Pediatric Nursing Demystified

For electrical burn—turn off power or use wood or nonconductive

material to separate child from electricity.

Apply cool water.

Nursing alert Do not use ice!

• Cover the wound with a clean cloth.


• Remove burned clothing to remove heat and clear the wound for
  covering.


• Remove jewelry, particularly rings, which restrict circulation with
  edema.
  Assess for airway and breathing and provide rescue breathing if indicated.
  Keep victim warm.
  Follow-up management:


• Begin intravenous therapy (for burns ≥15 to 20% total body surface
  area [TBSA]).


• Fluid volume lost from open wound is replaced using formula to cal-
  culate.


• Maintain fluid infusion to keep urine output at 30 mL/hour or more
  [1 to 2 mL/kg in children weighing <66 pounds (30 kg)].
  Maintain stable airway (intubate if signs of respiratory distress noted,
  drowsiness, tachypnea, shortness of breath, wheezing, decreased oxy-
  gen levels).
  Begin oxygen therapy.
  Pain management:


• Analgesia, particularly prior to dressing change


• Fentanyl and midazolam (Versed)


• Patient-controlled analgesia (PCA) for older child
  Burn wound care:


• Clean wound with ordered cleanser.


• Dress wound with antimicrobial ointment and gauze:
  Acticoat
  Adaptic/Aquaphor
  Scarlet red
  Xeroflo
  Xeroform
  Silver nitrate 0.5% (AgNO 3 )
  Silver sulfadiazine 1.0%
  Mafenide acetate 10% (Sulfamylon)
  Bacitracin


• Occlusive dressing (hydrocolloid) if ordered to promote proper healing.


• Debride wound with hydrotherapy (soak in tub) or dressing change
  that strips away dead skin and secretions.

(^338) Pediatric Nursing Demystified