Background Burn wounds are still the leading cause of death and disability in the United States.

Clinical insights of burn care refers to the fluid and electrolyte physiology, surgical infections, nutritional maintenance, monitoring cardiopulmonary, and wound care, which requires full understanding of the disease process as a whole. Burn centers or unit should be equipped with equipment that can provide support services for the long term patients with minor burns and do not require hospitalization. About 2 million people in the United States suffer burns each year, 500,000 people were treated in emergency rooms, while 74 000 patients needed treatment in hospital admissions due to burns. More than 20,000 patients have suffered severe burns so that require treatment at a specialized burns care center. The remaining twelve thousand people died from burn injuries. The majority of the age group suffered from burn wounds is children under the age of six years. The second largest burn incident is due to work-related cases and most of the 25-35 years old. Despite smaller incidents occurred in aging patients, special treatment in the facility burns for the elders still in demand. According to current research, the survival rate in elderly has improved more rapidly than the general population of other burns. The incidence of burns, particularly in men, because of the dominance of male workers in heavy industry and the lives of men are at higher risk. Incidence of burn is also higher in lower socioeconomic groups. However, the causes of burn can be ranged by many factors such as the use of heat, electrical surges, and crowded places, and even bad smoke detector. A burn injury report was generated that from public housing or areas within the industry and especially oil industries are possible to suffer from burn. Meanwhile, the

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city centers reports many cases such as for blister injury, or a minor burn. Occupational health hazards such as dealing with high-voltage energy from the subway or from the production of high-temperature steam are probable cause of burn in a working condition. (Scwartz Seymour, 2000). The chemical process of burn should be cut off immediately to prevent further burn injuries. Some of the intervention such as removing the victim by extinguishing the fire, to dissolve chemical reactions, and separating from the electrical current may eliminate the process of burn. The most important thing for the victim is to determine respiratory status such as shortness of breath or condition where oxygen is necessary to save the victim. If the patient is burned in a closed room, the risk of carbon monoxide poisoning is higher and should require 100% oxygen mask to support the victim. Some advance procedure such as endotracheal tube or ventilator can be implemented for victims suffering from respiratory failure. To prevent loss of body heat and reduces the risk of a hypothermia victims should be covered by a clean blanket. In Indonesia, at more than 250 people per year suffered from burns. Children and the elderly accounted for the highest death rate from burns that occurred in Indonesia (Http://www.lukabakar.net.htm) Based on the description above the author is interested in discussing the case in Indonesia because the prevalence number of incidence is still high. Other than that incidence of burns is still quite high in the child's age and the elderly in Indonesia. Lastly, the people of Indonesia are still not aware of proper handling to cope with severe burns. A client by initials of Mr. S, 55 years, male admitted to Budhi Asih Hospital emergency room on the 6th of June 2012 and was taken to the 7th floor west at 07:00 pm carried by officers from the
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workplace of employees with primary complaints of burn wounds. On arrival at the hospital the medical staffs performed the assessment of the burn. The client confessed his burn wounds was as a result of dipping his hands into a bucket of chloride acid which is considered as an unsafe act. About an hour later the client felt a sense of burn as his skin turned chapped. Clients directly referred to the hospital one hour after the burn. Client experienced burn wounds approximately 18% around the area of ante brachii both dextra and sinistra sides. Clients did not admit he had any previous history of hypertension, diabetes mellitus, or any chronic diseases. During clinical assessment clients appeared conscious at a level of compos mentis, Body weight did decrease from 70 kg to 68 kg since illness started. Clients vital signs are: Blood Pressure 170/100 mmHg, Pulse 80 x /mnt, strong, Respiration 26 x / mnt, temperature 36 C. The client was ordered to be given medicines as followed: Ranitidine Injection IV, ketorolac 2x1, Ceftriaxone IV Injection and infusion Asering mounted at 500cc / 8 hour at 20 drops per minute. Laboratory tests on June 6, 2012 result: Leukocytes: 13.8 thousand / uL, hemoglobin 10.4 g / dL, hematocrit: 29%, platelets: 255 thousand / uL, Albumin 2.6 g / dL. During the day of assessment, the client looked grimaced. The clients required full assistance from his wife for caring his activity daily needs. According to 11 Gordon Patterns of Health functions, the client was assessed and received the following results on June 18, 2012: Patterns of perception of health - health care The client admitted he consumed too much chicken noodle, meatballs from public food stalls. The client understands that the process of healing will require some time. The client has some strong hopes that he may be healed sometime soon and that he could go back to work again. Client suffered second degree burn on his right and left hand approximately 18 percent with a pain scale of 4 (1-5), stiff fingers, suffered dizziness and difficulty of sleeping. During

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hospitalization the client did not consume cigarettes. The client did not try to treat the wound with ointment such as mebo prior to his admission to the emergency room. He was admitted to the emergency room one hour later after the incident. Based on the assessment of the results obtained that the perception of nursing diagnoses in patterns of health - health care in the pattern of Gordon is a lack of knowledge related to the lack of information about the handling of hydrochloric acid. This diagnosis was found because the client has little clue of proper handling hydrochloric acid is supposed to do with personal protective equipment. In addition, clients are not informed about the risks and ways to handle hydrochloric acid. Then, the clients misperceptions about the hydrochloric acid, should have known that dipping his hands into these substances can be life-threating. Where an individual is expected to adapt toward the changes occurred internal and external environmental for proper health maintenance. (Potter & Perry, 2005).

2. The pattern of Nutrition - Metabolic Before his illness, the client ate three meals a day and his eating patterns were little changed but the client. The client does not have any history of food allergy. Clients also had no trouble with swallowing or chewing solid foods. Client's weight before the illness was around 70 kg and his height is 171cm. During hospitalization there is an altered eating pattern and the client was experiencing decreased appetite. The client did not eat full portion of his food and his weight was decreased from 68 kg from 06-06-2012. Based on the assessment obtained from above that the nursing diagnose in nutritional patterns is Altered Nutrition: less than body requirement related to an inadequate intake. Nursing diagnosis was found due to decreased appetite client the clients inability to spoon feed his own meals.
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This is due to altered digestive process from the pain factor. Pain can cause a decrease appetite because of the increased stress from the burn wound. (Smeltzer, 2002). Elimination pattern Clients urinate 3-4 times per day before the illness, clear yellow and the client does not experience pain while urinating. Clients says he was consuming a bottle of mineral water (600ml) per day. Clients do not use cathether. Clients do not have complaints during bowel movements. While in the hospital clients urinate 2-3 times per day, clear yellow colored, does not use cathether, and no complaints of back pain or a sense of distension prostatenya section. Clients do not have a sense of inhibition if it is to defecate. Clients bowel sounds 18x per minute. Palpation of the entire abdomen quandran client does not feel pain or distention of the liver. Fluid balance IVFD asering 500ml/8jam with 20 drops per minute rate. Calculation starts from the date of June 18 around 8:00 clock in shifts until June 19, 2012. Intake drink (600 ml / 24 hours), infusion of 2000 ml / 24 hours, and output (1680 cc / 24 hours, IWL 680 cc / 24 hours, metabolic 340cc/24 hours), so the balance of fluid intake and output is. Input: 2000 + 600 = 2.600 cc / hr Output: 2700, the remaining amount from 2600 to 2700 = -100 cc/24 hours. Based on data obtained from the assessment of the case Tn.S that nursing diagnosis on the pattern of elimination in the pattern of Gordon was not found. 3. Activity patterns of exercise Before the ill clients who berhungan activities with work that is driving the vehicle. Clients have never had complaints of burns during the work so far. Clients are able to drive a vehicle that was carrying for 8 hours per day. Client does not have a family history of diseases such as heart disease, stroke, diabletes mellitus or hypertension. During the client's hospital clients a light activity such as walking to the bathroom. Clients assisted by his wife in the conduct of all

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activities. Clients feel helpless if the client has to hold her hand. So if the client wants to retrieve the object the client was helped by his wife. Not attached oxygen and vital signs: blood pressure 140/80 mmHg, respiratory 22x/menit, temperature 36 C and 86 pulse / min. Based on data obtained from the assessment that the activity pattern of nursing diagnoses Gordon is an exercise in pattern of activity intolerance related to the limited range of motion at an area hospital. Nursing diagnoses were found because the client is assisted by a family activity. Meanwhile, the activity is an activity that performs a muscle movement to increase the power of self-made independently. 4. The pattern of Rest - Sleep Before the sleep patterns of sick clients around 7 hours per day and because the lien is often used during the day to sleep about 30 minutes. Client has a principle that he was a driver who also need time for her to drive isitirahat good. However, while in the hospital clients to sleep at night about 5-6 hours during the day and clients are sometimes biased to sleep. Complaints by clients mengurangnya hours of sleep because of pain in the arm by hand. Clients looked lethargic during the day, clients seemed to evaporate during the day. Based on data obtained from the results of that assessment on nursing diagnosis istrirahat pattern - the pattern of sleep disruption in sleep patterns Gordon is associated with difficulty sleeping. Client's sleep patterns disturbed by night and by day resulting in decreased quality of sleep. In saying by Dr. McKhan from John Hopkins University School of Medicine, the adult total sleep time that is required is 7-8 hours. (Guy McKhann, 2010) 5. Pattern of Cognitive - Perceptual Normal sounding speech system clients, and clients are able to respond to normal questions. Clients use the Indonesian language and strongly interacting with the cooperative. Memhami
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client talks and the topic being discussed. Normal auditory function the client, the client does not have a hearing loss or hearing aid use. Clients normal visual function and no eye diseases such as conjunctivitis, the client does not use a glass eye and a normal response to Chaya. Client's skin temperature felt warm and looked no skin disorders around badanya except for the two arms with a broad hand burns 18%. Client's level of consciousness is compos mentis, the Glasgow coma scale Eyes 4, Verbal 5, and 6 total motor 15 and the client does not experience confusion in time, place and name. Based on data obtained from the assessment of diagnosis peerawatan carry on cognitive perceptual pattern was not found on the client. 6. Pattern of Self Perception - Self-concept Client perceptions of burns suffered is feeling sad and powerless / client problem he faced was not able to return to work immediately and perform daily activities independently. The very thought of the current client is anxious to return to work. Expectations of the client after the burn treatment is to be able to recover quickly kemabli work immediately. Based on the results of the assessment of the data obtained that the pattern of self-perception of nursing diagnosis Gordon's self-concept in a pattern not found. 7. The role of pattern Client's role as a father in the family and as a search for the necessities of life in the family. Homeless clients lived in Jakarta with his wife and children. Client relationship with the family very well as well as tetanganya. In hubungak communication with others as well as medical staff officers client does not appear to have problems. During the hospital accompanied by his wife's clients. And clients are very cooperative with medical staff and submit and listen to all suggestions on a good burn. Based on the results of the assessment of the data obtained that the pattern of nursing diagnoses in Gordon's role in the pattern of no problems were found.
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8. The pattern of Sexuality - Reproductive In the pattern of client sexuality never do it with someone other than his wife. Kontraceptif like condom usage is not used. Clients realize that venereal disease can be obtained because of illicit sex. On the client does not have erectile problems and impotence did not experience any disturbance. Clients have never experienced swelling in the genital area. Based on data obtained from the results of that assessment on nursing diagnosis seksulitas pattern - the pattern of reproduction in Gordon was not found. 9. Coping patterns - Stress Tolerance Assessed at the time the client thinks it is like to recover from burns suffered in order to return to work. Coping mechanism against stress on the client is talking or trying to look busy task. Client looks slightly worried look and withstand the pain experienced. Menunkukan client does not seem emotional at the time of assessment. At the client's medical staff to respond cooperatively and to see a good eye contact with mengunkan polite language. Based on the assessment results obtained from the nursing diagnosis on stress coping patterns in the pattern of Gordon was not found. 10. The pattern of Confidence Islam and religious clients often attend Friday prayers and keagaaman around his residence. Religious activity is carried client is prayers. During hospital clients do not attend Friday prayers keagaam because his burns. Clients do not pray at the place and the clients still have the confidence that God can heal all diseases. Based on data obtained from the assessment of nursing diagnosis in a pattern that vote of confidence in Gordon pattern was not found. Based on the description above so I'll just take the three priorities for the nursing diagnosis nursing action on Mr.. S. Prioritization is according to Maslow kebuhtan is of physiological,

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safety and comfort, lovable and loved, appreciated and valued, aktulisasi themselves. In addition, the authors chose the diagnosis of the most threatening to the life that did not threaten the lives of clients. Three nursing diagnosis are: A. Changes in nutrition less than body requirements berhungan with an inadequate intake. Action taken is to examine the sign - a sign of a weight loss client's premises are not experiencing the drastic weight loss. Clients are encouraged to stop the consumption of cigarettes in order to improve the client so desires. So that the client is also able to spend a portion makananya full. The author also recommends employers to control the pain with deep breathing techniques so that clients are able to eat again if you do not experience excessive pain. Activity intolerance related to burns. Action taken is to examine the client burns and assess how the client can move the finger - a finger to move the client looks stiff fingers. Clients are encouraged to try slowly shaking his fingers agan client can prevent contractures or stiffness. Assessing the client's ability to grasp. However, the authors still recommend a client to try to prevent more stiffness in his hand. Lack of knowledge related to lack of information about health. Action taken is to provide information about the health of the burn, with jut a client to use personal protective equipment if a client facing chemicals. With the results seem to understand the client and family about the need for personal protective equipment to prevent contact of harmful chemicals. Explain how the handler with debridement of burns and the client can memhami importance handlers burns with tools and how - the right way. However, the authors still recommend a client to perform the movement of the radius of the client that the client is free

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from the risk of contractures. And the client must understand the ways that burns wounds can heal faster.

The medication therapy the client is obtained by ketorolac 15 mg / ml 2x1 IV injection. Indications: ketorolac is indicated for short-term management of acute moderate to severe pain after surgical procedures. Contraindications: Patients who previously have had an allergy to this drug, because there is the possibility of cross-sensitivity, cerebrovascular disease is suspected and that's for sure. Side effects: Hypersensitivity reactions, fever, joint pain, muscle pain. Ceftriaxone 1 gram IV injection 2x1. Indications: Lower respiratory tract infections, skin, urinary tract. Side effects: diarrhea, nausea, vomiting, stomatitis, glossitis, dermatitis, pruritus, urticaria, edema, erythema multiforma, and anaphylactic reactions. Contraindications: Hypersensitivity to Ceftriaxone or other cephalosporins. Ranitidine 25 mg / ml 2x1 IV injection. Indications: ranitidine used for the treatment of acute gastric and duodenal ulcers, reflux esophagitis, gastric acid hypersecretion pathological circumstances such as Zollinger-Ellison syndrome, postoperative hypersecretion. Side effects: dizziness, drowsiness, insomnia, vertigo, constipation, diarrhea, nausea, vomiting, and thrombocytopenia. Contract Indications: Patients who are hypersensitive to ranitidine. (Http://www.hexpharmjaya.com) Under these conditions, the role of promotive, preventive, curative, and rehabilitative roles that are necessitated to care for patients. The patient may be given promotive health education about burns. Preventive aspect is able to address the prevention of the occurrence of burns due to the chemicals by using protective equipment in accordance with the procedure. Of the curative aspect, advocating on the client to handle the burn with a drug - drugs that are available to speed up the healing process. And rehabilitiatif the client if the client could recover properly control
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handle to the hospital for his burns his hand in the second arm of the contractures and maintain.

Of explanation has been given to research that uses pattern disumpulkan Gordon can be applied in developing treatments to clients. The data obtained from Gordon patterns can help the client to determine the diagnosis nursing diagnosis and nursing action selection that is right for the client's health. In burns caused by hydrochloric acid, the client is a victim of a totally lack of knowledge in menlindungi him. So, as for the advice to be conveyed by the authors is for the nursing staff are expected to apply the Gordon pattern assessment. The author hopes that cases like Mr.. S can be in minimaliskan by Gordon assessment pattern. And for patients with severe burns and are expected to maintain the safety kesehatanya itself from environmental and chemical substances that can threaten human life.

References: http://www.hexpharmjaya.com

Guy McKhann, M.D. And Marilyn Albert, Ph.D. Keep your brain young, 2010, New York: Media Pressindo, p 71

http://www.lukabakar.net

Potter P. A. Anne Perry. P (2004), Fundamentals of Nursing: Concepts, Process and Practice Issue 4, Volume 1. New York: EGC Schwartz, Seymour I. Of 2000. Essence of the principles of surgery. New York: EGC.

Smeltzer, SC and Bare, BG. Textbook of Medical Surgery. Issue 8, Volume 2. New York: EGC. 2002

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