Download 3B_Burns Case Study Presentation_Esson

A.J., a 65-year-old married white male, is brought to
the emergency department with burns to his face and right
arm and hand from a kitchen grease fire. He arrives with
an 18-gauge IV with lactated Ringer's solution infusing at
100 mL/hr and he is receiving 100% humidified oxygen by
mask.
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•Complains of impaired vision and difficulty
swallowing
•Cannot remember the accident
•Expresses a great deal of fear
•States he is a “diabetic” and has “high blood
pressure”
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•Is
awake, alert, and oriented, but in obvious
distress
•Eyes are red, irritated
•Voice is hoarse; nasal hair is singed
•Face is reddened with blisters noted on the nose
and mouth
•Right arm and hand have shiny, bright red, wet
wounds
•Patient is shivering
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Remove the patient from the source of the burn
Stop the burning process
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Establish a patent airway
Intubate nasotracheal or endotracheal tube
Check vital signs
Establish IV Access with bore needle
Remove Clothes and Wrap with clean sheets
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Priority Decision: What factors place
A.J. at high risk for inhalation injury?
•Complains of difficulty swallowing (dysphagia)
•Exposure of respiratory tract to intense heat and
flames
•Hoarse voice
•Nasal hairs singed
•Blisters on the face from burn
What priority interventions
can be anticipated?
•Assess ABC (AIRWAY, BREATHING,
CIRCUATION)
•Administer 100% humidified oxygen
•Place patient in an upright position
•Monitor vital signs including oxygen saturation
•Replace fluids with lactated Ringer’s solution
•Cardiac management
•Administer pain medication
•Care for wounds
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QUESTION #3
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What pain medications might
be considered to relieve his
pain?
• Continuous IV of an opioid for a steady
therapeutic level.
• Short acting analgesic can be used for
treatment-induced pain.
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QUESTION #4
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Which of the criteria for burn
center referral does A.J. meet for
admission to the hospital burn
unit?
• Partial thickness burns greater than 10% total body
surface area
• Burns that involve the face, hands, feet, genitalia,
perineum, or major joints
• Inhalation injury
• Burn injury in patients who will require special social,
emotional, or long-term rehabilitative intervention
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QUESTION #5
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What metabolic disturbances would be
expected soon after A.J.’s admission?
Explain the physiological basis for these
changes.
1. The physiological changes of a burn depend
on the tissue type injured.
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Physiological Changes Cont.
• Hypovolemia due to Increase Capillary permeability
• Movement of sodium and plasma proteins
• Fluid also moves to areas that normally have minimal
to no fluid.
• Decreased blood pressure
• Increased heart rate
• Fluid Evaporation and Fluid loss.
• Impaired Circulation.
• Thrombosis decreasing the red blood cell circulation
• Electrolyte imbalances occur as sodium shifts to the
interstitial spaces and potassium is released from
injured cells and hemolyzed RBCs into the extracellular
spaces.
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QUESTION #6
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How might A.J.’s co-morbidities
affect his burn care and
rehabilitation?
•Pre-existing conditions can lead to a poorer
prognosis
•Diabetes patients have a higher predisposition to
infection from burns
•Diabetes can increase risk for poor healing and
gangrene
•Hypertension and diabetes can impair oxygen
delivery to wound sites
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QUESTION #7
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What measures should be taken
to support A.J.’s caregivers?
• Make her aware that her husbands appearance will be
different, such as from his wounds, dressings and edema.
• Let her know that his swelling will go down with time.
• Try to explain to her what’s going on and why
• Be sure to answer any questions she may have, or at
least find someone that can.
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QUESTION #8
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Priority Decision: Based on the
assessment data presented, develop
three priority nursing diagnosis.
Identify any collaborative problems.
Diagnosis:
Acute pain r/t burn injury aeb pt’s obvious distress
Ineffective airway clearance r/t mechanical obstruction
2° edema aeb hoarse voice, burns to face
Impaired skin integrity r/t burn injury aeb right arm,
hand, face burns
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Identify any collaborative problems.
• Older adult (65 yrs. old)
•Preexisting cardiovascular issues (HTN)
•Diabetes
•Difficulty swallowing (dysphagia)
•Expresses a great deal of fear
•Obvious pain from burns
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CITATION:
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., &
Camera, I. (2011). Medical-Surgical Nursing. (8 ed., pp.
472-495). St. Louis, MO: Elsevier.
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QUESTIONS?
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