The Child with Integumentary Dysfunction: Burns

Objectives

1.Interpret normal and abnormal assessment findings in the child with burn injuries.

2.Predict potential complications in children with burn injuries.

3.Formulate a plan of care for children with burn injuries.

4.Explain the rehabilitation process for children with burn injuries.

Don’t have to know any formulas – rule of nines

Common Patterns and Developmental Levels

●Hot water scalds common in toddlers- turn handles pots and pans

●Electrical burns – put mouth common in young children

●Flame-related burns common in older children

●Chemical burns- severity depend how long theu were exposed on skin

●Child abuse

●Child with matches or lighters:

○1 in 10 house fires

Most burns are thermal- ex. Fired

What are the characteristics of a burn injury

1) Extent of injury described in terms of total body surface area: age-related charts- how much of body was burned

2) Depth of injury

○First-degree: superficial

○Second-degree: partial thickness

○Third-degree: full thickness

○Fourth-degree: full thickness and underlying tissue

3) Severity of injury

•Don’t have to memorize.

•Pg 1548

1- red

2-blister

3- tissue w no bone

4- bone

What are the types of severity in a burn injury

How do you manage minor burns 

●Usually managed outpatient

●Wound cleaned with water and soap

●Débridement- clean out or dead tissue.

●Dressings per orders-

●Infection prevention

●Updated Tetanus vaccine

●Families can care for them at homd

How do you manage major burns 

●Airway maintenance first priority

●Fluid replacement therapy

○Critical in first 24 hours- crystaloids, LR and NS , D5 . To keep kidneys functioning and prevent system damages

●Nutrition

○Enhanced metabolic demands- high protein high calorie diet , can have oral or tube feedings . Vit A, C, zinc can promote wound healing

●Medication

○Antibiotics, pain- morphine , fentanyl, propofol, sedatives. Meds given IV

●Wound Management

○Prevent infection and close wound as fast as can. Get meds before debridement. Can use human skin, sheets, different grafts.

Swelling or trauma to face or neck- put on 100% oxygen or can see trauma on them . If loc changes and severe burns- can be intubated

Repsiratory distress- watch closelt

Priority

1.Airway

2.s/s shock

3.Prevent infection

What are the complications of burns

•Airway compromise

•Maintain body temperature

•Infection

•Profound shock

•Pneumonia, pulmonary edema, pulmonary embolus, aspiration

•Renal Failure

•Loss of function of burned area

Explain rehab process for a kid with burn injury

•Begins once wound coverage is achieved

•Prevention & management of contractures

•Physical & Occupational Therapy

•Multi-disciplinary team

•Facilitate adaptation of child and family

oScar tissue doesn’t grow as child does- Scar tissue will not expand as they grow- have to have surgeries

o

•Prevent future injuries

What a burn injuries associated with child abuse

•History doesn’t match injury

•Document thoroughly

•Report any and all suspected abuse to CPS

Social services consult

Objectives for The child with Musculoskeletal
Dysfunction

1.Describe common conditions affecting the musculoskeletal system that require hospitalization in children.

2.Interpret normal and abnormal assessment findings in the child with musculoskeletal illness.

3.Formulate a care plan for a child hospitalized with a musculoskeletal illness.

4.Implement appropriate nursing interventions for a child with musculoskeletal illness.

5.Predict potential complications of musculoskeletal illness in children.

6.Outline preoperative and postoperative care of the child with surgical treatment for musculoskeletal illness.

7.Teach families about care of the child with musculoskeletal illness.

8.Explain techniques to care for a child immobilized with an injury or a debilitating condition.

9.Explain the functions of the various types of traction and appropriate nursing care of the child in traction.

What is traction

●Traction

○Forward force produced by attaching weight to distal bone fragment

○

●Countertraction

○Backward force provided by body weight

○

●Frictional force

○Provided by patient’s contact with the bed

What are the types of traction

Traction depends on:

oChild’s age

oCondition of soft tissues

oType and degree of fracture

oManual- use hands to align leg and bone and position skin.on affected side. Ex. Putting on cast but someone else is holding fracture leg still.

oSkin- Apply directly to skin but indirect to any bone. adhesive bandages, splints, temporary

oSkeletal- halo, direct to bone itself, pins wires or tongs are directly inserted to help realign it. If they have a halo never pull on rods

oImmediately know where screwdriver is if need to do CPR

How do you care for a kid in traction

●Purpose- relief and realign bone and prevent future injury- prevent deformities in extremity

●General considerations

●Skin traction

●Skeletal traction

●Skin integrity

●Prevent complications

• You can change the weights to pull on bone to prevent further injury

• Make sure don’t release traction- ONLY BY provider

• Don’t ever let weights fall on the ground- have someone help you

• Under 3 less than 25 lb- flat on bed but legs up at 90- flyant traction- femur or hips

• Look at bandages, splint is its too tight or loose

• Halos- worried about infection- orders on how to keep clean

• Cover pins so kid doesn’t scratch themselves.

• Only replace straps or bandages when necessary

• Watch pressure points- turn but also keep in mind how align them properly. Massage under straps to promote circulation.

• Good diet/ nutrition.

• Cast or splint- neuro assessment- 6ps- pulse, pallor, pain, paresthesia, , report if it changes

• Do rom w other extremeties, deep breathing- areate the lungs

• Give pain management- shouldn’t hurt but unconfortable

What is Developmental Dysplasia of the Hip (DDH)

●Femoral head slips in and out of socket

○Shortened limb, restricted abduction- away, asymmetry of gluteal & thigh fat folds- when prone fast creases are asymmetrical, telescoping of thigh

○Ortolani test- when hip clicks with abduction, Barlow test- when it dislocates from abduction, Allis sign-when you put their knee up and one knee is lower than the other - will be done by provider

●Nursing Management

○Cast care

○Skin integrity

○Education

Swaddling incorrectly can cause risk for DDH

Don’t force their hips into swaddling- want them to be in relaxed frog position.

What is the medical management for Developmental Dysplasia of the Hip (DDH)

•Medical Management

oPavlik Harness- newborn to 6 months. Wear 22-24 hrs a day. Can wear stuff underneath

oRevaluated 6-12 months

oSurgery

oClosed reduction + spica cast if older than 6 months. Don’t use bar as a handle

Bryant’s traction

No toys they can put down their cast

Skin integrity- keep clean and dry

Special car seats

What is Clubfoot (talipes equinovarus)

●Congenital abnormality, foot is twisted out of normal position

○Cause unknown

○Unilateral or bilateral

●Medical management

○Casting, shoes, surgery

●Nursing management

○Education

Cast and skin care

Complete assessment to see how to tx it

1^st stage- correct deformity

2^nd stage- maintain correction until normal balance is regained and prevent deformity from occurring again

Serial casting- get casted for wks at a time over and over again bc they grow fast. Do for up to 10-12wks.

Will have corrective shoes after serial casting to maintain that and prevent deformity from happening again, if it doesn’t work w casting and shoes can do surgery.

Do neuro checks- keep cast clean and dry

Compartment syndrome – don’t want

What is Osteogenesis Imperfecta

●Brittle-bone disease

○Frequent fractures, blue sclera, thin soft skin, short stature, hearing loss, delay in walking- loss of collagen

●Medical Management

○No cure- meds can slow release of calcium

○Physical therapy promote strength

○Casting, bracing, splinting, wheelchairs 

●Nursing Management

○Positioning

○Education- don’t pull ankles up, move them on blankets

○Cast care

Some types can cause infant mortality and some are minor

Bones break easily- handle w care

Freq er visits- may be accused of being abusive

What is Slipped Capital Femoral Epiphysis (SCFE)

●Femoral head slips off femur neck

oLimp, pain, stiffness, loss of motion,

    can’t bear weight

●Medical Management

○X-Ray

○Non-weight bearing

○Surgery- pain management, cast care

●Nursing Management

○Education

○Post-op care

Think ice cream slips off cone

Emergency bc worried about blood supply dying to the femur

See more in teenage phase in boys- acute trauma or genetic, large BMI can cause it

Limp on effected side, stiff, loss of motion on side, continual or intermittient pain radiates down leg

What is Osteomyelitis

●Bone infection dt staph. More fre kids under 10

○History of trauma can put them at risk

○Appear ill, irritable, fever, rapid pulse, dehydration, tachycardia. Very sick

○Localized at site: tenderness, warmth, swelling, pain, resistant to passive movement, very guarded

●Medical Management

○Antibiotics- start abx culture and adjust. Will have PICC linesHigh dose abx , possible surgery

●Nursing Management

○Pain management

○Comfort care- pain meds

Don’t have them bear weight on extremity

If they have a penetrating injury or absess they will go in and do surgery or if they dont respond to abx

Elevated ESR- erythrocyte sedimentation rate, CRP- reactive protein these labs monitor inflammation these 2 would be elevated.