Nursing Care Plan for a Child with Third-Degree Burns

Third-degree burns are severe and involve damage to all layers of the skin, including nerve endings, blood vessels, and tissues. In children, these burns require immediate and specialized care due to their delicate physiology and increased risk of complications such as infection, dehydration, and shock. Below is a comprehensive nursing care plan tailored for a child with third-degree burns.

1. Assessment

Subjective Data:

Reports of pain (if nerve endings are not completely destroyed).
Parental concerns about the child’s condition.
Anxiety or fear expressed by the child or family.

Objective Data:

Full-thickness burn involving all layers of the skin.
Charred, white, or leathery appearance of the burned area.
Absence of sensation in the burned area due to nerve damage.
Signs of systemic complications (e.g., hypovolemic shock, respiratory distress if inhalation injury is present).
Vital signs: Tachycardia, hypotension, fever (indicative of infection), or respiratory distress.

2. Nursing Diagnoses

Impaired Skin Integrity related to full-thickness tissue destruction.
Risk for Infection related to loss of skin barrier function.
Acute Pain related to tissue damage and inflammation.
Fluid Volume Deficit related to increased capillary permeability and fluid loss from the burn wound.
Anxiety/Fear related to the traumatic nature of the injury and hospitalization.
Risk for Altered Growth and Development related to prolonged hospitalization and potential scarring.

3. Goals and Outcomes

The child’s skin integrity will be maintained, and wound healing will progress without complications.
The child will remain free from infection during the treatment period.
The child’s pain will be adequately managed.
The child will maintain adequate fluid balance and vital signs within normal limits.
The child and family will demonstrate reduced anxiety and coping strategies.
The child will achieve age-appropriate growth and development milestones despite the injury.

4. Nursing Interventions

A. Impaired Skin Integrity

Intervention: Cleanse the burn wound gently with sterile saline or prescribed antiseptic solutions.
Rationale: Prevents further tissue damage and reduces the risk of infection.
Intervention: Apply prescribed topical antimicrobial agents (e.g., silver sulfadiazine) and dressings.
Rationale: Promotes healing and protects the wound from contamination.
Intervention: Monitor for signs of wound healing or complications (e.g., eschar formation, infection).
Rationale: Early detection of complications ensures timely intervention.

B. Risk for Infection

Intervention: Maintain strict aseptic technique during wound care and dressing changes.
Rationale: Reduces the risk of introducing pathogens into the wound.
Intervention: Administer prescribed antibiotics as ordered.
Rationale: Treats or prevents systemic or localized infections.
Intervention: Monitor temperature, white blood cell count, and wound characteristics for signs of infection.
Rationale: Early identification of infection allows prompt treatment.

C. Acute Pain

Intervention: Administer prescribed analgesics (e.g., opioids, acetaminophen) as ordered.
Rationale: Provides pain relief and improves comfort.
Intervention: Use non-pharmacological pain management techniques (e.g., distraction, guided imagery, positioning).
Rationale: Complements pharmacological interventions and reduces reliance on medications.
Intervention: Assess pain level using an age-appropriate pain scale (e.g., FLACC scale for non-verbal children).
Rationale: Ensures accurate pain assessment and effective management.

D. Fluid Volume Deficit

Intervention: Monitor intake and output closely, including urine output.
Rationale: Ensures adequate fluid resuscitation and renal perfusion.
Intervention: Administer intravenous fluids (e.g., lactated Ringer’s solution) as prescribed using the Parkland formula.
Rationale: Replaces lost fluids and prevents hypovolemic shock.
Intervention: Assess vital signs frequently for signs of hypovolemia (e.g., tachycardia, hypotension).
Rationale: Early detection of fluid imbalance allows timely intervention.

E. Anxiety/Fear

Intervention: Provide age-appropriate explanations of procedures and treatments to the child and family.
Rationale: Reduces fear and promotes understanding and cooperation.
Intervention: Encourage parental presence and involvement in care.
Rationale: Provides emotional support and reassurance to the child.
Intervention: Refer to a child life specialist or psychologist if needed.
Rationale: Helps the child and family cope with the trauma of the injury.

F. Risk for Altered Growth and Development

Intervention: Encourage participation in age-appropriate activities during hospitalization.
Rationale: Supports normal growth and development.
Intervention: Collaborate with physical and occupational therapists for rehabilitation planning.
Rationale: Minimizes long-term functional limitations caused by scarring or contractures.
Intervention: Educate parents about scar management techniques (e.g., pressure garments, silicone sheets).
Rationale: Reduces the risk of hypertrophic scarring and promotes optimal healing.

5. Evaluation

The child’s wound shows signs of healing without infection (e.g., decreased erythema, no purulent drainage).
The child remains free from systemic or localized infections.
The child reports reduced pain levels, and vital signs stabilize.
The child maintains adequate fluid balance, as evidenced by stable vital signs and urine output.
The child and family demonstrate reduced anxiety and effective coping strategies.
The child achieves age-appropriate developmental milestones and participates in rehabilitation activities.

6. Patient and Family Education

Teach parents how to care for the burn wound at home, including dressing changes and signs of infection.
Emphasize the importance of follow-up appointments with the burn team and specialists.
Discuss the need for scar management and potential reconstructive surgeries.
Provide resources for psychological support for the child and family.

This nursing care plan addresses the complex needs of a child with third-degree burns, focusing on wound care, pain management, infection prevention, and psychosocial support. Collaboration with the interdisciplinary team (e.g., physicians, dietitians, therapists) is essential to ensure comprehensive care and optimal outcomes.

Nursing Care Plan for a Child with Third-Degree Burns