Nursing Field Notes / Skin + Wound · Pathophysiology Course

Burns 🔥

NG-026 SKIN + WOUND ADHD-friendly visual edition

Burn injuries = direct tissue damage from exposure to sun, chemicals, thermal (boiling liquids), or electricity — the deeper the damage goes, the higher the degree.

📄 Simple Nursing original — opens in Drive →

🚿 The 3 C'sCool water · Cover · Clothing removal.

🧊 NO ice, NO creamsNo antibiotic ointment to open skin either.

💧 Moist + blisters = 2nd°“Red, moist, shiny fluid filled vesicles.”

🤍 Waxy white / charred = 3rd°Dry, leathery, non-blanchable.

🔥

CAUSE

STEP 1 · WHAT & WHY

Four ways to cook skin — and the six floors the damage can reach.

🔥 Four causes of direct tissue damage

☀️ Sun
the slow roast

🧪 Chemicals
the splash that keeps burning

♨️ Thermal
boiling liquids — the classic scald

⚡ Electricity
the current cooker

🧠 “Some Cooks Touch Electricity” = Sun · Chemicals · Thermal · Electricity — the 4 burn makers.

🧱 The skin stack — 3 layers

1️⃣ Epidermis — the top coat
2️⃣ Dermis — the working middle
3️⃣ Subcutaneous tissue — “that fatty bubble looking tissue”

Under the skin we find fascia, muscle & bone.

⭐ Why the layers matter

Degree = depth. Each degree of burn reaches one floor deeper into the stack — that's how you'll read the diagram below.

🧠 “Every Day Someone Finds My Burns” = Epidermis · Dermis · Subcutaneous · Fascia · Muscle · Bone — top to bottom.

🔎

CLUES

STEP 2 · READ THE DEPTH

Look at the burn, name the floor it reached — dry & red, wet & blistered, or waxy & dead.

🕳️ Burn depth map — how far down did it go?

🌡️ Degree vs degree — the look test

Degree	Thickness	What you see 👀
1st° ☀️	Superficial	Dry with blanchable redness
2nd° 💧	Partial thickness	“Red, moist, shiny fluid filled vesicles” · painful blisters
3rd° 🤍	Full-thickness	Dry waxy white, leathery, or charred black · non-blanchable
4th° 🦴	Full-thickness	Deepest — down where fascia, muscle & bone live

🧠 “1 is red, 2 is wet, 3 is dry & dead.” And the blanch test: if it blanches, blood still branches — 3rd° won't blanch.

🚿

CARE

STEP 3 · PREHOSPITAL · MINOR BURNS

Three C's, in order — and two traps the exam loves.

✅ Prehospital care — the 3 C's

🚿 Cool water — briefly soak the area.
❌ NO ice, creams, or antibiotic ointment to open skin

🩹 Cover the area — “Clean dry cloth”

💍 Clothing & jewelry removal — only if NOT adhered to the skin

🧠 Cool it, Cover it, Clear it off — 3 C's, in that order. Cool the burn, never the whole patient.

⛔ Never-do list

❌ NO ice on the burn
❌ NO creams
❌ NO antibiotic ointment to open skin 💊🚫
❌ Don't pull off anything stuck to the burn

Cool water only — soothe it, don't smother it.

⭐ Stuck to the skin? Step away NCLEX TIP

HCP removes anything sticking to the skin.

You remove clothing & jewelry that is not adhered — if it's melted in or stuck on, it stays until the HCP takes it off.

🧠 “If it's stuck, it stays — the HCP peels, not you.”

⚡

QUICK RECALL

SAY IT OUT LOUD

🚿 Cool · Cover · ClothingThe 3 C's of prehospital burn care.

🧊 NO ice · creams · ointmentCool water only on the burn.

💧 Wet + painful blisters= 2nd° partial thickness.

⭐ Stuck to skin = HCP's jobOnly remove what's NOT adhered.

🎯 Cover & check — 4 rapid-fire questions

Q1: A burn is “red, moist, shiny” with fluid-filled vesicles and painful blisters. What degree?

Second-degree (partial thickness).

Q2: First C of prehospital burn care — and what do you NEVER apply?

Cool water, briefly soak the area — NO ice, creams, or antibiotic ointment to open skin.

Q3: The client's shirt is stuck to the burn. Do you remove it?

NO — only remove clothing/jewelry that is not adhered. The HCP removes anything sticking to the skin.

Q4: Dry, waxy white, leathery or charred black, and it does NOT blanch. What degree?

Third-degree (full-thickness) — non-blanchable.