Thermal Burns Nursing Guide

This guide serves as a quick reference for thermal burns, providing an overview and essential nursing considerations based on the nursing process. 

Etiology and epidemiology 

Etiology 

Thermal burns occur when the skin comes into contact with flames, hot objects, or substances. The heat causes soft tissue damage, increasing capillary permeability, which leads to fluid loss. Severe burns may result in increased plasma viscosity and micro-thrombi formation. 

Epidemiology 

Approximately 86% of burn cases in the U.S. are thermal burns. 

• 43% were due to fire or flame
• 34% from scalding (hot liquids or steam)
• 9% from contact with hot objects 

Complications 

• Infection
• Respiratory issues
• Scarring
• Deformity
• Death 

Risk factors 

• Occupational and environmental hazards
• E-cigarette use 

Diagnosis 

Common diagnostic tools for thermal burns include: 

• Arterial blood gas (ABG) levels
• Coagulation profile
• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP)
• Creatine kinase and electrolyte levels
• Blood type and screen
• Urinalysis
• Chest X-ray (for concern of smoke inhalation or if intubation is necessary) 

Management 

Immediate actions 

1. Evaluate the need for resuscitation and provide it if necessary.
2. Secure the airway and assess for inhalation injury.
3. Remove contaminated clothing.
4. Cool the burn with saline or clean water. (Avoid ice.)
5. Cover with dry, sterile sheets after cooling. 

Wound care 

• Clean burns and debride open blisters.
• Treat wounds with topical antibiotics.
• Closed blisters should remain intact. Open blisters should be cleaned, treated with antibiotic ointment, and dressed.
• Use water-based treatments to cleanse and promote tissue healing. 

Additional measures 

• Administer IV fluids to prevent dehydration.
• Provide pain relief and anxiety management.
• Evaluate tetanus immunization and provide tetanus toxoid if needed.
• Treat respiratory symptoms and manage airway with intubation if required.
• In severe cases, perform escharotomy or refer to a burn center. 

Nursing considerations 

Nurses should apply the nursing process to develop an individualized care plan. 

Assessment 

History 

• Cause and duration of burn exposure
• Presence of systemic injury
• Intentional or accidental cause 

Physical examination 

• Assess the size, depth, and location of burns. Several methods are available to estimate the percentage of total body surface area burned.
• Rule of Nines: The head represents 9%, each arm is 9%, the anterior chest and abdomen are 18%, the posterior chest and back are 18%, each leg is 18%, and the perineum is 1%. For children, the head is 18%, and the legs are 13.5% each.
• Lund and Browder Chart: This is a more accurate method, especially in children, where each arm is 10%, the anterior and posterior trunks are each 13%, and the percentage calculated for the head and legs varies based on the patient's age.
• Palmar Surface: For small burns, the patient's palm surface (excluding the fingers) represents approximately 0.5% of their body surface area, and the hand surface (including the palm and fingers) represents about 1% of their body surface area.
• Look for redness, pain, numbness, blisters, or blackened skin. 

Burn depth classification: 

• Superficial burns (First-degree): Epidermis involvement with erythema, blanching, and minimal damage
• Partial-thickness burns (Second-degree): Partial-thickness burns with blisters and pain
• Full thickness (Third-degree): Burns with charred or white skin, minimal pain due to nerve damage 

Other findings 

• Hypotension, dizziness, weakness, muscle twitching, seizures, or dysrhythmias 

Nursing diagnoses/risk for: 

• Anxiety
• Fluid volume deficit
• Ineffective coping or body image disturbance
• Impaired skin or tissue integrity
• Risk for infection
• Pain and activity intolerance
• Altered nutrition or temperature regulation 

Interventions 

• Administer oxygen and pain medications.
• Monitor lab results, vital signs, and fluid balance.
• Perform wound care using sterile techniques.
• Encourage emotional expression and provide support.
• Ensure a calm environment and infection precautions.
• Insert and maintain IV lines and Foley catheters as needed. 

Expected outcomes 

• Ability to perform daily activities independently
• Reduced anxiety and adequate pain management
• Normal tissue perfusion, oxygenation, and fluid balance
• Maintenance of body weight and temperature
• Infection-free recovery 

Individual/caregiver education 

• Teach proper wound care and medication adherence.
• Encourage safety precautions for hazardous work environments.
• Emphasize the importance of follow-ups and infection signs.
• Provide fire safety education, including creating family escape plans and installing smoke detectors. 

References 

1. Brink, C., Isaacs, Q., Scriba, M. F., et al. (2019). Infant burns: A single institution retrospective review. Burns, 45(7), 1518-1527. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30638666/  
2. Gentges, J., & Schieche, C. (2018). Electrical injuries in the emergency department: An evidence-based review. Emergency Medicine Practice, 20(11), 1-20. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30358379/  
3. Schaefer, T. J., & Tannan, S. C. (2021). Thermal burns. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430773/  
4. Radiation Emergency Medical Management. (2025).  Burn triage and treatment of thermal injuries in a radiation emergency. Retrieved from https://remm.hhs.gov/burns.htm