Question

The contents are:

• Empathetic conversation
• Nursing care
• Care Plan
• Lab tests and rationale
• Education
• Skin Assessment

Scenario:

An American Indan woman, 28 years old, staggers into the ED face is black with soot, her right arm and right leg burned, bleeding vaginally,pregnant, vomiting, bloody diarrhea, SOB,very confused, and jaundiced.

Set the scene. Use your imagination and describe this woman, her personal and medical history. You decide the conclusion of this scenario.

Answer 1

The women is in a serious condition. The skin on her right side is black and leathery . Her skin is dry and swellings are present. Face is black with soot. Changes in skin colour . She is in severe pain. Her eyes are yellow due to jaundice and vaginal bleeding. Pregnancy is at risk due to this and along with it vomiting and bloody diarrhoea is present. She is conscious but not oriented. She is in a confused , panic and sobbing state.

Empathetic conversation:

First understand what the person must be going through. Show care and concern and understand her feelings. Now ask qstns . First try to calm her down. Hear what she has to say. Ask her what all pain she is experiencing, she might be concerned about the pregnancy, give her mental and emotional support.

Nursing care:

It focuses on the major priorities for any trauma patient ; the burn wound is a secondary consideration.

• Focus on the major priorities of any trauma patient : Aseptic management of burn wounds and invasive line should be done
• Asses circumstances surrounding the injury : time of injury , mechanism of burn, whether the burn occurred in a closed space , the possibility of inhalation of noxious chemicals ,and any related trauma
• Monitor vital signs frequently
• Start cardiac monitoring if indicated
• Check peripheral pulses
• Monitor fluid intake ( IV fluids) and output ( urinary catheter ) and measure hourly
• obtain history : temperature, weight , preburn weight , allergies, past history, pregnancy history and current medication . Also odour and colour of vaginal discharge
• Check for corneal injury
• assess neurological status

Care plan:

• Priorities : initial priorities in the ED remain airway , breathing and circulation
• Airway : 100% humidified oxygen is administered and the patient is encouraged to cough so that secretions can be removed by coughing
• Chemical burns : all clothing and jewelry are removed and chemical burns should be flushed
• Intravenous access : a large bore IV catheter is inserted in non burned area
• Gastrointestinal access
• Clean beddings
• Fluid replacement therapy
• Monitor uterine activity , fatal status and abdominal status
• obtain blood type and cross match
• Administer heparin if indicated

Lab tests:

CBC , type and cross match , Rh tiger, fibrinogen levels , platelet counts , APTT, PT and HCG levels.

ESR , C-reactive protein level , creatinine , BUN , Glucose , Urinalysis, Coagulation profile

Education:

Talk to the patient about the possible changes that may occur in her skin and body , educate them about the time and chance for recovery. Talk about the possible complications in pregnancy. Chance for miscarriage. Reinforce the information provided by doctors . Discuss the short term and long term maternal / fetal implication of bleeding episode.

Skin assessment:

Dressings should be examined at 48 hours to reasses the burn , including depth. Dressings on superficial partial thickness burns can be changed after 3-5 days in the absence of infection. If infection occurs , daily wound inspection and dressing change is required.