Ihuman case study acute burn injury

Ihuman case study acute burn injury

Scenario
You are working in the emergency department (ED) of a community hospital when
the ambulance arrives with A., a 28-year-old woman who was involved in a
house fire. She was sleeping when the fire started and managed to make her way
out of the house through thick smoke. The emergency medical system crew
initiated humidified oxygen at 15L/min per non-rebreather mask and started a 16-
gauge IV with lactated Ringer’s solution. On arrival in the ED, her vital signs are
100/66, 125, 34, Spo2 93%. She appears anxious and in pain.

1. Describe the interventions needed to care for A. on her arrival in the ED.

Ans: Start with the assessment of ABC’s. Applying supplemental O2 to reduce
risk of carbon monoxide poisoning intubation to protect her airway if stridor is
present if she has facial burns. Assessing circulation and starting 2 large bore
IV’s additional trauma,obtain medical history and allergies, medicating with
narcotic for acute pain, maintaining body temperature,preventing infection and
providing emotional support. During the first 48 hours is to maintain circulatory
vascular volume.

2. As you perform your initial assessment, you note burns on A.’s right anterior leg,

left anterior and posterior leg, and anterior torso. Draw/Shade the affected areas,
and then, using the rule of nines, calculate the extent of A.’s burn injury.
9% Anterior – leg
18% Anterior – torso
9% Anterior – leg
9% Posterior – leg
= 45% total burn

ORDER NOW PLAGIARISM FREE IHUMAN CASE STUDY BURNS PAPER

3. You suspect that A. has sustained deep partial-thickness burns. Which best

describes this type of burn?

c. The wounds have severe edema, pain may or may not be present, and the color
varies.
4. Because you are concerned about possible smoke inhalation, what will you monitor
for in A.?

Chart View
Laboratory Test Values
Hgb 20 g/dL
Hct 51%
K 4 mEq/dL
Na 133 mEq/dL
Cl 100 mEq/dL
Glu 159 mg/dL
BUN 28 mg/dL
Cre 1 mg/dL
5. Interpret A.’s laboratory results.

Ans: Hgb and Hct is increased due to fluid loss. K is within normal limits (3 5),
Na is decreased due Na being trapped in fluid which is causing edema is
within normal limits, Glucose is elevated of stress response, BUN is elevated as
fluid loss, Creatinine is within normal limits
6. A. is undergoing burn fluid resuscitation using the standard Baxter (Parkland)
formula. She was admitted at 0400. She weighs 154 pounds. Calculate her fluid
requirements, specify the fluids used in the Baxter (Parkland) formula, specify how
much will be given, and indicate what time intervals will be used.
Ans: 4mL/kg% TBSA burned. 4mL/50kg/45% = 9000ml
7. A. is in severe pain. What is the drug of choice for pain relief after burn injury, and
how should it be given?
Ans: morphine sulfate, Dilaudid, Fentanyl, and non-opioid analgesic
Case Study Progress
A. does not exhibit any signs of smoke inhalation injury and is admitted to the medical
unit for further treatment. As her nurse, you are concerned about meeting her needs for
infection prevention, skin integrity, nutrition, fluids, and psychologic support.

14. Tissues under and around A.’s burns are severely swollen. She looks at you with
tears in her eyes and asks, “Will they stay this way?” What is your answer?

Ans: Leakage of fluid and electrolytes from the vascular spaces continues which
then leads to extensive edema, even in areas that have not been burned. Fluid
shifts with excessive weight gain occur within the first 12 hours after burn injury
and can continue for up to 36 hours.
15. A. is concerned about visible scars. What will you tell her to calm her fears?

Ans: Women are more prone to psychosocial issues due to self esteem and self
imaging disturbances are many options that are nonsurgical and
surgical patients’ griefing stage. Recommend counseling if necessary or
a support group
Chart View
Vital Signs
Blood pressure 90/50 mm Hg
Heart rate 130 beats/min
Respiratory rate 24 breaths/min
Temperature 99° F (37° C)
Case Study Progress
Eighteen hours after the injury, the UAP reports these vital signs for A. and states that
the urine output for the past hour was 20mL.
16. What do you suspect is occurring, and why does this concern you?

Ans: Large drop in intravascular fluid volume which leads to a decrease in BP,
and increase in HR/RR and impaired organ infusion. It can lead to hypovolemic
shock
17. What treatment do you anticipate?

Ans: A patent airway since she has a inhalation injury. Around the clock pain
management is going to be a major part of the treatment plan since it can
correlate with the patient’s respiratory status. Continuous monitoring or urinary
output hourly,due to slightly decreased Na level. Rapid infusion of IV fluids to

maintain sufficient blood flow for normal CO,MAP and tissue oxygenation.
Address psychosocial needs and concerns for the patient.
Chart View
Laboratory Test Values
Hgb 24 g/dL
Hct 59%
K 5 mEq/dL
Na 128 mEq/dL
Cl 92 mEq/dL
Glu 122 mg/dL
BUN 38 mg/dL
Cre 1 mg/dL
18. The physician increases A.’s IV rate and orders a new set of lab work.
Compare A.’s current laboratory results with those from admission.
Ans: Hgb and Hct: increased due to fluid resuscitation. K+: slightly elevated due
to the cellular shift of K+ due to IV fluids. Na + and CI : decreased due to increase
in blood volume and peripheral blood flow to vital organs. Glucose: decreased to
normal organ. BUN and Creatinine: increased due to increase blood flow and O
to kidneys
19. By the end of your shift, which of the following assessment findings would best
indicate that A. is responding to therapy?
d. Blood pressure 104/64; urine output 40mL/hr for past 4 hours