“ COMBUSTIO “

OLEH :

VIVI OKTARINA
NIM. 1914201078

PROGRAM STUDI ILMU KEPERAWATAN

STIKes FORT DE KOCK
TAHUN 2019
 BASIC CONCEPTS COMBUSTIO

A. DEFINITION
Combustio is damage or loss of tissue caused by contact with heat
sources such as fire, hot water, chemicals, electricity, and radiation. (Moenajat,
2001)
Combustio is the response of skin and subcutaneous tissue to temperature
or thermal trauma. Combustio with a porsial thickness is a thickness that does
not damage the skin epithelium, nor only partially damages the epithelium can
usually recover with conservative treatment. Full thickness combustion
damages all sources of skin epithelial regrowth and can require skin excision
and excision if it is extensive (Pierce A. Grace & Neil R. Borley, 2006: 87)
Combustio is injury caused by fire, and by other causes due to attack. It
can also be caused by hot water, chemicals and radiation. (Soelarto,
Reksoprodjo, et al. 1995: 432)

B. COMBUSTIO CLASSIFICATION
Combustio is classified based on the cause, depth of the wound, and the
seriousness of the wound, namely:
1. Based on the cause
- Combustio because of fire
- Combustio because of hot water
- Combustio because of chemicals
- Burns because of electricity
- Combustio due to radiation
- Combustio due to low temperatures (frost bite).
2. Based on Combustio depth
a. First degree combustion
- Damage occurs in the epidermal layer
- Dry skin, hyperemia in the form of erythema
- Bulae was not found
- Pain due to irritated sensory nerve endings
 - Healing occurs spontaneously within 5-10 days
b. Second degree combustio
- Damage includes the epidermis and part of the dermis, in the form of
an inflammatory reaction accompanied by an exudation process.
- Bulae found.
- Pain due to irritated nerve endings.
- The base of the wound is red or pale, often located higher than normal
skin.
c. Third degree combustio
- Damage covers all layers of the dermis and deeper layers.
- Skin organs such as hair follicles, sweat glands, sebaceous glands are
damaged.
- Bulae was not found.
- Burning skin is gray and pale. Because it's dry is lower than the
surrounding skin.
- Protein coagulation occurs in the epidermis and dermis known as
eskar.
- There was no pain and sensation loss, because the sensory nerve
endings suffered damage / death.
- Healing occurs for a long time because there is no spontaneous
epithelial process from the wound bed.
3. Based on the seriousness of the wound
The American Burn Association classifies Combustio into three
categories, namely:
a. Major Combustio
- Combustio with an area of more than 25% in adults and more than
20% in children.
- Combustio fullthickness of more than 20%.
- There is a Combustio on the hands, face, eyes, ears, feet, and
perineum.
- There is inhalation trauma and multiple injuries without calculating
the degree and extent of the wound.
 - There is a high-voltage electric Combustio.
b. Moderate combustio
- Combustio with an area of 15-25% in adults and 10-20% in children.
- Combustio fullthickness of less than 10%.
- There is no Combustio on the hands, face, eyes, ears, feet, and
perineum.
c. Combustio minor
Combustio minor as defined by Trofino (1991) and Griglak (1992) are:
- Combustio with an area of less than 15% in adults and less than 10%
in children.
- Combustio fullthickness of less than 2%.
- There is no Combustio in the face, hands and feet.
- Wound is not circumferential.
- There is no trauma inhalation, electrical, fracture.

C. ETIOLOGY
Caused by the transfer of energy from a heat source to the body through
conduction or electromagnetic radiation.
- Combustio because of fire
- Combustio because of hot water
- Combustio because of chemicals
- Burns because of electricity
- Combustio due to radiation
- Combustio due to low temperatures (frost bite).

D. COMBUSTIO PHASE
Based on the course of the disease Combustio is divided into 3 phases,
namely:
1. The acute phase
In this phase the problem is around airway disorders due to inhalation injury
and circulation disorders. In this phase there is a disturbance in the balance
of fluid and electrolyte circulation due to systemic thermal injury.
 2. Sub acute phase
This phase takes place after the shock is over. Open wounds caused by
tissue damage (skin and underlying tissue) cause inflammation, sepsis and
evaporation of body fluids accompanied by heat / energy.
3. Advanced phase
This phase takes place after the closure of the wound until maturation
occurs. The problem in this phase is the emergence of complications from
Combustio in the form of hypertrophic scars, contractures, and other
deformities.

E. PATHOPHYSOLOGY
Combustio causes an increase in permeability of blood vessels so that
water, chloride and protein in the body will come out of the cell and cause
edema which can continue in a state of hypovolemia and hemoconcentration.
Burn shock (hypovolemic shock) is a complication that often occurs, the body's
systemic manifestation of this condition are:
1. Cardiovascular response
Intravascular to extravascular fluid transfer through capillary leakage results
in loss of Na, water and plasma proteins and tissue edema followed by a
decrease in cardiac output. Hemoconcentration of red blood cells, decreased
perfusion in major organs, complete edema.
2. Renal Response
With decreasing inravascular volume, the flow to the kidneys decreases
resulting in decreased urine output and can result in kidney failure
3. Gastro Intestinal Response
The general response to Combustio> 20% is a decrease in gastrointestinal
activity. This is caused by a combination of the effects of the hypovolemic
and neurologic responses and the endocrine response to the presence of
extensive injury. Installation of NGT prevents abdominal distension,
vomiting and aspiration.
 4. Immonological Response
Part of a mechanical basis, the skin as a defense mechanism from incoming
organisms. Impaired skin integrity will allow microorganisms to enter the
wound.

F. COMBUSTIO ADVANCED COMPLICATIONS

- Hypertrophy
- contracture

G. NURSING DIAGNOSES THAT MAY APPEAR

1. Lack of fluid volume
2. Risk of infection due to loss of skin barrier and disruption of the immune
response
3. Nutritional imbalances are less than the body's needs because of
hypermetabolism and the need for wound healing
4. Damage to the integrity of the skin due to open Combustio
5. Acute or chronic pain due to open nerves, wound healing and Combustio
treatment
6. Knowledge deficiency due to Combustio handling process
7. Anxiety
8. Decreased cardiac output due to decreased cardiac volume and contractility
and heart frequency
9. Risk of ineffective kidney perfusion
10. Risk of ineffectiveness of brain tissue perfusion
11. Ineffective breathing pattern due to deformity of the chest wall, fatigue of
the respiratory muscles, hyperventilation
12. Impaired body image