Question

• Head to Toe Assessment
• Empathetic conversation
• Risk Factors
• Nursing care
• complications
• Care Plan
• Lab tests and rationale
• Diagnostic tests and preparation
• Education
• Burn Assessment
• 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. This is a very detailed scenario, so don't cut it short.

Answer 1

#. Empathetic conversation - showing genuine interest and asking patient to share their thoughts, feelings, perceptions, and experiences is one of the most efficient and direct ways to develop empathy and understanding.

#. Risk factors :

-residential fires (40-50% of deaths can be prevented with working smoke alarms)

-intentional burns (abuse)

- Not having smoke alarm, space heater use, winter time, candle use, 40% due to alcohol use etc

#. Nursing interventions :-

#. Emergent Phase (Nursing & Collaborative Management)

1) Airway

-100% oxygen

-Provide airway/respiratory support as needed

-Watch for signs & symptoms of inhalation injury

2) Breathing

-Respiratory rate/effort (looking for crackles)

3) Circulation

-P, Capillary refill, HR, BP

4) History of how injury occurred

-Time, Place, Source, Tx, Hx of fall

5) PMH, Current medications, & allergies

6) Assessment of TBSA & burn depth

7) Large gauge IV

8) Foley

9) Baseline height, weight, labs

10) Tetanus

11) EKG

12) Patient/family support

#. Acute Phase (Nursing & Collaborative Management)

1) Cardiopulmonary/Monitor for:

-CHF

-Pulmonary edema

-Airway obstruction

2) Fever

3) Neurologic system

4) Musculoskeletal system

-Decreased ROM

-Contractures

5) Gastrointestinal system

-Paralytic ileus

6) Endocrine system

-↑ Blood glucose levels

-↑ Insulin production

-Hyperglycemia

7) Prevention of infection

-Septic shock is major cause of death

8) Burn eschar

-No blood supply

-Antibodies cannot reach the area

-Large numbers of bacteria appear & can spread into the systemic circulation

9) Primary source of bacterial infection is the intestinal tract

10) Mucosal barrier becomes permeable

11) Microbes & toxins can pass into main circulation

12) Routine wound cultures

13) Antibiotics when required

14) Wound care

15) Excision & grafting

16 Pain management

17) Physical & occupational therapy

18) Nutritional therapy

19) Psychosocial care

#. Complications :-

Loss of baby

Bacterial infection, which may lead to a bloodstream infection (sepsis)

Fluid loss, including low blood volume (hypovolemia)

Dangerously low body temperature (hypothermia)

Breathing problems from the intake of hot air or smoke

Scars or ridged areas caused by an overgrowth of scar tissue (keloids)

Bone and joint problems, such as when scar tissue causes the shortening and tightening of skin, muscles or tendons (contractures)