Question

Tracy Moore a 29-year-old white female was transported by ambulance to the emergency room after being rescued from her burning house she was asleep at night when a spurt from the family fireplace started a fire leaving her trapped in her bedroom by the time the fire rescue squad arrived she had suffered severe burns vitals at the scene were as follows heart rate 110 blood pressure 150 over 90 respirations 22 temperature 100.1 spo2 96% room air a the back of her head is painful and sensitive to touch the area is white with moderate edema and her hair is missing in places B her right hand is black and brown with minimal sensation and the burning stands up the front and back of her right arm to the shoulder. c. her right leg is red with no blisters and extremely painful there is moderate edema the burn is covering the back of her leg from her ankle to her buttocks
1. what is the total body surface area burned based on the rules of nine for burns a b and c
2. for each of the Burns in a b and c indicate the type of burn based upon it's description
3.what type of pain management will Tracy require for each of the burns explain your answers
4. name two complications Tracy is at rest for due to her Pacific Burns and discuss how you will manage these complications
5. what is the classification of burn depth
6. during the emergent stage what is the nurses priority name three
7.. what is the rule of nines

Answer 1

1) What is the total body surface area burned based on the rules of nine for burns a b and c?

a) the back of her head is painful and sensitive to touch the area is white with moderate edema and her hair is missing in places - 4.5%(back of head only)

b) her right hand is black and brown with minimal sensation and the burning stands up the front and back of her right arm to the shoulder - 4.5%(front) + 4.5%(back) = 9%

c) her right leg is red with no blisters and extremely painful there is moderate edema the burn is covering the back of her leg from her ankle to her buttocks -9%(back only)

Total Body Surface Area burned = 4.5% + 9% + 9% = 22.5%

2) For each of the Burns in a b and c indicate the type of burn based upon it's description.

a) the back of her head is painful and sensitive to touch the area is white with moderate edema and her hair is missing in places - Third-degree burns (full thickness burns) go through the dermis and affect deeper tissues. They result in white or blackened, charred skin that may be numb.

b) her right hand is black and brown with minimal sensation and the burning stands up the front and back of her right arm to the shoulder - Third-degree burns (full thickness burns) go through the dermis and affect deeper tissues. They result in white or blackened, charred skin that may be numb.

c) her right leg is red with no blisters and extremely painful there is moderate edema the burn is covering the back of her leg from her ankle to her buttocks - First-degree burns are considered mild compared to other burns. They result in pain and reddening of the epidermis.

3) What type of pain management will Tracy require for each of the burns explain your answers?

Burn pain requires careful assessment and a multidisciplinary approach that may include both medication and non-medication treatments for management. Following a burn injury, the patient experiences a very strong sharp pain owing to stimulation of pain sensing nerves termed as skin nociceptors. Pain can be managed with over the counter medications.

i) Pharmacological Management

• NSAIDS for long term pain relief
• Paracetamol for minor burns
• Anti convulsant medications for neuropathic pain
• Anti depressants for stress
• Opioids for short term pain relief such as morphine, fentanyl, ketamine, etc.

ii) Non pharmacological Therapies

• Physical therapy for controlling edema
• Body and limb positioning to prevent contractures
• Elevation to decrease edema
• Splinting to reduce contractures
• Manipulative exercises to release contractures
• Cognitive relaxation techniques
• Somatic relaxation techniques
• Hypnosis

4. Name two complications Tracy is at rest for due to her Pacific Burns and discuss how you will manage these complications

i) Contractures

Bone and joint problems, such as when scar tissue causes the shortening and tightening of skin, muscles or tendons. Burn scar contractures do not go away on their own, although may improve with the passage of time, with occupational therapy and physiotherapy, and with splinting

Iii) Infection

• Change the dressing daily (twice daily if possible) or as often as necessary to prevent seepage through the dressing. On each dressing change, remove any loose tissue.
• Inspect the wounds for discoloration or haemorrhage, which indicate developing infection.
• Fever is not a useful sign as it may persist until the burn wound is closed.
• Cellulitis in the surrounding tissue is a better indicator of infection.
• Give systemic antibiotics in cases of haemolytic streptococcal wound infection or septicaemia.
• Pseudomonas aeruginosa infection often results in septicaemia and death. Treat with systemic aminoglycosides.
• Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5% aqueous) is the cheapest, is applied with occlusive dressings but does not penetrate eschar. It depletes electrolytes and stains the local environment.
• Use silver sulfadiazine (1% miscible ointment) with a single layer dressing. It has limited eschar penetration and may cause neutropenia.
• Mafenide acetate (11% in a miscible ointment) is used without dressings. It penetrates eschar but causes acidosis. Alternating these agents is an appropriate strategy.
• Treat burned hands with special care to preserve function. − Cover the hands with silver sulfadiazine and place them in loose polythene gloves or bags secured at the wrist with a crepe bandage
• At least once a day, remove the gloves, bathe the hands, inspect the burn and then reapply silver sulfadiazine and the gloves

5. What is the classification of burn depth?

i) Superficial burns

ii) Superficial partial thickness burns

iii) Deep partial thickness burns

iv) Full thickness burns

6. During the emergent stage what is the nurses priority name three?

The emergent phase starts with the onset of burn injury and lasts until the completion of fluid resuscitation or a period of about the first 24 hours. During the emergent phase, the priority of patient care involves:

i) maintaining an adequate airway

ii) treating the patient for burn shock

iii) wound care

7. What is the rule of nines?

When measuring burns in adults, the rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate the body surface area on an adult that has been burned by using multiples of 9.