Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

COLLEGE OF NURSING
University Town, Musuan, Maramag, Bukidnon
E-mail: nursing@cmu.edu.ph

NCM 74
Care of Clients with Problems in Nutrition, and Gastrointestinal, Metabolism
and Endocrine, Perception and Coordination, Acute and Chronic

CHEMICAL BURNS MANUSCRIPT

Submitted by:
Balcos, Andrea A.

Submitted to:
Neda Joy Espina, MAN, LPT, RN
Clinical Instructor

February 2022
WHAT IS CHEMICAL BURNS
Chemical burns are injuries to the skin,
eyes, mouth, or internal organs that occur when
a corrosive substance comes into contact with
them. Caustic burns are another term for this
type of burn. Chemical burns can happen in the
home, at work, or at school. They can result from
an accident or an assault.
PREVALENCE OF CHEMICAL BURNS
The prevalence of chemical burns was 1%
during 2008-2018. Acid and alkali burns were
accounted for 93.5% and 6.5% of burns,
respectively. 77.4% of patients were male, and
22.6% were female. The mean age of patients
was 27 years. The average burn percentage was
16%. 70.6% of patients were illiterate or had
primary education.
TYPES OF CHEMICAL BURNS
Chemical burns are classified like other burns
based on the amount of damage done:
 Superficial or first-degree burns only
affect the outer layer of skin, called the
epidermis. The area will be red and painful,
but there usually is no permanent damage.
 Partial thickness or second-degree
burns extend into the second layer of skin
called the dermis. You may
have blisters and swelling, and it may
leave scars.
 Full thickness or third-degree burns go
through the skin and may damage tissue
underneath. The area may look black or
white. Because nerves are destroyed, you
may not feel pain.
ETIOLOGY
Strong Acids and bases causes most
chemical burns. So when a harsh chemicals
come into contact with your skin, eyes or any
tissue in your body, they can destroy cells. The
damage may go past the superficial layers in the
skin or tissue and cause deep damage. So,
chemical burns can be far more serious than
thermal burns. Chemicals often stay on your skin
for long periods of time, it eats away your tissue.
PREDISPOSING FACTORS
 Age – Infants, Young Children, Older
adults
 People with disabilities
Because these groups may not be able to
handle chemicals properly making them at
higher risk.
PRECIPITATING FACTORS
People whose jobs put them in contact
with chemicals, or even at home like bleaches
PATHOPHYSIOLOGY
When you exposed or like in contact, you
ingestion or inhaled corrosive substance, there is
destruction of tissue (skin, connective tissue,
bone). But always remember that the severity of
tissue destruction is depends on, temperature of
insult, heat capacity, duration of contact,
conductivity of tissue and skin composition.
So first is the superficial thickness,
where the epidermis is the only affected area. It
will directly damage the keratinocytes and direct
stimulation of nerve endings. The Prostaglandins,
Arachidonic Acid, Substance P &
Proinflammatory cytokines are released into
surrounding tissue. So, there is an irritation of
dermal vascular plexus and Increase vascular
permeability and vasodilation.
For the Superficial Partial Thickness
where the epidermal skin layer and the papillary
dermis is affected. There is a Transfer of heat
energy & direct injury to cellular membranes and
with this there is an increase capillary
permeability, so Fluid leaks between dermal and
epidermal layer and the thin epidermal layer
forming fluid-filled vesicle breaks open. Also it will
directly damage the keratinocytes. So the
proinflammatory cytokines are released into
surrounding tissue. So, again like with the
superficial thickness there is an irritation of dermal
vascular plexus and Increase vascular
permeability and vasodilation.
For the Deep Partial Thickness where
the epidermal layer, papillary dermis portion of
reticular dermis is affected. Majority of the
somatosensory structures are completely injured
so the cutaneous capillary bed is destroyed. Also.
There is a Transfer of heat energy & direct injury
to cellular membranes and with this there is an
increase capillary permeability, so Fluid leaks
between dermal and epidermal layer and the thin
epidermal layer forming fluid-filled vesicle breaks
open.
And lastly for the Deep Partial Thickness
where the epidermal and entire dermal layer is
affected. No healthy dermal appendages
available to re-epithelislize wound,
Somatosensory are completely destroyed and the
cutaneous capillary bed is destroyed.
SIGNS AND SYMPTOMS
The symptoms of chemical burns can vary
depending on how the burn occurred. But the
General and common symptoms of chemicals
touching skin and eyes are:
 Irritation and redness
 Edema
 Blanching with pressure
 Pain
 Moist wound
 Blister
 Analgesia – loss of sensation of pain that
results from an interruption in the
nervous system pathway between sense
organ and brain.
 Non-blanchable
But the last two is already in a worst
situation, because nerve endings are
destroyed the wound becomes surprisingly
painless. Where some will recover over the
course of treatment but others suffer a
permanent nerve destruction and related
disabilities.
DIAGNOSTIC TESTS
Physical Assessment - Physical
examination of burn injury consists of a
thorough of thickness and total body surface
area of the patient body. Patient may be
have burn on his head, neck, arm, leg, trunk,
Posterior, and genatilia.
Rule of Nine Test - the rule of nines assesses
the percentage of burn and is used to help guide
treatment decisions including fluid resuscitation
and becomes part of the guidelines to determine
transfer to a burn unit.
CBC - Blood tests - Swallowing chemicals can
affect how your organs work. You can also absorb
chemicals in your body through your skin or eye
burns. Complete blood count (CBC) and other lab
tests to check your kidney, liver, lung and
metabolic function for any type of chemical burn.
Chest Radiography - used to evaluate the
lungs, heart and chest wall and may be used to
help diagnose shortness of breath, persistent
cough, fever, chest pain or injury
Abdominal Radiography - It is used to evaluate
the stomach, liver, intestines and spleen and
may be used to help diagnose unexplained pain,
nausea or vomiting.
Laboratory studies depend on the burn type and
extent of exposure.
For severe burns, consider the following:
Electrolyte test - Can help determine whether
there's an electrolyte imbalance in the body.
BUN and Creatinine test - BUN and creatinine
levels that are within the ranges established by
the laboratory performing the test suggest
that your kidneys are functioning as they should.
Increased BUN and creatinine levels may mean
that your kidneys are not working as they
should.
Urinalysis - It is suggested that urine output
(volume, osmolality and free osmolal output) is
a useful index of the effectiveness of
resuscitation since it provides a reliable
indication of renal perfusion except when renal
function itself is impaired.
ABG levels - measures the acidity (pH) and the
levels of oxygen and carbon dioxide in the blood
from an artery.
NURSING DIAGNOSIS
Possible Nursing Diagnosis related to chemical
burn:
 Deficient Fluid Volume
 Risk for infection r/t destruction of skin barrier
 Acute pain r/t destruction of skin and edema
formation
 Impaired Physical Mobility r/t pain and
decreased strength.
 Impaired Skin Integrity r/t disrupted of skin
surface with destruction of skin layers
MEDICAL MANAGEMENT
 Intravenous Therapy
 Support Care
 Hand Hygiene
 Wound Care
PHARMACOLOGICAL MANAGEMENT
 Administer topical agents as indicated
 Administer other medications as
appropriate: Subechar clysis or
systemic antibiotic, tetanus toxoid, or
clostridial antitoxin, as appropriate.
 Administer other medications as
appropriate: Diuretics, Antacids,
Potassium.
 Administer calculated IV replacement
of fluids, electrolytes, plasma, and
albumin.
NURSING MANAGEMENT
 Ensure that all the chemicals have been
flushed away.
 Anticipate pain medication needs to make
the patient more comfortable.
 Assess reports of pain, noting the
character and intensity (0-10 scale) - Pain
is nearly always present to some degree

because of varying severity of tissue
involvement and destruction but is usually
most severe during dressing changes and
debridement. Changes in location,
character, intensity of pain may indicate
developing complications (limb ischemia)
or herald improvement and/or return of
nerve function and sensation.
 Cover wounds as soon as possible unless
an open-air burn care method is required.
- Temperature changes and air movement
can cause great pain to exposed nerve
endings.
 Maintain comfortable environmental
temperature provide heat lumps, heat-
retaining body covering. - Temperature
regulation may be lost with major burns.
External heat sources may be necessary to
prevent chilling.
 Place IV and or invasive lines in non-
burned area.
 Encourage expression of feeling about
pain.
 Involve patient in determining scheduled
for activities, drug administration.
 Monitor vital signs, central venous
pressure. Note for capillary refill and
strength in peripheral pulses.
 Monitor urinary output. Observe urine color
and hematest as indicated.
 Estimate wound drainage and insensible
losses.
 Assess and document size, color, depth of
the wound, noting necrotic tissue and
condition around the skin. - Provides
baseline information about need for skin
grafting and possible clues about
circulation in area to support graft.
 Promote uninterrupted sleep periods.
 Teach the pt. to look for signs and
symptoms of infection: fever and increased
redness.
 Encourage and emphasize a model of
good hand washing techniques for all
individuals coming in contact with the
patient this is to prevent infection.
 Encourage family/SO support and
assistance with ROM. - Enables family/SO
to be active in patient care and provides
more consistent therapy.
PATIENT EDUCATION
For cases of occupational exposure,
educate the patient on the proper safety
precautions that should be taken when working
with hazardous materials. All industries are
required to inform employees of any dangerous
materials they may come into contact with in the
workplace and must provide them with adequate
training and protective equipment.
When children experience chemical burns,
counsel the parents on how to keep medications
and chemicals out of the reach of children.
Parents may not think that something like
automatic dishwashing detergent can be a danger
to children. Inform them of the various substances
in the home that are potentially dangerous.
Consultation with the local social services
agency may be indicated to evaluate the child's
home situation.
Hygiene
 You should bathe at least once a day.
 Always test the temperature of the water
with unburned/normal skin.
 Use a mild unscented soap and a soft cloth
to remove all creams and dry flaky skin
Blisters
 Wear the prescribed pressure garments
under loose-fitting clothing
 Avoid being in one position (such as
standing or sitting) for a long time
  Do not break the blister! Follow bathing If Not Treated:
instructions and continue to wear pressure
garments.  Infection
 Low blood volume
If a blister breaks:  Breathing Problems
 Scarring
 Keep it clean.  Bone and Joint Problems
 Soak or gently remove all crusts with a  Permanent Disability
clean cloth twice a day.
 Apply medicated ointment twice a day or References:
more often if needed. Barhum, L. (2017, June 25). What to know about
 Cover the blister with gauze. chemical burns. MedicalNewsToday.
https://www.medicalnewstoday.com/articles/
 Stop when the blister area is healed
318084#Seeking-medical-care
Burn Care Unit Staff. (2017). Discharge
Swelling
Instructions After You Leave the Burn Unit.
Nova Scotia Health Authority.
 Swelling may happen even after burned
https://www.nshealth.ca/sites/nshealth.ca/file
areas are healed. s/patientinformation/0212.pdf
 Control and prevent swelling by: › wearing Dock, E. (2020, February 20). Chemical Burns.
pressure garments all the time, removing Healthline.
for dressing changes and hygiene https://www.healthline.com/health/chemical-
burn-or-reaction
Itching Vera, M. B. (2020, March 5). 11 Burn Injury
Nursing Care Plans. Nurseslabs.
 Do not scratch! Put gentle pressure with https://nurseslabs.com/11-burn-injury-
the back of your hand or pat/tap the itchy nursing-care-plans/9/
area. Wayne, G. B. (2021, September 2). Acute Pain
 Take a cool shower with unscented soap. Nursing Care Plan. Nurseslabs.
https://nurseslabs.com/acute-pain/
 Skin massage with lotion and/or touching
Vera, M. B. (2020b, March 5). 11 Burn Injury
with firm pressure on healed areas can Nursing Care Plans. Nurseslabs.
help reduce itching https://nurseslabs.com/11-burn-injury-
nursing-care-plans/7/
PROGNOSIS
If Treated:

 Small lesions heal well, whether dermal

or esophageal
 Larger dermal burns can produce
scarring but they will still heal.
 More severe burns will still recover
given the proper treatment and
rehabilitation