27: Ruby

Ruby is 18 months old. She pulled a hot cup of tea over herself. She has 9% TBSA partial thickness scalds to her chin, neck, anterior torso, left shoulder and left arm.

  • Consider what her problems/needs are using the 12 activities of daily living.
  • Consider the potential longer term problems if healing is delayed.

› Suggested answers

The following table outlines which ADLs will be potentially affected with this size of burn injury over and above a child of this age:

ADL

NEEDS

Eating and drinking

Additional fluids should not be required for this size of burn; however a diet chart should be maintained as a record of oral intake and output.

 

If calorie/ fluid intake is below what the child normally has within 24 hours, then advice from a dietitian should be obtained.

 

Healing will be compromised if dietary intake is poor.

Washing and dressing

The burn wound is likely to be covered with dressings. Initially, it may be too painful to carry out dressing changes without a general anaesthetic.

 

Washing and dressing should still be encouraged/ promoted even though there are dressings in situ. This can help the patient/ family psychologically too as it promotes normality.

Controlling temperature

Regular monitoring of temperature alongside other observations will indicate whether or not an inflammatory response occurs as a result of this injury or from an infection. An infection can occur at any time after injury and until the wound is fully healed.

Mobilisation

Normal mobilisation should be encouraged.

Working and playing

Normal play should be encouraged. The dressings should not be too restrictive. Utilise the skills of the play therapist.

Sleeping

A problem with sleep can occur if the child is in pain, too hot, or suffering from post burns itching.

 

A lack of sleep is not good for the child’s recovery or the parent/ carer’s wellbeing.

If healing is delayed, then the potential problems include the following:

  • A need for surgery (skin grafting) to heal the wounds.
  • Further pain, distress/anxiety from multiple painful dressing changes.
  • Scarring and its long-term effects such as itch, sensitivity to touch, skin tightness and contracture formation which will restrict movement and function.