Case Study 2: Burns
Situation: You are working the day shift on the medical-surgical unit in a small district hospital. Your assignment includes an 18-year-old female college student, admitted the previous night. She was caught in a house fire and sustained burns over 30% of her body surface area, with partial-thickness burns on her legs and back.
1. The client is undergoing burn fluid resuscitation using the standard Baxter (Parkland) formula. She was burned at 0200 and admitted at 0400. She weighs 110 pounds. Calculate her fluid requirements, specify the fluids used in the Baxter formula, specify how much will be given, and indicate what time intervals will be used.
Baxter Formula: Lactated ringer's 4 ml/kg/%burn/24 hours -
…show more content…
• Eyes: Eyes may be red and irritated by the smoke, and there may be burns on the corneas in the eyes. • Skin color: Skin color may range from pale to bluish to cherry red. • Soot ➢ Soot in the nostrils or throat may give a clue as to the degree of smoke inhalation. ➢ The nostrils and nasal passages may be swollen.
• Headache ➢ In all fires, people are exposed to various quantities of carbon monoxide. ➢ The patient may have no respiratory problems, but may still have inhaled carbon monoxide. ➢ Headache, nausea, and vomiting are symptoms of carbon monoxide poisoning.
• Changes in mental status ➢ Chemical asphyxiants and low levels of oxygen can lead to mental status changes. ➢ Confusion, fainting, seizures, and coma are all potential complications following smoke inhalation.
3. The client is concerned about visible scars. What will you tell her to allay her fears?
I would inform the patient that most skin burns that are small and superficial will heal within one week and will not usually scar. After a superficial partial-thickness burn, the skin may become darker or lighter in color, but will not usually scar.
4. The client is in severe pain. What is the drug of choice for pain relief following burn injury, and how should it be given?
Morphine Sulfate or Meperidine (Demerol) through
Scarring, effects of poisoning such as vomiting, drowsiness or seizures. Respiratory problems from drowning, suffocation or poisoning.
smoke can trigger an attack to be worse if you have asthma. Respiratory diseases can be
R/s Quankeya’s (8) whole right leg is burnt. R/s Quankeya’s leg is wrapped from her upper thigh to the top of her knee and from the bottom of her knee straight down to her ankle is also wrapped. R/s according the child’s guardian, Keyanna, Quankeya and a smaller cousin put water in the microwave and was burn. R/s it was reported that Keyanna was in back of house when the children were putting the water in the microwave. R/s the smaller child was burned on the left side. R/s Keyanna stated that she was told to take Quankeya to the burn center, but she didn’t take the child instead she will call the Burn Center when she gets a chance. R/s Quankeya is not coherent and Keyanna said the child is on Tylenol with Codeine. R/s the fluid is seeping through the band aid. R/s five other children are in the home.
Most of the patients in the burns clinic have undergone surgery and came in for follow up, rehabilitation, and tissue expansion. Family dynamics were also discussed to determine the family’s needs for referral or health promotion teaching as well as emotional support.
Second-degree burn damage goes deeper into the layers, not only affecting the epidermis, but also damaging the upper region of the dermis (Marieb, 2006, p. 121). Blisters are caused due to the separation and fluid accumulation between the epidermis and dermis (Tortora and Grabowski, 1996, p. 136). Barring infection, regrowth of cells is possible as there are still epithelial cells present (Marieb, 2006, p. 122). An individual may consider increasing fluids to replace fluid loss due to the dehydration caused to the skin by the sunburn. Healing typically takes three to four weeks, and no special treatment is necessary. Home and over-the-counter remedies may help reduce pain. Special care is needed when using these remedies to ensure infection does not set-in on the exposed areas of blistered skin. Both first and second-degree burns are considered partial-thickness burns as only the epidermis and upper portion of the dermis are damaged.
Complains of burning eyes, clear drainage from the nose, as well as waking up with dark circles under her eyes. Sometimes wakes up during the night coughing and states it has been like this “since the smoke started.”
This case involving Mr. Jones at age 25, was severely burned in a propane gas explosion in which he was rushed to the Burn Treatment Unit of Parkland Hospital in Dallas. When examined in the hospital he was found to have serve burns of 65 percent of his body; his face and hands had have third degree burns. In which both eyes were severely damaged. So he had to take full burn therapy that was commenced during his stay. This case raises the question whether it is right to continue the procedure with the patient receiving pain. The reason this case is important because we either have to agree or disagree with the choices made by the physician. That it is important that the physicians should be taking care of their patients and making sure they cause no harm to the patients. I will be arguing that I disagree with the physician in this case he acted unjustifiable with his patient and that he should of have performed the following action in pleasing the patient. The patient Mr. Jones at age 25 years old, had been severely burned, discharged totally blind, he barely had minimal use of his hands. He had badly scarred and had to depend on others to assist him with his personal functions.
The objective of this reflection is to explore and reflect upon a situation from a clinical placement on an orthopedic unit. The incident showed that I did not provide safe, timely and competent care for my patient when the oxygen saturation was low. Furthermore, this reflection will include a description of the incident, and I will conclude with explaining what I have learned from the experience and how it will change my future actions.
Pharmacist – Burn patients experience pain during dressing changes, debridement, surgical interventions & physical and occupational therapy. Pain management is essential . Also burn patients need to prevent infection so its up to the Pharmacist to coordinate these meds to have the best outcome for the patient.
Great post. I like the points you outlined about assessment of Mr. J. You started with maintaining ABC’s to checking lower extremities pulses to ensure that it is not cut off by the tight constrictive band of the eschar. ECG should be monitored at least the first 24 hours because Mr. J is prone to cardiac arrest due to high electrical voltage injury. Fluid resuscitation with 14 or 16 gauge preferably through unburned tissue, and infusion of lactated Ringer’s solution will help to prevent shock. Assessment of vital signs and pain is very important, the nurse should also assess for history of tetanus immunization because burn wounds are prone to tetanus. Mr.’s brief medical history is important in case he has any allergies, current medical
These downfalls include, twice daily dressing changes, painful debridement with each dressing change, and pseudoeschar formation (Zacharevskij et al, 2017). While SSD cream should be helping to soften and remove forming eschar, it can also be causing a soft layer of eschar as well. Therefore, an important question is: In patients with partial thickness burns, would the use of hydrocolloid dressings compared to the use of SSD cream increase healing time and function by reducing scaring over a period of six months? This evidence-based practice project will delve into which burn dressing is more appropriate for the first-line treatment in partial thickness burn
Smoking harms nearly every organ in the body, causing many diseases, and reducing the overall health of an individual (Lidia Arcavi & Neal L. Benowitz, 2004). The effects of smoking start out in the respiratory system where smoke irritates the trachea and larynx which leads to reduced lung function and breathlessness due to swelling and narrowing of the lung airways, and also leads to excess mucus in the lung passages. The excess mucus causes impairment of the lungs' clearance system leading to the build-up of poisonous substances which results in lung irritation and damage, increased risk of lung infection, symptoms such as coughing and wheezing, and permanent damage to the air sacs of the lungs (Lidia Arcavi & Neal L. Benowitz, 2004).
Burns disrupt the continuity of skin and are one of the most prevalent and devastating forms of trauma. In 2016 in the United States, 486,000 people received medical treatment for burn injuries and 40,000 people were hospitalized for burn injuries. The varying degrees of burns that present for medical
Cigarette smoking can damage the respiratory system greatly. There are six major parts of the respiratory system that are damaged as a result of smoking. The cilia, mucus membranes, alveoli, capillaries, and surfactant and water layers of the lungs all face damage. Normally, respiratory tubules produce mucus that coat our body and trap infectious organisms, dirt, and other unwanted substances. Cilia, small hairs, have a function that essentially eliminates these unwanted substances by sweeping it towards the mouth. When someone inhales smoke, these cilia slow down their motion. They do not move as fast as they would. Eventually, as one continues to smoke, the cilia face paralysis and will disappear in time. Smokers typically develop a cough
To a large extent, people are underestimating the health risks of passive or second hand smoking. A number of the direct effects include cough, sore throat, nausea, headache, dizziness and eye irritation. In children, new cases of asthma may possibly be induced, while adults with asthma can have an incidence of decline in lung function. (Gardezi, 2005).