|Year : 2015 | Volume
| Issue : 2 | Page : 61-71
Burn management: Challenging roles of burn nurses - Part II
Beulah Premkumar1, Regina Xavier1, Alice S Kumar1, Jabin Khaja2, Prasanna K Sathiyanathan3, Harini Srinivasan4, Kalaivani Gnanamani5
1 Professor, College of Nursing, CMC, Vellore, India
2 Associate Professor, College of Nursing, CMC, Vellore, India
3 Junior Lecturer, College of Nursing, CMC, Vellore, India
4 Tutor, College of Nursing, CMC, Vellore, India
5 Charge Nurse, CMC, Vellore, India
|Date of Web Publication||23-May-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Premkumar B, Xavier R, Kumar AS, Khaja J, Sathiyanathan PK, Srinivasan H, Gnanamani K. Burn management: Challenging roles of burn nurses - Part II. Indian J Cont Nsg Edn 2015;16:61-71
|How to cite this URL:|
Premkumar B, Xavier R, Kumar AS, Khaja J, Sathiyanathan PK, Srinivasan H, Gnanamani K. Burn management: Challenging roles of burn nurses - Part II. Indian J Cont Nsg Edn [serial online] 2015 [cited 2022 Aug 16];16:61-71. Available from: https://www.ijcne.org/text.asp?2015/16/2/61/284863
| Introduction|| |
In the previous CNE series on Burn Management Part I, indepth information on classification of burns, its assessment, and management was provided. The major aspects of management included first aid, fluid resuscitation, nutritional management, wound management, pharmacological, and surgical management. This is followed up with the discussion on the nursing management of patient with burns as part II in this CNE series. Nursing management during three phases namely emergent, acute and rehabilitative phases is presented in detail. The nursing interventions during these phases differ and nurses require specialized skills towards providing excellent care to patients (Black, Hawks, & Keene, 2001; Herndon, 2007).
| Phases of Burn Management|| |
The nursing care depends on the type, severity, and stage of the burn. Whatever the cause of burn, the care is focused on three major phases, the emergent, acute, or rehabilitative phase (Ignatavicius & Workman, 2002; Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2007; Smeltzer, Bare, Hinkle, & Cheever, 2010).
The emergent phase lasts from 24-48 hours of occurrence of burn. This phase is also referred to as the resuscitative phase and the duration is from onset of injury to completion of fluid resuscitation. Events within first few hours after burn injury can make the difference between life and death. The major nursing concerns are providing first aid and stabilizing the patient hemodynamically. The clothes are removed and the wound is cooled with tepid water.
Circulation, airway, and breathing takes the first priority. The patient should also be stabilized in terms of fractures, hemorrhage, spine immobilization, and other injuries. Intravenous fluids are given to prevent and treat hypovolemic shock. Pain is managed with appropriate analgesics and patient controlled analgesia is found to be very effective.
The acute phase of burn injury is considered to be between 36 and 48 hours. The duration is mainly from the start of diuresis to the completion of wound closure. This phase requires management by the multidisciplinary team. The nurse needs to co-ordinate the work of the health team to ensure quick recovery and prevention of complications. The goals of management include wound closure with no infection, minimum scarring, maximum function, maintenance of comfort as much as possible, adequate nutritional support, and maintenance of fluid, electrolyte, and acid-base balance. Pain management is also continued.
Efforts for rehabilitation starts in the first phase but the actual rehabilitation occurs after the wound closure and extends till the patient returns to an optimal level of physical and psychological functioning. This may take months or many years. Reconstructive surgeries are done to restore the normal or optimal functioning. The burn affects the psychosocial status and the care depends on the age of the patient, location of the burn, recovery from injury, cause of the injury, and ability to continue at pre-burn level of normal daily activities. In order to achieve the normalcy the nurse needs to co-ordinate with the other health team members. Multidisciplinary team approach is the effective mode of management. Specialized burn nurses provide and ensure comprehensive care to improve the quality of life of burn patients. The rehabilitative team involved in care is depicted in [Figure 1].
The specific needs of burn patients and their nursing diagnoses during various phases are listed in [Table 1] (Herdman, 2012; Sterling, Heimbach, & Gibran, 2010; Trofino, 1991).
| Case Report|| |
The nursing management of a patient with burns is discussed using nursing process approach based on a case report of a patient with electrical burn (Bunn, Roberts, Tasker, & Trivedi, 2004; Comer, 2005).
Mr. S, 22 years old, unmarried, untrained electrical line man, from a poor socio economic back-ground in his village closer to Vellore District sustained an electrical Burn injury. Immediately he was taken to a Government Hospital in a nearby town where he was diagnosed to have 10% electrical burns involving both hands and left leg. His parents are farmers and own a small piece of land. They earn a small profit having seasonal cultivation in this land.
During the first 48 hours he received treatment with adequate intravenous fluids. On the third day, his heart rate was 134/min and blood pressure 176/65 mm of Hg. He received Inj. Morphine 5mg for pain. The next day he had debridement in both hands, amputation of 5th finger of the right hand, 2nd and 3rd fingers of left hand, and 4th and 5th toe of the left leg. Subsequently he had debridement of left leg wound followed by Below Knee Amputation (BKA) and later after a week he had Right Below Elbow Amputation (BEA). He had oozing from all the wounds.
Laboratory investigations were done during his stay in the hospital and the findings are as follows:
- Na 128 - 131 mEq /L
- K- 4.0 mEq/L
- CPK: 149 unit / L
- PCV: 28.2 % - 45.2%
- WBC: 13, 300 - 21,400 mcl
- Blood Borne Viruses: Negative
| Nursing care|| |
1. Nursing diagnosis: Ineffective airway clearance related to airway edema, increased production and accumulation of secretions secondary to pathophysiological changes
Expected outcome: Patent airway is maintained as evidenced by saturation within normal range, absence of copious secretions and normal respiratory rate and breath sounds
- Assessed the airway characteristics and respiratory parameters such as respiratory rate, breath sounds and saturation
- Positioned him in semi fowlers at 45 degree angle to promote lung expansion
- Administered nebulisations to promote dilation of airways and bring out secretions
- Performed 2 hourly suctioning
Evaluation: He did not develop any respiratory complications.
2. Nursing diagnosis: Decreased cardiac output related to massive fluid and tissue loss, third space fluid with increased capillary permeability and evaporative losses from the burn wound
Expected outcome: Maintenance of an optimal Cardiac output as evidenced by blood pressure within normal range, absence of signs of poor organ perfusion, and normal urine output
- Assessed heart rate, blood pressure, arrhythmias, capillary refill time, skin turgor, bleeding sites, vital signs every hour
- Monitored urine output every hour
- Assessed peripheral sites for perfusion which revealed gangrene
- Minimised evaporative fluid loss by covering the burn wound appropriately
- Administered IV fluid Ringers Lactate (RL) 1000 ml in the emergent phase over 8 hours
Evaluation: Maintained normal vital signs as evidenced by Heart rate of 134/min, blood pressure of 176/65mm of Hg, warm peripheries, and normal urine output.
3. Nursing diagnosis: Deficient Fluid volume related to evaporative losses from the burn wound secondary to increased capillary permeability
Expected outcome: Maintenance of adequate fluid levels as evidenced by absence of dehydration, normal urine output, absence of weight loss, normal pulses, and blood pressure
- Assessed his blood pressure, pulse rate, skin turgor, capillary refill and electrolyte levels
- Assessed the urine output and found to be less than 3 0 ml/hr and henceforth informed the physician
- Initiated IV access and IV fluids, Inj. RL 1000 ml was administered in the emergent phase over 8 hours
- Covered the burn wound appropriately to prevent evaporative fluid losses
Evaluation: Optimal fluid balance was maintained as evidenced by normal blood pressure, heart rate, skin turgor and urinary output.
4. Nursing Diagnosis: Acute Pain related to burn injury, exposed nerves, grafting procedure and therapeutic procedures
Expected Outcome: Pain is minimized as evidenced by reduction in pain score and verbalization
- Assessed pain level using pain intensity scale (VAS), pain score was 8/10
- Observed for nonverbal indicators of pain such as grimacing, tachycardia, and clenched fists
- Administered Inj morphine 8mg prn
- Educated Mr. S about provision of pharmacological pain relief measures and options for non pharmacological measures like TV, music, diversional therapy. Instructed and assisted him in relaxation, and imagery techniques
- Lubricated healing burn wounds with coconut oil
Evaluation: Pain was minimized as evidenced by reduction in pain score from 8 /10 to 4/10.
5. Nursing Diagnosis: Imbalanced nutrition: less than body requirement related to hypermetabolism secondary to burn injury
Expected Outcome: Maintenance of adequate nutritional status as evidenced by increase in body weight, increase in albumin level and faster wound healing process
- Provided high-caloric, high-protein diet that included patient preferences and homemade food (3 000kcal, 170gms protein diet/day)
- Administered 1200ml burn formula diet (BFD) per day
- Convinced the patient and the family members to give nutritional supplements as prescribed
- Administered supplemental vitamins and minerals as prescribed (Tab. Vitamin C 500mg, Tab. Zincovit 1 daily)
- Allowed him to have timely food and fluid intake
Evaluation: His nutritional status improved although he had a deficit of protein.
6. Nursing Diagnosis: Infection, actual related to loss of skin barrier and impaired immune response as evidenced by Pseudomonas aergunisa, Enterococcus, Enterobacter, non fermenting gram negative bacilli in culture
Expected outcome: Infection was controlled as evidenced by absence of further infection, culture reports, WBC and ESR counts
- Monitored burn wound for changes and drainage. Redness, swelling and mild oozing was identified
- Wound was oozing continuously and dressing was done twice daily
- Used aseptic measures in all aspects of patient care; meticulous hand washing before and after patient care was carried out. Used clean and sterile gloves for wound care; used mask and hair caps when wounds are exposed and during dressing procedures
- Monitored all invasive lines and changed invasive lines appropriately every 72 hours under strict aseptic technique
- Controlled visitors inside burn ICU and taught the close relative all necessary aseptic precautions to be followed when entering the ICU
- Provided a clean environment which was cleaned using Bacillocid, Lysol and room was fumigated before receiving him
- Spot culture was assessed from fans, AC machine filter, tubelight, windows and doors handle, solution bottles for hospital acquired infection
- Monitored WBC count, culture and sensitivity results of him once a week. WBC was 21,400,ccmm, blood culture and sensitivity revealed Pseudomonas aergunisa, Enterococcus, Enterobacter, non fermenting gram negative bacilli
- Administered antibiotics Inj. Crystalline Penicillin 20L Q6H, Inj. Cefazolin 1g Q6H, Inj Gentamycin 160mg od were administered
- Provided regular autoclaved linen and assisted him with personal hygiene which includes hydrotherapy
Evaluation: Mr. S developed Pseudomonas aeruginosa, Enterococcus, Enterobacter, Non fermenting gram negative bacilli infection during the course of hospital stay, further infection was prevented. The full course of antibiotics such as Crystalline Penicillin, Cefazolin and Gentamycin were completed.
7. Nursing Diagnosis: Impaired physical mobility related to below knee amputation secondary to burn wound
Expected Outcome: Physical mobility is enhanced within limitations as evidenced by progressive ability to perform range of motion exercise and absence of contractures
- Positioned him carefully to prevent flexed position in burned areas such as hands and legs. Foot splint was kept to prevent foot drop, and positioned him comfortably in semi-fowlers
- Implemented range of motion (ROM) exercises to shoulder and thighs several times daily to prevent muscle atrophy
- Assisted with early ambulation to increase the use of muscles
- Used splints (foot splints) and exercise devices like wheel chair and walker
- Encouraged and provided assistance in self-care activities such as bathing, dressing, and grooming
Evaluation: He was able to perform range of motion exercises, muscle strength was maintained, joint contractures were prevented and he was sent on a wheel chair at discharge.
8. Nursing Diagnosis: Impaired skin integrity related to open burn wound
Expected Outcome: Skin integrity is maintained as evidenced by enhanced wound healing process in the entry and exit wounds of electrical current
- Inspected the entry and exit site of electrical burn injury and identified it as a deep burn injury
- Cleansed the wound with Normal Saline 0.9% daily; used jelonet, provided wound care with topical Silver Sulfa Diazine 1%. Dressing was done twice daily as he had more oozing
- Provided donor site care with Normal Saline 0.9%
- Prevented pressure sore, infection, and contracture of skin grafts by providing suitable positioning and supportive devices
- Provided adequate nutritional support in order to ensure enhanced wound healing (3000Kcal,170gm protein diet)
Evaluation: Meticulous wound cleansing was done every day to ensure that his wound was free from infection and Silver Sulfa Diazene was applied. Special care was provided to entry and exit site ofburn injury wounds.
9. Nursing Diagnosis: Body image disturbance related to maladaptive process in self secondary to amputation, burn scar, prosthesis and assisting devices
Expected outcome: Positive body image is enhanced as evidenced by participation of Mr. S in social activities and family responsibilities
- Encouraged him to express feelings about loss and change in the body image
- Provided support by active listening during every conversation
- Assisted him and family to identify sources of support as professional team members and related social groups
- Assisted him to identify and use helpful coping strategies
- Encouraged him by giving examples of previously burn injured amputees who are now leading a fruitful life
Evaluation: He was able to adapt to positive coping mechanism with minimal disturbances.
10. Nursing Diagnosis: Situational low self-esteem related to threatened or actual change in body image, physical loss, and loss of role responsibility
Expected outcome: Self-esteem is improved as evidenced by making social contact with family and others
- Allowed time for two way communication and open discussion with doctors and nurses on his rehabilitative measures
- Provided honest and accurate information about the projected appearance
- Assessed the need for limit setting for maladaptive behavior but he was found to be co-operative throughout
- Consulted with team members to formulate change treatment plan as the needs come up
- Promoted Mr. S’ self-confidence by providing information about the progress
- Provided encouragement and positive reinforcement by explaining about previous burn survivors and amputees
Evaluation: Self-esteem was improved as evidenced by his expression “I want to continue my job and take care of my mother. I will be on wheel chair to continue my job even if I fail to use prosthetic after BKA.”
11. Nursing Diagnosis: Interrupted family processes related to financial crisis and social stigma secondary to burn injury
Expected Outcome: Family processes is enhanced as evidenced by involvement of family in the care of Mr. S and verbalization of improved family coping strategies
- Demonstrated willingness to listen to his concerns related to financial crisis
- Provided realistic support whenever he was found to be upset or anxious
- Provided family counselling to his sister and mother in assisting to set the goals on accepting the crisis, for which the compliance for patient and family were obliging
- Referred family to social services and other resources as needed like Chief Minister’s health insurance scheme for his financial assistance
- Identified the coping patterns of the family and helped them to build on it
Evaluation: The health care team members encouraged and motivated the family in taking care of Mr. S. At the time of discharge the family members were empowered to take care of him at home and during the rehabilitative phase.
12. Nursing Diagnosis: Impaired individual coping related to altered body image, altered self esteem and social stigma as living as an amputee
Expected Outcome: His coping is enhanced as evidenced by absence of anxiety and grieving about body image and social stigma
- Demonstrated acceptance of Mr. S by the health team members
- Provided positive feedback and support
- Assisted patient to set achievable short-term goals like sitting up, performing range of motion exercises for increased independence in activities of daily living
- Used multidisciplinary approach to promote mobility and independence such as exercise, ambulation and dressing
- Consulted Psychiatrist for his regressive or maladaptive behaviours
- Used therapeutic Counselling for assisting him to adopt positive coping behaviours
Evaluation: His coping skills had improved as evidenced by his verbalization that he would continue his work in the best possible way.
13. Nursing Diagnosis: Anticipatory grieving related to sudden trauma encountered, physical disfigurement, impending loss of limbs (finger, toes, below elbow amputation, below knee amputation), loss of normal way of life and fear regarding future
Expected outcome: Mr. S demonstrates progression through the grieving process as evidenced by verbalization of feelings about the burn injury and verbalization of a plan for integrating prescribed follow-up care into lifestyle
- Assessed Mr. S and significant others for cues as to how they are dealing with the present situation
- Explained the planned treatment and ongoing changes to him and relatives along with other health care team members
- Planned for provision of frequent opportunities for verbalization without excessive confrontation about amputation
- Permitted expression of feelings within appropriate limits on admission
- Acknowledged appropriate let out of grief
Evaluation: Mr. S and his family members had been counselled periodically and their psychosocial needs were also attended promptly by the team and his coping mechanisms were facilitated.
14. Nursing Diagnosis: Risk for complications (Sepsis, Acute Respiratory Failure, Visceral damage) related to massive burn injury
Expected Outcome: Complications are prevented (Sepsis, Acute Respiratory Failure, Visceral damage) as evidenced by absence of the same
- Provided clean environment
- Performed dressing under aseptic techniques twice daily using Silver Sulfa Diazene and 0.9% Normal Saline
- Performed frequent hand washing and encouraged family members also to do so
- Ensured that floor was cleaned and mopped with Lysol and liquid soap before dressing
- Administered antibiotics Inj. Crystalline Penicillin 20LU Q6H, Inj. Cefazolin 1g Q6H, Inj Gentamycin 160mg OD were administered
Acute Respiratory failure (ARF)
- Monitored vital signs every 4 hours
- Positioned him in semi fowlers position
- Administered nebulisations- Salbutamol and Saline 4 hourly
- Health teaching given on deep breathing and coughing exercises
- Encouraged him to do incentive spirometer
- Assessed each system for abnormalities, findings were normal. Watched for swelling and oedema which progresses after 48 hours around hands and legs. He had edema around his hands and legs
- Checked for peripheral pulses and capillary refill time
- Assessed for 6 P’s - Pallor, Pulselessness, Pain, Poiklothermia, Paresthesia, and Paralysis every 4 hours in the upper and lower extremities which were deranged and was surgically managed with left below elbow amputation and left leg below knee amputation
- Administered IV fluids (as per Parkland formula 3000ml per day), a total of 5 pints of RL was given in the first 72 hours
- Cared for post op debridement and fasciotomy with meticulous wound care
- Assessed for tolerance to feeds, abdominal distension, nausea and vomiting, bowel sounds, and NG aspiration 4 hourly which was maintained within normal limits
- Administered buttermilk via NG tube before starting BFD and oral feeds
- Started very early nutritional supplementation by BFD and high-calorie, high-Protein diet (3000kcal, 170gms protein)
Evaluation: Mr. S was free from complications such as ARF, Compartment syndrome and Curling’s Ulcer. However he developed sepsis from Pseudomonas aeruginosa, Enterococcus, Enterobacteria, non-fermenting gram negative bacilli for which he was given antibiotics.
15. Nursing Diagnosis: Readiness for enhanced knowledge regarding rehabilitation strategies, post discharge homecare, and follow-up needs related lack of information
Expected outcome: Enhanced level of knowledge in Mr. S and family members
- Provided information about daily wound care and specific instructions like oil massage of graft donor site and healed burn wound
- Instructed Mr. S to wear pressure garments for two years
- Advised Mr. S to avoid direct sunlight for one year
- Advised him to use sunshade lotion before exposure to sunlight
- Provided information regarding rehabilitative measures to the supporting group and family with disability certificate received from CMC
Evaluation: His learning needs were met. He verbalized confidence in home care.
| Conclusion|| |
Caring for a burn patient is a challenge to nurses. Burn patients undergo physical, psychological, and spiritual trauma. The nurse prioritizes the needs of the patient and acts promptly to prevent complications and enhances quick recovery with good quality of life. During the initial phase of the burn, the focus of care is on reviving the patient. During the acute phase, nurse as a health team member ensures that complications are prevented or minimized. The rehabilitation phase is a long period in the lives of many burn victims, where the nurse extends her role as burn educator, rehabilitator, and counselor. Consistent follow up is provided either in the outpatient setting or in the burn rehaiblitation centers to ensure optimal functioning of the individual. Psychosocial issue becomes a major concern in the rehabilitative phase which requires comprehensive care with realistic approaches to empower the patient to lead independant and quality life.
Conflicts of Interest: The authors have declared no conflicts of interest.
| continuing education series no: 29 Burn Management: challenging roles of burn nurses - Part II|| |
| Objectives|| |
After reading the preceding article and taking this test, you should be able to :
- List the phases of burn management
- Explain the nursing care of patient with burns in different phases
- Enumerate the complications of burn
- Discuss the challenging role of burn nurses in burn management
1. In burn management when a patient is due for dressing at 8: 30 am, the priority assessment for him at 8:00 am will be to
- Assess the lab and culture reports
- Assess and prepare appropriate splint for dressing.
- Assess the nutritional needs
- Assess the wound and collect equipment accordingly
2. In thermal burns, vital signs of a patient are Blood Pressure - 90/58 mmHg, Respiratory rate - 32/mt and Heart rate - 128/mt, indicating
- Hemorrhage from thermal burns
- Impaired coagulation
- Inhalation of carbon monoxide from flames
3. Curling’s ulcer is related to catecholamine release and is manifested by
- Hematemesis and malena
- Hemoptysis and hematochezia
- Hemorrhage and purpura
- Hematoma and petechiae
4. Electrical injury caused by above 1000 Volts is categorized under
- Minor burn
- Moderate burn
- Severe burn
- Major burn
5. The type of fluid infused during the emergent phase in burn management is
- Colloids and Crystalloids
- Packed Red Blood Cells
6. A laboratory report that requires an immediate action is
- S erum sodium - 132 mEq/L
- Serum potassium - 6.0 mEq/L
- Serum protein - 4.5 g/dl
- S erum albumin - 2.4 g/dl
7. The most appropriate nursing action to prevent cross contamination in a large burn wound is by
- Using clean gloves always while handling the patient
- Washing hands when entering the patient’s room
- Changing sterile gloves after dressing each site
- Administering topical antibiotics before the dressing
8. The priority nursing problem in acute phase of burns is
- Fluid volume excess
- Acute pain
- Ineffective coping of burn survivor
- Ineffective peripheral tissue perfusion
9. The major complication in acute phase of burns is
- Curling’s ulcer
- Hypovolemic shock
- Hypertrophic Scar
10. Fluid volume excess in acute phase of burn management occurs due to
- Neglecting intervention for Compartment syndrome
- Hyperfunctioning of antidiuretic hormones
- Forcing patient for oral intake of fluids
- Careless over rushing of intravenous fluids
11. The specific monitoring to identify visceral organ damage in acute phase of electrical burns is
- Physical mobility with range of motion and muscle power
- WBC count, culture and sensitivity, temperature, wound with pus
- Bradypnea with altered ABG
- Altered ECG pattern, decreased urine output, decreased score in Glasgow coma scale
12. The choice of topical application commonly used for burn dressing is
- Silver Sulfadiazene
- Liquid paraffin
13. The immediate treatment done for management of Compartment syndrome is
14. The nursing intervention mandatory to prevent contractures in a burn victim is
- Wound dressing and exercise
- Positioning and exercise
- Diet and exercises
- Medications and dressing
15. The position recommended to prevent neck contracture in burn is by keeping neck in
16. The grafted /donor site should be massaged with
- Talcum powder
17. The instruction to be considered while applying a sun shade lotion is
- Clotting factor
- Sun protective factor
- Bleeding factor
- S edimentary factor
18. To prevent hyperpigmentation of burnt skin scar, patient is advised to use
- Umbrella, sunshade lotion, hat
- Umbrella, sunshade lotion mixed with oil
- Talcum powder, umbrella, hat
- Talcum powder, sunshade lotion
19. The nurse should be watchful in observing the donor site for the presence of
- Odour, oozing, exudates
- Moisture, edema, tenderness
- Bleeding , compartment syndrome, edema
- Edema, oozing ,moisture
20. The priority in discharge plan for home care of burn amputee is
- Healed stump for artificial limb
- Exercise to prevent contracture
- Continuation of high protein diet
- Scar management
| CE Test No : 29 Burn Management: Challenging Roles Of Burn Nurses - Part II|| |
Select the best answer and shade the circle against the suitable alphabet in the answer form provided.
| Answer Form|| |
Evaluation : Listed below are statements about the CNE on Burn Management: Challenging Roles of Burn Nurses - Part II. Please circle the number that best indicates your response.
Strongly Disagree Disagree Agree Strongly Agree
The stated objectives were met 1 2 3 4
The content was clearly presented 1 2 3 4
The content was related to the objectives 1 2 3 4
The test questions were clearly stated 1 2 3 4
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Cut out or photocopy this form, fill and mail before June 30, 2016 to The Editor-in-Chief, IJCNE, College of Nursing, CMC, Vellore - 632 004, along with a Demand Draft for Rs. 100/- (Rupees hundred only), drawn in favour of CMC, Vellore Association. A certificate will be awarded to all the participants and a merit certificate to those who secure marks 80% and above. Participants who secure 100% will be awarded one year free subscription of IJCNE. Also, all those who score marks 80% and above will be awarded 2 credit hours (1 creditpoint).
| References|| |
Black, J. M., Hawks, J. H., & Keene A. M. (2001). Medical surgical nursing: Clinical management for positive outcomes
. Philadelphia: W. B. Saunders.
Comer, S. (2005). Delmar’s critical care nursing care plans
. Germany: Cengage Learning.
Herdman, T. H. (2012). Nursing diagnosis: Definitions and classification 2012-2014
. Oxford: Wiley-Blackwell Publishers.
Herndon, D. N. (2007). Total burn care
. Philadelphia: Saunders.
Smeltzer, C. S., Bare, G. B., Hinkle, L. J., & Cheever, K. H. (2012). Brunner & Suddarth’s textbook of medical- surgical nursing
. Philadelphia. Lippincott Wilkins and Williams.
Sterling, J. P., Heimbach, D. M., & Gibran, N. S. (2010). Management of the burn wound. ACS Surgery: Principles and Practice
. Retrieved doi: 10.2310/ 7800.S07C15.
Trofino, R. B. (1991). Nursing care of the burn-injured patient
. Philadelphia: F.A.Davis Company.
Ignatavicius, D. D., & Workman, M. L. (2002). Medical Surgical Nursing
(4th ed.). Philadelphia: W. B. Saunders.
Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., O’Brien, P. G., & Bucher, L. (2007). Medical surgical nursing: Assessment and management of clinical problems
(7th ed.). St. Louis, Missouri: Mosby’s publication.