FAR EASTERN UNIVERSITY

INSTITUTE OF HEALTH SCIENCES AND NURSING

FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

MODULE # 3 – ALTERATIONS IN FLUIDS AND ELECTROLYTES

Introduction:

Fluids and electrolytes balance are a crucial in maintaining homeostasis within the
body. A temporary disturbance in body’s level of fluid and electrolytes can be a serious illness
to children. Nurses play a vital role in assessing and ensure patient’s health and prevent
conditions that may result to imbalances.

Learning Outcomes.

1. Recognize that fluid and electrolytes homeostasis is different in infants, children, and
adults.

2. Identify factors affecting normal fluid and electrolyte balance.

3. Collect assessment data related to fluid and electrolyte imbalance.

4. Apply nursing process to provide culturally, competent care for pediatrics.

Topics:

1. Dehydration

2. Acute Glomerulonephritis

3. Urinary tract Infection

4. Burns

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Fluids are vital to all forms of life. They help maintain body temperature and cell shape, and
they help transport nutrients, gases, and wastes. To maintain fluid balance. the amount of fluid
gained throughout the day must equal the amount lost Some can be measured some are not.

Electrolytes works with fluids to maintain health and well-being. Electrolytes are crucial for
nearly all cellular reactions and functions.

Urinary system maintains the proper balance of fluid and electrolytes in the blood. When
disease occur such as abnormal kidney function, excessive amounts of fluid may occur.
- excessive body fluid loss
- may result to diabetic ketoacidosis, GI infections, and extensive burns
I. DEHYDRATION - classified as isotonic, hypotonic, hypertonic dehydration

Pediatric dehydration – is common complication of illness. Volume depletion in

children is caused by fluid losses from vomiting or diarrhea.
A. Developmental and Biological
1. Smaller the child the greater proportion of body water to weight and
proportion of extracellular fluid to intracellular fluid
2. Infants larger proportional surface area of GI tract than adults
3. Infants greater body surface area and higher metabolic rate than adults

B. General Appearance:
Here are the things to look upon:
1. Skin – a. Check for dry skin and their
mucous membrane
b. Poor skin turgor, tenting,
dough- like feel
c. Temperature increase
d. Sunken eyeballs, no tears

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

e. Pale, ashen, cyanotic nail beds or mucous membranes

f. Delayed capillary refill >3 seconds

2. Cardiovascular – a. Pulse rate change-rapid, weak, or thready, bounding or

arrythmias, rate and quality increase
b. Blood Pressure – take note on the increase or decrease
BP
3. Respiratory rate – a. Change in rate or quality
b. Dehydration of hypovolemia- shows tachypnea, apnea,
or deep shallow respirations
c. Fluid overload – shows moist breath sounds and may
have presence of cough

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

C. Treatment Modalities –

Classification of degree of dehydration (adapted from the WHO)

Severe dehydration Some dehydration No dehydration

At least 2 of the following At least 2 of the following No signs of "severe"

signs: signs: or "some"
dehydration.

Mental Lethargic or unconscious Restless or irritable Normal

status

Radial Weak or absent Palpable Easily palpable

pulse

Eyes Sunken Sunken Normal

Skin pinch Goes back very slowly Goes back slowly Goes back quickly
(> 2 seconds) (< 2 seconds) (< 1 second)

Thirst Drinks poorly or not able Thirst, drinks quickly No thirst, drinks
to drink normally

Severe Dehydration:

1. Treat Shock if present

-if able to drink administer oral rehydration solution (ORS)while with IV access
- insert peripheral IV line using
large IV catheter g24
- Administer Lactated Ringer and
monitor infusion rate. Monitor if
presence of peri orbital edema, this means
over hydration, regulate flow rate accurately

2. Observe child within 2 hours, continue

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

giving ORS if able to drink

3. Monitor ongoing losses closely. Strict monitoring regularly
4. If remains lethargic check blood glucose and treat if hypoglycemic or low sugar level
5. One stabilized reassess degree of dehydration and continue IV rehydration if still
needed. If IV rehydration not anymore required ORS maybe given.

Some Dehydration:

[Link] ORS for 4 hours specially for every loos stool or vomiting

2. Encourage additional age- appropriate fluid intake including breastfeeding

3. Monitor ongoing losses closely. Assess clinical condition and degree of dehydration at

regular intervals to ensure continuation of appropriate treatment.

NO Dehydration:

1. Prevent dehydration –Encourage age-appropriate fluid intake, including breastfeeding

in young children.
2. If with Diarrhea – administer zinc sulfate to children under 5 years of age
Diet: may give banana, rice apple and toast (BRAT)

D. Teaching/Parent Instruction:
Thongs to watch out for go to hospital for consult and treatment:
1. If diarrhea or vomiting increases.
2. No improvement seen in child’s hydration status
3. Child appear wore pr weak
4. Child will not take fluids
5. No urine output

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

II. ACUTE GLOMERULONEPHRITIS:

Glomerulonephritis -inflammation of the glomerulus of the kidney , may occur as a

separate entity but usually occurs in children as an immune complex disease after
infection with nephritogenic streptococci. Inflammation of tiny filters in the
kidneys(glomeruli)Glomeruli remove excess fluid, electrolytes and waste from the
bloodstream and pass out through urine. This may come sudden or gradually
chronic.
1. Assessment:
Acute glomerulonephritis is most common in children ages 5-10 years old. Boys
appear to develop the disease more often than girls. A child with history of
streptococci infection like respiratory tract infection, otitis media, tonsillitis,

streptococcus throat infection should have a urinalysis test 2 weeks after the
infection to evaluate glomerulonephritis.

Symptoms:

- Pink or cola colored urine from RBC (hematuria)

- Foamy urine due to excess protein (Proteinuria)
- High blood pressure
- Fluid retention (Edema) with swelling in the face, hands, feet and abdomen

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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

2. Treatment Management:
a. Antibiotic will be prescribed for 1-2 weeks
b. Diuretics may be given
c. If with heart failure- keep the child in semi-fowler’s position, give digitalis
and oxygen
d. If with hypertension – a anti-hypertensive medications be given
e. Diet – restricting salt to avoid edema and low protein intake to reduce
protein in the urine
f. Weigh the child every day. Best time early morning upon waking up.
g. Monitor intake and output
h. Bed rest maybe advised.

3. Nursing Diagnosis:
a. Excessive Fluid volume- due to decrease regulatory mechanism (renal failure)
b. Activity Intolerance- maybe related to anemia and on bed rest
c. Risk for Injury – due to renal function. Target to put the blood pressure in
normal
d. Risk for Infection- Chronic disease, Target to have no sore throat and throat
cultures will be negative

II. URINARY TRACT INFECTION ( UTI )

Is clinical condition that may involve the

a. Urethra c. Bladder e. Ureters

b. Renal pelvis d. Calyces f. Renal parenchyma

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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Risk Factors

1. Common in kids 5 years old; During the first few months of life, incidence in
boys exceeds that in girls. By the end of the first year and thereafter, first-time
and recurrent UTIs are most common in girls.

2. Alteration of the peri urethral flora by antibiotic therapy

3. Genetic factors
4. Local inflammation

a. Cystitis - An infection of the urethra and bladder

b. Pyelonephritis - infection of the ureters up to the kidneys

5. Anatomical abnormality of the urinary tract (malformed kidney or a blockage

somewhere along the tract of normal urine flow)

6. Vesicoureteral reflux (VUR) - an abnormal backward flow (reflux) of urine from

the bladder up the ureters and toward the kidneys.

7. Poor toilet and hygiene habits

8. Use of bubble baths or soaps that irritate the urethra

9. Family history of UTIs

10. Infrequent urination

11. Incomplete emptying of the bladder (permit incubation of bacteria in the

bladder)

12. Constipation (rectum chronically dilated by feces)

13. Catheterization

14. Previous UTIs

15. Children who receive antibiotics

These agents may alter gastrointestinal (GI) and peri urethral flora, disturbing the

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

urinary tract's natural defense against colonization by pathogenic bacteria

16. Tight clothing or diapers

17. Sexual intercourse

18. Altered urine and bladder chemistry

Etiology

1. Bacterial infections

E coli

Streptococcus group B, especially among neonates

Enterococcus species
Proteus species

Pseudomonas aeruginosa
Klebsiella species

Staphylococcus saprophyticus, especially among female adolescents & sexually

active females

2. Fungi (Candida species)

Pathophysiology

In a urinary tract infection (UTI), bacteria usually enter the urinary tract through
the urethra. Typically, UTIs develop when uropathogens that have colonized the
periurethral area ascend to the bladder via the urethra. From the bladder, pathogens
can spread up the urinary tract to the kidneys (pyelonephritis) and possibly to the
bloodstream (bacteremia). Poor containment of infection, including bacteremia, is more
often seen in infants younger than 2 months.

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Urine in the proximal urethra and urinary bladder is normally sterile. Entry of
bacteria into the urinary bladder can result from turbulent flow during normal voiding,
voiding dysfunction, or catheterization. In addition, sexual intercourse or genital
manipulation may foster the entry of bacteria into the urinary bladder. More rarely,
the urinary tract may be colonized during systemic bacteremia (sepsis); this usually
happens in infancy. Pathogens can also infect the urinary tract through direct spread via
the fecal-perineal-urethral route

Classifications of UTI

1. Bacteriuria - bacteria in the urine

a. Asymptomatic bacteriuria – significant bacteriuria with no evidence of clinical

infection.

b. Symptomatic bacteriuria – accompanied by physical signs of UTI.

c. Recurrent UTI – repeated episode of bacteriuria or symptomatic UTI

d. Persistent – persistent of bacteriuria despite antibiotic treatment.

2. Febrile UTI – accompanied by fever and other physical signs of UTI

a. Cystitis – inflammation of the bladder.

b. Urethritis – inflammation of the urethra.

c. Pyelonephritis – inflammation of upper urinary tract and kidneys

d. Urosepsis – febrile UTI coexisting with systemic signs of bacterial illness; blood

culture reveals presence of urinary pathogen.

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Clinical Manifestations

1. Pain, burning, or a stinging sensation when peeing

2. Increased urge to urinate or frequent urination

3. Fever (though this is not always present)

4. Frequent night waking to go to the bathroom (Enuresis)

5. Wetting problems, even though the child is toilet taught

6. Low back pain or abdominal pain in the bladder (generally below the navel)

7. Foul-smelling urine that may look cloudy or contain blood

8. Jaundice

9. Hematuria (may not be present)

10. Poor feeding

Diagnostic and Laboratory Procedures

1. Urinalysis

(+) for proteinuria – presence of bacteria

(+) RBC or hematuria – mucosal irritation

pH elevated – presence of RBCs or WBCs and bacteria make urine more alkaline

2. Urine culture collected by:

a. Midstream clean - catch technique

b. Suprapubic aspiration

c. Catheterization

3. Ultrasound of the kidneys and bladder

4. Voiding Cystourethrogram (VCUG)

X-rays taken during urination

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Therapeutic Management

1. Complete oral antibiotics specific causative organism

2. Increase Fluid Intake to flush the infection out of the urinary system

3. Cranberry juice to acidify the urine

4. Suggest child to sit and void in the bathtub of warm water

5. Acetaminophen (Tylenol) to reduce pain enough to allow voiding

6. Encourage child to drink extra fluids as soon as symptoms are noticed and for the

next 24 hours

7. Encourage child to urinate often and to empty his or her bladder each time

8. Teach preventive measures

Prevention

1. Frequent diaper changes

2. Teach children not to "hold it" when they have to go

3. Avoid bubble baths and strong soaps that might cause irritation

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

4. Wear cotton underwear instead of nylon because it's less likely to encourage bacterial

Growth

5. Drink plenty of fluids

6. Avoid caffeine, which can irritate the bladder

IV. BURN

♦ A burn is a type of injury to skin or flesh

Common Causes of burns:

1. Thermal

a. Scalding (exposure to hot drinks, high temperature tap water in showers, hot
cooking oil, or steam)

b. Contact with hot objects (tipped-over coffee cups, hot foods, cooking fluids)

c. Fireworks

2. Electricity

♦ high voltage (greater than or equal to 1000 volts)

♦ low voltage (less than 1000 volts)

The most common causes of electrical burns in children are

a. Biting on electrical cords

b. Sticking fingers on electrical outlets

c. Lightning

3. Chemicals

a. Ingestion

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

b. Spilling onto the skin

Common agents include:

a. Acids are those with pH less than 7 (common household compounds like
acetic acid, hydrochloric acid, or sulfuric acid like toilet cleaners)

b. Bases or alkali compounds with pH greater than 7 (Ammonia, Sodium

hypochlorite or bleach)
4. Friction (Contact with flames or hot objects (from the stove, fireplace, curling
iron, etc.)

5. Radiation (Overexposure to the sun)

a. Exposure to ultraviolet light (from the sun, tanning booths or arc welding)
b. Ionizing radiation (from radiation therapy, X-rays or radioactive fallout
Pathophysiology

The skin is the body's first defense against infection by microorganisms. A burn is
also a break in the skin, and

the risk of infection exists both at the site of the injury and potentially throughout the
body. Burns that extend deeper may cause permanent injury and scarring and not allow
the skin in that area to return to normal function

There are three skin layers:

1. Epidermis, the outer layer of the skin; Only the epidermis has the ability to
regenerate itself

2. Dermis, made up of collagen and elastic fibers and where nerves, blood vessels,

sweat glands, and hair follicles reside.

3. Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are
located. This is the layer of tissue that is most important in temperature regulation. At

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

temperatures greater than 44 °C (111 °F), proteins begin losing their three-
dimensional shape and start breaking down. This results in cell and tissue
damage. Many of the direct health effects of a burn are secondary to

disruption in the normal functioning of the skin. They include disruption of the skin's

sensation, ability to prevent waterloss through evaporation, and ability to control

body temperature. Disruption of cell membranes causes cells to lose

potassium to the spaces outside the cell and to take up water and sodium. In large

burns (over 30% of the total body surface area), there is a significant inflammatory

response. This results in increased leakage of fluid from the capillaries, and

subsequent tissue edema. This causes overall blood volume loss, with the remaining

blood suffering significant plasma loss, making the blood more concentrated. Poor

blood flow to organs such as the kidneys and gastrointestinal tract may result in renal

failure and stomach ulcers. Increased levels of catecholamines and cortisol can

cause a hypermetabolic state that can last for years. This is associated with increased

cardiac output, metabolism, as fast heart rate, and poor immune function.

Three types of burns according to depth:

1. Superficial or First-degree burns

♦ the mildest form

♦ burns that cause local inflammation of the superficial skin

Clinical Manifestations:

♦ redness, pain, and minor swelling, skin may be very tender to touch.

♦ Skin is dry without blisters.

Healing time: 3 to 6 days; the superficial skin layer over the burn may peel off in

1 or 2 days.
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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

2. Partial-thickness or Second-degree burns blisters ,

severe pain , redness

♦ more serious and involve the skin layers beneath the top layer

Clinical Manifestations:

♦ blisters, severe pain, and redness

♦ The blisters sometimes break open and the area is wet looking with a bright

pink to cherry red color.

Healing time: Can take up to 3 weeks or more.

3. Full-thickness or Third-degree burns =dry , waxxy , leathery , no pain

♦ the most serious type of burn

♦ involve all the layers of the skin and underlying tissue, in effect killing that

area of skin

♦ the nerves and blood vessels are damaged

Clinical Manifestations:

♦ The surface appears dry and can look waxy white, leathery, brown, ocharred.

♦ There may be little or no pain or the area may feel numb at first because of

nerve damage.

Healing time: Healing time depends on the severity of the burn.

4. Fourth-degree burn

♦ involves injury to deeper tissues, such as muscle or bone

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Burns can be classified by depth, mechanism of injury, extent, and associated injuries

The size of a burn is measured as a percentage of total body surface area (TBSA) affected by
partial thickness or full thickness burns.

c. Wallace Rule of Nines – easy d. Person’s Palmar size – size of

to remember a person’s

but only accurate in people over 16 yo handprint (including the palm and fingers)

is approximately 1% of their TBSA

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

c. Lund and Browder Chart - takes into account

the different proportions of body parts in

adults and children

children = head larger area, limbs lower area than adults

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Therapeutic Management

1. Remove the victim from the burning area, remembering not to put the rescuer in

danger.

2. Remove the child from the heat source

3. Remove clothing from the burned area immediately

4. Do not break any blisters

5. Gently clean the wound with lukewarm water

6. Early cooling (within 30 minutes of the burn) with cool water 10–25 °C (50.0–77.0 °F)
or hold a clean, cold compress on the burn for approximately 3-5 minutes to reduces

burn depth and pain (do not use ice, as it may cause more destruction to the injured
skin; avoid over-cooling as it can result in hypothermia)
7. Keep your child lying down with the burned area elevated.

8. Remove all jewelry and clothing from around the burn (in case there's any swelling
after the injury), except for clothing that's stuck to the skin. If you're having difficulty
removing clothing, you may need to cut it off or wait until medical assistance arrives.

9. The burn may be dressed in a topical antibiotic ointment like Bacitracin or Neosporin.
Silvadene (silver sulfadiazine) topical is the preferred agent for most burns Do not apply
butter, grease, powder, or any other remedies to the burn, as these can make the burn
deeper and increase the risk of infection.

10. Manage first-degree burns without dressings

11. Ask somebody to call for emergency medical care while doing first aid for second-

and third-degree burns

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

For Flame Burns:

1. Extinguish the flames by having your child roll on the ground.

2. Cover him or her with a blanket or jacket.

3. Remove smoldering clothing and any jewelry around the burned area.

4. Call for medical assistance

For Electrical Burns:

♦ Make sure the child is not in contact with the electrical source before touching him.

For chemical burns:

1. Flush the area with lots of running water for 5 minutes or more. If the burned area is
large, use a tub, shower,

buckets of water, or a garden hose.

2. Do not remove any of child's clothing before flushing the burn with water. Continue
flushing the burn, then remove

clothing from the burned area.

3. If the burned area from a chemical is small, flush for another 10-20 minutes

4. Clean with soap and water

5. Apply a sterile gauze pad or bandage

6. Call your doctor

7. Chemical burns to the mouth or eyes require immediate medical evaluation after
thorough flushing with water

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Seek Medical Help Immediately When:

1. Child has a second- or third-degree burn.

2. The burned area is large (2-3 inches in diameter)

3. For any burn that appears to cover more than 10% of the body

4. The burn comes from a fire, an electrical wire or socket, or chemicals.

5. The burn is on the face, scalp, hands, joint surfaces, or genitals.

6. The burn looks infected (with swelling, pus, increasing redness, or red streaking of the
skin near wound)

Medical Management

1. Isotonic crystalloid solution is given

2. Maintenance fluid because of the subsequent inflammatory response that causes

significant capillary fluid leakage and edema

2. Blood transfusions when hemoglobin level falls below 60-80 g/L (6-8 g/dL) due to

associated risk of complications

4. Early feeding

5. Tetanus booster shot should be given if an individual has not been immunized within

the last five years.

6. Hyperbaric oxygenation may be useful in addition to traditional treatments

7. Early intubation

8. Resuscitation begins with assessment and stabilization of the person's airway,

breathing and circulation.

9. Care of the burn wound itself (Sulfamylon (mafenide acetate) cream which produces

a burning sensation when applied

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
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NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

10. Pain management by analgesics (Ibuprofen and acetaminophen)

11. Antihistamines and massage during the healing process to aid with itching

12. Calcium gluconate is an antidote for burns caused by hydrofluoric acid (fluorescent
lights, fire extinguishers, etc)

autograft: tissue transplanted from one part of the body to another

isograft: tissue obtianed from genetically identical individual
xeonograph: tissue graft in which donor and recipient are of different species
Surgery allograft: uses skin obtained from another human being

1. Skin grafts or flaps

2. Escharotomy - surgical release of the skin done to treat or prevent problems with

distal circulation, or ventilation

3. Fasciotomy - fascia is cut to relieve tension or pressure to treat the resulting loss of
circulation to an area of tissue or muscle (may be required for electrical burns)

Alternative medicine

♦ Honey has been used since ancient times to aid wound healing & may be beneficial
in first- & second-degree burns.

Preventing Burns:

1. Proper construction of buildings

2. Keep matches, lighters, chemicals, and lit candles out of kids’ reach

3. Put child-safety covers on all electrical outlets

4. Get rid of equipment and appliances with old or frayed cords and extension cords

that look damaged.

5. If using a humidifier or vaporizer, use a cool-mist model rather than a hot-steam one.

6. Use of fire-resistant clothing

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

7. Care when using irons, flat irons, or curling irons.

8. Provide smoke alarms and sprinkler systems; check these monthly and change the

batteries twice a year.

9. Don't smoke inside the house

10. Care when using fireworks or sparklers

11. Limit hot water temperatures to 120°F (49°C), or use the "low-medium setting"

12. Always test bath water with the elbow before putting the child in it

13. Always turn the cold water on first and turn it off last when running water in the

bathtub or sink.

14. Turn kids away from the faucet or fixtures

15. Turn pot handles toward the back of the stove every time you cook

16. Block access to the stove as much as possible

17. Never let a child use a walker in the kitchen

18. Avoid using tablecloths or large placemats. Youngsters can pull on them & overturn

a hot drink or plate of food

19. Keep hot drinks and foods out of reach of children

20. Never drink hot beverages or soup with a child sitting on your lap or carry hot liquids

or dishes around kids. If you have to walk with hot liquid in the kitchen make sure you

know where kids are so you don't trip over them

21. Never hold a baby or small child while cooking

22. Never warm baby bottles in the microwave oven. The liquid may heat unevenly,

resulting in pockets of breast milk or formula that can scald a baby's mouth

23. Use playground equipment with caution. Use the equipment only in the morning,

when it's had a chance to cool down during the night

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INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

24. Remove child's safety seat or stroller from the hot sun when not in use

25. Before leaving the car on a hot day, hide the seat belts' metal latch plates in the

seats to prevent the sun from hitting them directly

26. Don't forget to apply sunscreen 20-30 minutes before going out and reapply every 2

hours or more often if in water.

Use a product with the SPF of 15 or higher. Do not use sunscreen on infants under 6

months of age

Common complications of burns:

1. Infection

2. Pneumonia occurs particularly commonly in those with inhalation injuries.

3. Cellulitis

4. Urinary tract infections

5. Respiratory Failure

6. Anemia secondary to full thickness burns of greater than 10% TBSA.

7. Compartment syndrome due to electrical burns

8. Rhabdomyolysis due to muscle breakdown

9. Keloids particularly in those who are young and dark skinned.

10. Breathing problems if the burn involves the face, nose, mouth or neck causing.

inflammation and swelling resulting to obstruction of the airway.

11. If circumferential burns occur to arms, legs, fingers, or toes, the same constriction.

may not allow blood flow and put the survival of the extremity at risk.

12. Burns to areas of the body with flexion creases, like the palm of the hand, the back

of the knee, the face, and the groin may need specialized care. As the burn matures,

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NUR 1210 – PEDIA CONCEPT
Prepared by MCN FEU Faculty Lecturers
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

the skin may scar and shorten, preventing full range of motion of the body area.

13. Fluid and electrolyte problems If more than15%-20% of the body is involved.

14. Shock if inadequate fluid is not provided intravenously.

15. Risk of death if burns involve greater than 50%

16. Disturbance in body image

17. Post-traumatic stress disorder

Prognosis

♦ The prognosis is worse in those with larger burns, those who are older, and those.

who are females The Baux score used to determine prognosis of major burns. The

score is determined by adding the size of the burn (% TBSA) to the

age of the person, to predict percent mortality after trauma.

LEARNING RESOURCES:

LEARNING ACTIVITIES:

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NUR 1210 – PEDIA CONCEPT
Prepared by MCN FEU Faculty Lecturers
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

REFERENCES

Hockenberry, M.; Wilson, D; Rodgers, C. Wong’s Nursing Care of Infants and Children (2019) 2nd

Philippine Edition: Elsevier Saunders

Silbert-Flagg, Joanne. Maternal and child health nursing. Care of the childbearing and

childrearing family. Ninth edition. Philadelphia; Lippincott Williams & Wilkins: 2023.

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