Reference no: EM133851193

Question

BURN CASE STUDY Patient Profile: Mrs. Johnson is a 53-year-old white woman transferred via ambulance to the hospital for a burn from spilled grease. She was cooking dinner when she bent over to pick up something from the floor, knocking a pan of hot grease on her right side. Her husband called 911, and the ambulance team brought her to the emergency department. In ED, she received a tetanus shot, morphine for pain, and two large bore IVs were inserted and fluids were administered through each; total of 2 L of intravenous fluids, initially. The patient is complaining of difficulty opening her right eye. She can open it enough to see, although her vision is blurry. Patient Progress: Mrs. Johnson began a long, slow recovery. She was transferred to a specialty burn unit. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers (i.e. bedsores). She lost 9 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories ("Kcals") per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse. Discharged home after 17 weeks. Objective Data: Physical Examination: Initial and extended Initial vital signs: blood pressure 70/40, pulse 128, temperature 99º F, respirations 38 ED stabilized VS: blood pressure 112/70, pulse 100, temperature 1000F, respirations 26 Initially in ED was fully alert and oriented Upon transfer to burn unit; awakens only when spoken to; slow to respond but oriented to self and situation Pupils equal, round, reactive to light and accommodation; right eye swollen· (R) eye vision blurred Foley to DD and hourly urine monitoring for the first 48 hours; urine output initially 25 ml hourly increasing to adequate output volume. Heart rate and rhythm rapid (stabilizing several days after admission to 88 bpm) regular; no murmur throughout hospitalization. Lungs clear to auscultation initially and during subsequent assessments. Abdomen rounded, non-distended, occasional bouts of diarrhea, resolved after adjustments were made. Bowel sounds present and hyperactive in all four quadrants after initiation of TF· (L) nare NG tube placed and intact removed prior to discharge. Weight loss of 9 pounds over 3 weeks. Moves all left extremities· right limbs have limited ROM. Medical Findings/Prognosis - H&P Second- and third-degree burns over right side of face and neck, right side of anterior trunk, two thirds of lower right thigh, and right arm. Total body surface affected estimated at 32%. Will require escharotomies and skin grafting. Extended stay in burn unit; eventual discharge to home (approximate 16-18 week stay). Follow up rehab plan for physical and occupational therapy at home. Community health nurse visits twice weekly to note healing and continued progress. Psychosocial Data· Married, lives with husband· works for a city official as a secretary. Mother of three adult children· Denies tobacco, alcohol, and drug use.

Critical Thinking Questions

Analyze the difference between a second-degree (partial thickness) and third-degree (full-thickness) burns.

Evaluate how the extent of a burn injury is determined. List and detail the three stages/phases of burns.

Describe what phase Mrs. Johnson is during the initial physical examination.

Analyze how the nurse make this determination. Describe Resuscitative Fluid Management (calculations, pathophysiology and rationale).

Identify the primary nursing concerns during the initial physical examination. Elaborate on both the nursing and collaborative management that are important during the initial physical examination.

Predict what long-term problems may the patient have as a result of extensive scar tissue formation over her right trunk and her right elbow.

Identify nursing interventions to address the emotional needs of a burn patient.