AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: Nursing students will gain an understanding of burns and the process of healing.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given a scenario of a patient in a clinical setting with burns provide safe and
effective care
TEACHING POINTS
1. Given a scenario of a patient in a clinical
setting with burns describe the etiology and
pathology of burns
2.
3.
4.
5.
Given a scenario of a patient in a clinical
setting with burns Identify the characteristics,
signs and symptoms, and basic treatment of
the three burn depth classifications
Given a scenario of a patient in a clinical
setting with burns apply the rule of nines in
determining the percent of body surface
burned
Given a scenario of a patient in a clinical
setting with burns describe management of
the burn patient to include inhalation injuries
and fluid volume resuscitation
Given a scenario of a patient in a clinical
setting with burns differentiate between open
and closed methods of wound care for burns
6.
7.
8
Given a scenario of a burn victim, use the
Brooks modified formula to calculate the
amount of IV solution necessary to treat the
patient IAW cited references
Given a scenario of a patient in a clinical
setting with burns name the three sources of
skin grafts and list purposes of a skin graft
Given a scenario of a patient in a clinical
setting with burns describe nutritional
considerations for the burn patient
9.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
LESSON PLAN APPROVAL
End of Lesson Test: None
Instructional Time: 243
Reference(s):
Click here to enter reference(s).
Minutes
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Signature of Standards Officer
1
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light,
radiation or friction. Most burns affect only the skin (epidermal tissue and
dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can
also be injured. Burns may be treated with first aid, in an out-of-hospital
setting, or may require more specialised treatment such as those available at
specialised burn centers. Managing burn injuries properly is important
because they are common, painful and can result in disfiguring and disabling
scarring, amputation of affected parts or death in severe cases. Complications
such as shock, infection, multiple organ dysfunction syndrome, electrolyte
imbalance and respiratory distress may occur. The treatment of burns may
include the removal of dead tissue (debridement), applying dressings to the
wound, fluid resuscitation, administering antibiotics, and skin grafting.While
large burns can be fatal, modern treatments developed in the last 60 years have
significantly improved the prognosis of such burns, especially in children and
young adults. In the United States, approximately 4 out of every 100 people
to suffer burns will die from their injuries. The majority of these fatalities
occur either at the scene or on the way to hospital.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Given a scenario of a patient in a clinical setting with burns describe the etiology and
pathology of burns
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Etiology and pathology
a. Thermal
i. Flames, scalding and thermal energy (heat), most common type of burn
b. Non-thermal
i. Electricity
2
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
ii. Chemicals
iii. Radiation
c. Effects of burns
i. Depends on two factors
1. Extent of body surface burned, total body surface area (TBSA) and
2. Depth of burn injury
ii. A current of only 0.1 AMP to the heart can cause ventricular fibrillation
d. Body injuries
i. Nervous System
1. Possible paralysis
2. Maybe unconscious
3. Possible respiratory paralysis
ii. Sensory Organs
1. Loss of sight, hearing, speech
2. Possible tympanic rupture
iii. Skin
1. Causes a burn that is typically mottled, feathery, or patchy; appearing in a
scattered pattern, kind of resembling flowers
iv. Heart
1. Cardiac damage is common
2. Most serious injury to the heart is when the current crosses the heart
disrupting the hearts rhythm
v. Vascular System
1. Patient maybe unresponsive
2. Appear ashen and molten
3. Cool to touch extremities with possibly no pulse
4. Moderate injury the condition will correct itself quickly
5. Severe cases the blood will coagulate and tissues in the arms and legs may
die
6. Renal failure may occur
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Given a scenario of a patient in a clinical setting with burns Identify the
characteristics, signs and symptoms, and basic treatment of the three burn depth classifications
Minutes
Allocated Time:
Introduction:
Learner Participation:
3
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Knowledge Lesson
Skill Lesson
Learning Support:
Please follow along with your hand outs and take notes.
Powerpoint presentation with associated handouts.
1. First degree (superficial)
e. The epidermis is injured, but the dermis is unaffected. It heals in less than 5 days, usually
spontaneously with symptomatic treatment
f. Type - sunburn, low intensity flash flame, brief scald
g. Appearance - dry surface without vesicles; minimal or no edema red; blanches on pressure
and refills when pressure is removed; increased erythema (redness)
h. Sensation - painful
2. Second degree (partial thickness)
a. Affects both the epidermis and the dermis
b. A superficial partial thickness burn can heal within 2 weeks with only some pigmentation
changes but no scarring
c. A deep partial thickness burn may need debridement and skin grafts
d. It can take up to 3 weeks to heal and can leave some scarring
e. Type - scalds, flash flame to clothes or skin, chemicals, ultraviolet light (sunburn)
f. Appearance - blistered, moist, mottled pink or reddened, blanches on pressure and refills
g. Sensation - very painful
3. Third degree (full thickness)
a. All the layers of the skin are destroyed and thus there is no pain
b. If not debrided, this type of burn leads to sepsis, extensive scarring and contractures
c. Skin grafts are necessary because the skin cells are no longer alive to regenerate
d. This type of burn can also reach the muscle and bone
e. Type - fire, contact with hot objects or liquids, flame, chemicals, electrical contact
f. Appearance - tough with leathery eschar; white, charred, dark, brown, tan or red; does not
blanch on pressure; dull and dry
g. Sensation - little pain
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Given a scenario of a patient in a clinical setting with burns apply the rule of nines in
determining the percent of body surface burned
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
4
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Learning Support:
Powerpoint presentation with associated handouts.
4. Rule of nines
a. The rule of nines is used to determine the total body surface area (BSA) burned
b. The entire head is 9% (anterior being 4.5% and posterior being 4.5%)
c. Each upper extremity is 9% (anterior being 4.5 % and posterior being 4.5%)
d. The front torso is 18%
e. Posterior torso is 18%
f. Each lower extremity is 18% (anterior being 9% and posterior being 9%)
g. The perineum is 1%
h. For infants and children
i. Upper extremity is 9%
ii. Head and neck is 18%
iii. Anterior trunk is 18%
iv. Posterior trunk is 18%
v. Lower extremity is 14%
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Given a scenario of a patient in a clinical setting with burns describe management of
the burn patient to include inhalation injuries and fluid volume resuscitation
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
5. Inhalation burns
a. More than half of all fire related deaths are caused by smoke inhalation
b. 80% of those who die in residential fires do so because they inhaled heated air, smoke or
other toxic gases
c. Categorized as one of the most lethal types of burns especially when there is a cutaneous
injury associated with the respiratory tract burn
d. There are three causes:
i. Heat inhalation
ii. Inhalation of toxic chemicals or smoke
iii. Inhalation of carbon monoxide gas
e. When dealing with a patient found in a enclosed space suspect inhalation injuries
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
6
Severity depends on:
i. Products of combustion
ii. Degree of combustion
iii. Duration of exposure
iv. Whether the person was in a enclosed space
When noxious fumes are inhaled, the mucosa in the lungs swell and break, leaking fluid into
the nearby alveolar spaces and damaging the cilia
The mucus builds up and plugs the passages; which leads to reduce oxygen and can lead to
death if left untreated
Usual cause of death in inhalation cases is from pneumonia; more immediate death is often
caused by respiratory edema
Edema is the greater concern when dealing with this patient
Usual cause of death in inhalation cases is from pneumonia; more immediate death is often
caused by respiratory edema
Edema is the greater concern when dealing with this patient
Assume a unconscious burn victim is suffering from carbon dioxide poisoning
Very late signs of carbon monoxide poisoning include cherry red coloring to unburned skin,
changes in color of the mucus membrane, unconscious, and obvious neurological damage
Signs and symptoms
i. Edema of the face and neck
ii. Singed nasal hairs
iii. Carbonaceous sputum due to heavy smoke inhalation and necrosis of lung tissue
iv. Burned mucosa in mouth and throat
v. Sooty smell to breath
vi. Dyspnea
vii. Hoarseness
viii. Stridor (a medical emergency)
ix. Altered mental status
Treatment
i. Administer 100% humidified oxygen
ii. Place in semi-fowlers position to allow for easier breathing
iii. Clear air way with suctioning
iv. Mouth to mouth / mask maybe required
v. Maintain a open airway
vi. Move the patient to an area with fresh air
vii. Remove or loosen clothing that may interfere with breathing
viii. Evacuate
ix. Hyper baric treatment for critical cases
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
5. Teaching Point: Given a scenario of a patient in a clinical setting with burns differentiate between
open and closed methods of wound care for burns
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Closed method
a. Preferred method
b. The burn area is covered with a non-adherent dressing
c. Gauze impregnated with petroleum jelly
d. Ointment based antimicrobials.
e. Outer dressing is an occlusive dressing that prevents bacteria from coming in contact
with the wound
f. Advantages of the closed method
g. It protects the burn area from further injury
h. It prevents contamination of the burn area
i. Disadvantages of the closed method
j. It is painful
2. Silver Sulfadiazine (Silvadine)
a. Most effective if it is applied to burns immediately
b. Pain free, does not require occlusive dressing, joint motion unimpeded and it penetrates
the eschar, broad antimicrobial agent
c. Disadvantages
i. May delay epithelialization, bone marrow suppression, hypersensitivity reaction,
delayed eschar separation and resistance to certain gram-negative organisms
3. Mafenide Acetate (Sulfamylon)
a. Advantages
i. Best when treating highly contaminated wounds, penetrates eschar, joint
unimpeded and broad anti-gram-negative activity
b. Disadvantages
i. Exaggerates post-burn hyperventilation, painful application for 30 minutes,
hypersensitivity, delayed eschar separation
4. Silver Nitrate
a. Causes losses of sodium, potassium, chloride and calcium, best if applied immediately,
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
does not penetrate eschar, ineffective if the infection is already established
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
6. Teaching Point: Given a scenario of a burn victim, use the Brooks modified formula to calculate the
amount of IV solution necessary to treat the patient IAW cited references
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
5. Modified Brooke Formula for Fluid Replacement
a. Determine total body surface area burned (TBSA)
b. Obtain patient’s weight in kilograms (divide pounds by 2.2)
c. Calculate fluids for fluid resuscitation for the first 24 hours.
i. 4 cc’s of ringer’s lactate X% body surface area burned X kilograms in body
weight
ii. 4cc X % burn X kg weight = initial 24 hour fluid replacement
d. During first 8 hours, give one half of total calculated fluid
e. During second 8 hours, give one fourth of total fluids
f. During third 8 hours, give one-fourth of total fluids
g. Example:
i. Patient is a 24 year old male who was burned by a chemical. He sustained second
and third degree burns covering 35% of his body. He weighs 165 lbs
ii. Calculate the fluid needed for the first 24 hours
iii. How much fluid should he receive in the first 24 hours
1. 2.2 / 165 = 75
2. 4 X 35 X 75 =
3. 10, 500 cc / 24 hours
4. 5,250 for the first 8 hours
8
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
7. Teaching Point: Given a scenario of a patient in a clinical setting with burns name the three sources
of skin grafts and list purposes of a skin graft
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Skin Craft
a. Autograft uses the patient’s own skin, which is transplanted from one part of the body to
another
b. Allograft or homograft is human skin obtained from a cadaver. This is a temporary graft,
which is used to cover a large area
c. Heterograft is obtained from animals, principally pigs. Like allografts, heterografts are
temporary
2. Skin substitutes
a. Alternative materials used to cover the wound and promote healing.
i. TransCyte
ii. Biobrane
3. Purpose of skin graft
a. Lessen the potential for infection
b. Minimize fluid loss by evaporation
c. Hasten recovery
d. Reduce scarring
e. Prevent loss of function
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
8. Teaching Point: Given a scenario of a patient in a clinical setting with burns describe nutritional
considerations for the burn patient
Minutes
Allocated Time:
Introduction:
9
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Nutritional considerations
a. The nutritional challenge is providing enough nutrients to meet the increased metabolic
requirement of the burn patient
b. Adequate nutrition is required for healing and for skin grafting
2. Calorie needs may be increased to 4000 - 5000/day
3. Protein, calories and vitamins are required to repair the damaged tissue
4. Daily weight
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
You will be tested on this subject at a later date.
You will be expected to review and study the material taught in this session in
order to pass the associated written test. If you have difficulty with the material
please see me so we can review together.
None.
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
5.
10
Given a scenario of a patient in a clinical setting with burns describe
the etiology and pathology of burns
Given a scenario of a patient in a clinical setting with burns Identify
the characteristics, signs and symptoms, and basic treatment of the
three burn depth classifications
Given a scenario of a patient in a clinical setting with burns apply the
rule of nines in determining the percent of body surface burned
Given a scenario of a patient in a clinical setting with burns describe
management of the burn patient to include inhalation injuries and
fluid volume resuscitation
Given a scenario of a patient in a clinical setting with burns
differentiate between open and closed methods of wound care for
AFAMS Master Lesson Plan (MLP)
Nursing Program
Burns
6.
7.
8
burns
Given a scenario of a burn victim, use the Brooks modified formula to
calculate the amount of IV solution necessary to treat the patient IAW
cited references
Given a scenario of a patient in a clinical setting with burns name the
three sources of skin grafts and list purposes of a skin graft
Given a scenario of a patient in a clinical setting with burns describe
nutritional considerations for the burn patient
9.
10.
Closing Statement:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Re-motivating
Statement:
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light,
radiation or friction. Most burns affect only the skin (epidermal tissue and
dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can
also be injured. Burns may be treated with first aid, in an out-of-hospital
setting, or may require more specialised treatment such as those available at
specialised burn centers. Managing burn injuries properly is important because
they are common, painful and can result in disfiguring and disabling scarring,
amputation of affected parts or death in severe cases. Complications such as
shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance
and respiratory distress may occur. The treatment of burns may include the
removal of dead tissue (debridement), applying dressings to the wound, fluid
resuscitation, administering antibiotics, and skin grafting.While large burns can
be fatal, modern treatments developed in the last 60 years have significantly
improved the prognosis of such burns, especially in children and young adults.
In the United States, approximately 4 out of every 100 people to suffer burns
will die from their injuries. The majority of these fatalities occur either at the
scene or on the way to hospital.
11