Question

Create a concept map using case scenarios as a guide. A conceptual map should include pathophysiology, medical diagnosis, signs and symptoms, and risk factors if any. Nursing diagnosis, nursing interventions, medical management (medication and procedures), expected outcomes.

Abe, a 14-year old boy who stoked a fire in a wood-burning stove and was hurt by a subsequent explosion. He was transported to the local burn ICU (BICU). He sustained an 82% total body surface area (TBSA) thermal burn. Abe’s burns included bilateral full-thickness circumferential burns to his legs and feet, arms, and hands, genitalia, and deep partial-thickness burn to his head and anterior trunk.

Before Abe’s arrival to the BICU, the medical team stabilized Abe by initiating cervical spine precautions, endotracheal intubating him, and providing fluid resuscitation and sedation and analgesia with I.V. propofol and morphine via two large-bore peripheral venous catheters.

Once Abe was admitted to the BICU, a right brachial arterial line was placed along with right internal jugular central venous catheter. Initial I.V. fluid resuscitation was calculated based on Abe’s weight of 79 lbs (36 kg), a urinary catheter was placed, and a tetanus injection was administered. The morphine drip was discontinued, an I.V. ketamine drip was started, and wound care began.

Upon reassessment, the nursing staff noted that Abe’s pedal and radial pulses were absent bilaterally, and emergent bilateral upper and lower escharotomies were performed. At this point of care, Abe’s clinical status was critical but stable.

After escharotomies were completed and Abe was stable, and enteral nasogastic tube was placed in the left nares and feedings began. Abe received standard wound dressing with silver sulfadiazine until his burn wounds were grafted (with the exception of his genital burns).

Abe experienced a slow recovery. Within 72 hours of his admission to the BICU, the first surgical excision and grafting onAbe’s hands, feet, head, and neck were completed. His anterior trunk also required surgical excision and grafting at this time. Nurses explained to Abe’s parents that further excisions and grafting procedures would be performed until all of Abe’s burn wounds were closed. The excisions and grafting on Abe’s arms and legs were completed over the next month. A conservative approach was employed to treat Abe’s genital burn. Initially, all obvious retained material (loose debridement) and contaminated remnants of Abe’s clothing were removed.

Next, the BICU nurses completed a prolonged cooling down procedure with water. During the duration of Abe’s admission, topical antibiotic ointments such as Mupirocin were impregnated into gauze and applied over the perineal area and changed every bowel movement. Scheduled as P.R.N. cleansing as accomplished using 4% chlorhexidine skin wash.

This approach led to the successful healing of Abe’s genital burns. Abe was weaned from the ventilator on the third attempt during his second week in the BICU, and solid foods were introduced gradually.

Answer 1

Q. Conceptual maping:-

Ans:-Burn is the effect of thermal injury on the skin & tissue.

BURN

medical diagnosis

thermal burn 82% total body surface area (TBSA)

Bilateral full-thickness burns

Deep partial-thickness burn

Signs and symptoms Pain · Fluid & electrolyte disturbance Loss of function of skin hypovolemia edema

Pathophysiology

Fluid Shift

Fluid remobilization

·

Medical management:- Immediate:- Cervical spine precaution, Endotracheal intubation, Fluid resuscitation, Sedation & analgesics with morphine & propofol IN BICU:- right brachial arterial line insertion, jugular central venous catheter insertion, Fluid resuscitation, urinary catheterizatio, administration of tetanus inj, I.V. ketamine. topical antibiotic ointments such as Mupirocin Later: Escharotomies

Nursing Diagnosis:- Fluid volume deficit related to increased capillary permeability Pain related to tissue nerve injury Ineffective airway clearance related to edema

Nursing anagement:-

1. Assess the general condition of the patient

2. Monitor the vital signs

3. Start the cardiac monitoring

4. Monitor the fluid intake through IV fluid & output through urinary catheter.

5. Provide oxygen to the patient & Monitor ABG

6Maintain the proper positioning of the patient

7. Maintain the IV fluid line to maintain the fluid & electrolyte imbalance

8.Administer the analgesics to the patient.