Question

 

1. Diagnosis: Partial-thickness (second-degree) burns

Dylan DiSabatino is a 9-year-old Latino male who suffered partial-thickness burns on his right hand and fingers while playing with fireworks last Friday night.

a. Explain the pathophysiology of Partial-thickness (second-degree) burns

b. Explain the therapeutic regimen of Partial-thickness (second-degree) burns

2. Diagnosis:

. Wound infection, right foot, and heel

. Type 2 diabetes mellitus

Mathias Hedding is a 62-year-old white male with a history of type 2 diabetes mellitus and heart failure.

a. Explain the pathophysiology of Wound infection, right foot, and heel

b. Explain the therapeutic regimen of Wound infection, right foot, and heel

c. Explain the pathophysiology of Type 2 diabetes mellitus

d. Explain the therapeutic regimen of  Type 2 diabetes mellitus

 

Answer 1

1. a. Pathophysiology of partial thickness burns

Burns are most common trauma in children. It si resulted from accidental eenrgy transfer from a heat source to human body. the etiologies are thermal, electronic, radiation,or chemical burning.

depends on the extent of burn injury it is classified into first degree, second degree(partial thickness) nad third degree(full thickness) burns

Second degree burns are again divided into two stages a) superficial b) deep dremal

when the body exposed to heat source physiologic reactions are intiated same like inflamatory process, relexes are stimulated and vasodilation occur in the adjacent tissues. This results in redness and blanching with pressure.

Then platelets and leukocytes begin to attach t the vascular endothelium as an inflammatory process. In second degree burns the epidermisis damaged, it results in severe systemic reactions from fluid loss. It leads to increased capillary permeability and allows fluid and protien to shift from vascular to interstitial spaces for the first 24 to 36 hours. If patient is untreated can go for severe shock. This increased vascular permeability results in edema of the tissues.

Red blood cells also depleted bdue to thrmbosis, sludging, and rbc death from thermal injury. as fluid escapes from capillary walls results in high hemoglobin concemtration and increased viscosity. This capillary stasis may cause necrosis insevere burns.

b) Treatment

Treatment is based on the severity of burns

* Fluid management; I V Fluid Therapy- Fluid therapy is indicated for adults with 18- 20 % of TBSA and children with 12- 15 % of TBSA(total body surface area). Immediate fuid resucitation is indicated for these cases.

* administration of humidified oxygen in case of hypoxia.

* passive exercises for the affected side to prevent contractures.

* monitor peripheral pulses to ensure peripheral blood supply

* keep the patient NPO for first 24 hours if bowel movements are impaired. later small amount of enteral feedings can be intaited to restore GI function. When bowel sound are returned start normal diet as tolerated

* Administer analgesics to relieve pain.

* Wound cleaning and mangement;

Burn wound must be cleaned intially and following days with mild anti bacterial cleansing agents and saline or water.

Non viable tissurs are removed naturally or by surgical debridement.

* Topical anti microbials are used to reducs infection and promote healing

* Surgical excision nag grafting is done early to fascilitate the wound healing if indicated.