused by exposure to ultraviolet light x-rays, radioactive source

BURN SIZE

A. Small Burns

- response of the body to injury is localized to the injured area.

B. Large or extensive burns

- consists of 25% or more of the total body surface area


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- the response of the body to the injury is systemic

BURN DEPTH

A. Superficial thickness Burn (First degree burn)

- mild to severe erythema (pink to red) is present but no blisters

- skin blanches with pressure

- burn is painful with tingling sensation

- pain is eased by cooling

- discomfort lasts about 48 hours; healing occurs about 3-7 days

- skin grafts are not required

B. Partial thickness superficial burn (Second degree burn)

- large blisters cover an extensive area

- presence of edema

- mottled red base and broken epidermis, with a wet, shiny, surface

- burn is painful

- heals in 2-3 weeks

- grafts may be used if healing process is prolonged

C. Full thickness burn (Third Degree burn)

- burn leaves a deep, red, black, white, yellow or brown area

- burn causes tissue disruption with fat exposed- burn causes little or no pain

- edema is present

- scarring and wound contractures are likely to develop without preventive

measures

- healing takes weeks to months

D. Deep full thickness burn (Fourth Degree burn)

- burn involves injury to the muscle and bone

- injured area appears black

- absence of pain

- no blisters are present

- eschar is hard and inelastic

- healing takes weeks to months

- grafts are required
http://upload.wikimedia.org/wikipedia/en/9/93/Burn_Degree_Diagram.svghttp://upload.wikimedia.org/wikipedia/en/9/93/Burn_Degree_Diagram.svg


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PHASES OF BURNS

A. Emergent Phase

- begins at the time of injury and ends with the restoration of the capillary

permeability,

usually at 48 to 72 hours following the injury

- 2rimary goal is to prevent hypovolemic shock and preserve vital organ

functioning

- includes prehospital care and emergency room care

B. Resuscitative Phase

- begins with the initiation of fluids and ends when capillary integrity returns to

near-normal

levels and the large fluid shifts have decreased

C. Acute Phase

- begins with the client is hemodynamically stable, capillary permeability is

restored and

diuresis has begun

- usually begins 48-72 hours after the time of injury

- this phase continues until wound closure is achieved

- the focus is on infection control, wound care, wound closure, nutritional

support, pain

management, and physical therapyD. Rehabilitative Phase

- final phase of burn care

- goes beyond hospitalization

- goal of this phase are designed so that the client can gain independence

and achieve maximal function

BODY SYSTEMS CONTRIBUTION TO THE INTEGUMENTARY SYSTEM

To all body

systems

Skin and hair provide barriers that protect all internal organs

from damaging agents in the external environment.

Sweat gland and skin blood vessels help regulate body

temperature needed for proper functioning of other body

systems.

Skeletal system Skin helps activate vit. D , needed for proper absorption ofthe dietary calcium and phosphorus to build and maintainbones.
http://upload.wikimedia.org/wikipedia/en/9/93/Burn_Degree_Diagram.svg


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Muscular system Skin helps provide calcium ions, needed for musclecontraction.

Nervous system Nerve endings in skin & subcutaneous tissue provide inputto the brain for touch pressure, thermal and painsensations.

Endocrine system Keratinocytes in skin help activate vit. D to calcitriol, ahormone that aids absorption of dietary calcium &phosporus

Lymphatic andimmune system

Skin is first line of defense in immunity, providingmechanical barriers and chemical secretions thatdiscourage penetration and growth of microbes; langerhanscells in epidermis participate in immune responses byrecognizing and processing foreign antigens; macrophagesin the dermis phagocytize microbes that penetrate the skinsurface.

Respiratory

system

Hair in nose filter dust particles from inhaled air; stimulation

of pain nerve endings in skin may alter breathing rate.Digestive system Skin helps activate vit. D to the hormone calcitriol, which

promotes absorption of dietary calcium and phosporus inthe small intestine.

Urinary system Kidney cells receive partially activated vit. D hormone fromskin and convert it to calcitriol; some waste products areexcreted from body in sweat, contributing to excretion byurinary system.

Reproductivesystem

Nerve ending in skin and subcutaneous tissue respond toerotic stimuli, thereby contributing to sexual pleasure;suckling of a baby, stimulates nerve endings in skin, leading

to milk ejection; mammary gland (modified sweat glands)produce milk; skin stretches during pregnancy as fetusenlarges.

Cardiovascularsystem

Local chemical changes in dermis cause widening andnarrowing of skin blood vessels, which help adjust bloodflow to the skin.

PATHOPHYSIOLOGY OF BURNS

Precipitating Factors: Predisposing Factors:

Chemicals Age: Affects all ages; more severe in

Thermal infant and elderly

Radiation Dementia

Electrical Cigarette smoking and alcohol use

|__________________________________________________________||


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Exposure to burning agents

_______________________________________________________________________| | |

1st degree burn 2nd degree burn 3rd degree burn

| | |superficial epidermis deeper layers of the entire epidermis is

is burned epidermis are affected charred or burned

| | away and may extend

| | into the dermis or

| | subcutaneous tissue

inflammatory process |______________________________|

| |

localized vasodilation ---------- damaged cells( 3rd degree- receptors in the

in the damaged area | dermis have been destroyed)

| | |

light colored skin | inflammatory response( 2nd degree- release

appears red | of chemical mediators; 3rd degree- nearby

| release of potassium tissue)

| from the damaged cell |

| | capillaries more permeable

| increase potassium level |

| in the blood stream Na,H2O,and protein shift from intra-

| | vascular to interstitial space

| hyperkalemia |

| | oncotic pressure decreased

| | |

| | plasma leaves the capillaries

| | |

| | edema or blisters formation( 3rd degree-

| | in the nearby tissues)

| | |

|____________________ |________________________|

|SYSTEMIC MANIFESTATIONS

||

CENTRAL NERVOUS SYSTEM: CARDIOVASCULAR SYSTEM


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- Anxiety - hypotension

- Pain - tachycardia

- Restlessness - prolonged capillary refill

- Dysrhythmia

MUSCULOSKELETAL RESPIRATORY SYSTEM

- Limited ROM - tachypnea

- Deeply charred subcutaneous - adventitious breath sound

tissue,muscle and bone tissue - DOB

- Use of accessory muscles

INTEGUMENTARY: METABOLIC:

- Eschar formation - hyperglycemia

- Dry oral mucosa - hyponatremia

- Dry skin - hyperkalemia

- Poor skin turgor

-cool, clammy skin

GUT:

- oliguria

DISCHARGE PLAN

MEDICATIONS

Antimicrobial ointments (such as silver sulfadiazine, mafenide, silver nitrate, and

povidone-iodine) are frequently used to lower the occurrence of infection. Bacitracin

may be used for first-degree burns.


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Antibiotics (such as oxacillin, mezlocillin, and gentamicin) are used if infection is

detected at the burn site. Antibiotics will also probably be used if the risk of

developing infection is high (for example, when the body surface area of the burn is

large).

Burn patients may be discharged home with several different medications. Review how

and when to take these medications, what the drugs are used for, and any possible side

effects before leaving the hospital. A patient should not drink alcoholic beverages, drive, or

operates vehicles or machinery while taking pain medications. A patient should finish any

prescription for antibiotics, even if he/she is feeling well. If there is any concern of an

allergic reaction, please call the doctor.

EXERCISE

Activity is important for increasing the circulation, preventing loss of muscle strength,

and improving general well-being. A patient should follow the guidelines set up by the burn

team. Feelings of fatigue and weakness will gradually improve. Taking naps and engaging

in light activity will help. Patients should avoid strenuous activity, driving, heavy lifting, and

contact sports, until cleared by the doctor at the follow-up visit. Some burn patients may

have physical or occupational therapy home visits to assist in their recovery.

THERAPY

People with burns suffer pain, itching, and anxiety both from the burn itself and during the

healing of wounds. Some studies suggest that massage may help ease these symptoms in

both the emergency-care and recovery phases. Patients receiving a massage reported

significantly less itching, pain, anxiety, and depressed mood compared to those who

received standard care only.

Occupational and physical therapy begin very early for patients who are hospitalized for

burns. The techniques used by occupational and physical therapists improve movement

and function and reduce scar formation. Rehabilitation with the guidance of occupational

and physical therapists may include the practices listed below:

Body and limb positioning

Splinting

Assistance with activities of daily living until normal function and ability are recovered

Passive (physical therapist moves the patient's limbs) and active exercises

Assistance with walking

Several studies suggest that hypnosis may reduce pain and anxiety and enhance

relaxation in burn patients.


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Therapeutic touch (TT) is based on the theory that the body, mind, and emotions form a

complex energy field. Therapists seek to correct the body's imbalances by moving their

hands just over the body in a practice they call "the laying on of hands." This practice has

been used for a variety of ailments including the relief of pain and anxiety, but studies have

shown conflicting results. A recent trial of patients hospitalized for severe burns suggests

that TT may reduce pain and anxiety associated with burns.

HEALTH TEACHINGS

Soak the burned area in cold water for 10 minutes.

Gently wash the burn with warm, soapy water. Pat it dry with a clean towel, and

cover it with a clean, dry bandage.

You will need to clean the burn and put on new bandages several times a day. Be

sure that everything that touches the burn is clean. Only use the burn medicine

prescribed by your doctor. When changing bandages:

o Wash your hands well with soap and water. Dry them with a clean towel.

o Remove the outer bandage by cutting it off with a pair of scissors. Do not pull

off the bandage if it is sticking to the burn. Instead, soak it in warm water for a

few minutes and then remove it slowly.

o Gently wash the burn with warm, soapy water. Use a clean, soft washcloth to

help remove any old cream, blood, and loose skin. Do not break blisters. This

may increase the pain.

o Rinse the burn with clear warm water. Pat dry with a clean towel.

o With a clean tongue depressor, apply the antibiotic ointment prescribed by

your doctor to a gauze pad in a thin layer. Throw the tongue depressor away

when you're done. Do NOT put it back in the container of ointment.

o

Cover the burn with the gauze. Be careful not to touch the gauze that comesin contact with the burn. Carefully rewrap the burn with a clean bandage as

directed by your doctor.

Keep the bandage clean and dry. Change it if it gets wet.

If the burn is on your arm or leg, keep it raised or propped up for the first 24 hours to

help reduce swelling.

You may use aspirin, acetaminophen, or ibuprofen for pain.

Do not bump or overuse the burned area.

Drink plenty of water or juice to prevent dehydration.

To avoid getting burned, follow these guidelines:

o Wear sunscreen when you are out in the sun.

o Wear protective clothing and follow safety rules when you are working with

heat or radiation.


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o Teach your children not to play with matches or touch the stove (even when it

is not on).

o Throw away frayed electrical cords. Have an electrician fix all faulty or bad

electrical wiring in your house.

o Do not touch uncovered electrical wires or outlets.

o Test bath water before getting into a bathtub or putting your child in one.

o Do not set your hot water heater too high. Usually the dial should be set in the

middle between hot and cold.

o Do not smoke in bed.

Blisters - don't pop them because the fluid inside them protects the wound

Red spots in the skin of the wound - these are glands forming beneath the surface of theskin instead of up top where they should be. Don't pop or pinch them, but report this

to us.

Change of color of burned arm or leg - if you have to keep an arm or leg relatively immobile,

the blood flow into it changes. Blood will collect and the limb will appear darker than

normal. Don't worry, this will go away; elevate limbs when sitting or lying.

Skin sensitivity - Sometimes the wound is more sensitive to cold than is normal. Wrap

up a little warmer than usual; the wound is also more sensitive to injury and

sometimes little open breaks will appear in the skin. Please report them to us. We

will tell you how to treat them.

Sun exposure - It is very important to protect your skin from the sun and heat; wear light

clothing and hats and use sunscreen (at least SPF 25 sun block) for at least a year.

OUT-PATIENT

Patients will be told how often theyll need to be seen for follow-up appointments after

discharge. Please write down any questions or concerns for the doctor and bring the

questions with you. Make sure to ask about returning to work and normal activities like

driving.

DIET

Minor burns can be treated effectively with the use of natural products. It is especially

important for people who have sustained serious burns to obtain adequate amounts of

nutrients in their daily diet. Burn patients in hospitals are often given diets high in calories

and protein to speed recovery. When skin is burned, it may lose a substantial percentage of

micronutrients, such as copper, selenium, and zinc. This increases the risk for infection,

slows the healing process, prolongs the hospital stay, and even increases the risk of death.

Do not try to treat a second- or third-degree burn without seeking medical advice. Discuss

with your health care provider which supplements may be important for you. Always tell


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your health care provider about the herbs and supplements you are using or considering

using, as some supplements may interfere with conventional treatments.

Following these nutritional tips may improve your healing and general health.

Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes),

and vegetables (such as squash and bell peppers).

Avoid refined foods, such as white breads, pastas, and sugar.

Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for

protein.

Use healthy cooking oils, such as olive oil or vegetable oil.

Reduce or eliminate trans-fatty acids, found in commercially baked goods such as

cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and

margarine.

Avoid coffee and other stimulants, alcohol, and tobacco.

Drink 6 - 8 glasses of filtered water daily.

Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex

vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.

Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil, one to

two times daily, to help decrease inflammation, and for healing and immunity. Cold-

water fish, such as salmon or halibut, are good sources, but taking the supplement is

recommended.

Vitamin C, 500 - 1,000 mg, one to three times daily, as an antioxidant and for

healing.

Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.

L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health

and immunity.

Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs

(colony forming units) a day, when needed for maintenance of gastrointestinal and

immune health. You should refrigerate your probiotic supplements for best results.

Grapefruit seed extract ( Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite

beverage) three times daily when needed, for antibacterial, antifungal, and antiviral

activity, and for immunity.

Astaxanthin, 2 - 6 mg daily, for immune and antioxidant support.

Alpha-lipoic acid, 50 - 100 mg twice daily, for antioxidant support.

Whey protein, 10 - 20 grams daily mixed in favorite beverage or as a smoothie (use

soy or rice milk), twice daily, for support of immunity and weight gain.


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PROGNOSIS AND COMPLICATIONS:

Infection is the most common complication of burns and is the major cause of death

in burn victims. More than 10,000 Americans die every year from infections caused

by burns.

Compromised immune system

Functional or cosmetic damage (reconstructive surgery may be necessary)

Increased risk of developing cancer at the burn site

Carbon monoxide poisoning (in the case of a fire)

Heart attack which may be severe enough to cause the heart to stop (called

cardiopulmonary arrest)

First-degree burns generally heal on their own in 10 - 20 days if no infection develops. In

rare cases, first-degree burns spread more deeply to become second degree (this spread

is caused by infection). Third-degree burns may require a skin graft.

The prognosis for burns depends on many factors. These factors include the degree of the

burn, the amount of skin affected by the burn, what parts of the body were affected, and

any additional complications that might have developed.

In general, minor burns heal in five to ten days with few or no complications or scarring.

Moderate burns heal in ten to fourteen days and may leave scarring. Major burns take

more than fourteen days to heal and can leave significant scarring or, in the most severe

cases, can be fatal.

Burns- Final Copy

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