Question

Integumentary Case Study

 

Chief Complaint: 28-year-old woman admitted for first and second degree burns following her rescue from being lost in the Mojave Desert for 72 hours.

 History: Rachel McElravy, a 28-year-old white female, was transported by an air ambulance to the emergency room after wandering in the desert for 72 hours. She was doing research in a remote part of the Mojave Desert when, she got lost in her vehicle and had forgotten to bring her cell phone with her that day. When her fuel run out, she walked and walked believing she could find her way out. During the day, shade temperatures exceeded 110°F degrees with humidity levels at just 5%. When found, she had developed severe facial and arm burns and was severely dehydrated. Rachel’s core temperature was 101°F but she wasn’t sweating!

 In the hospital, Rachel was barley conscious, weak, nauseated, suffering from headaches and had low blood pressure of about 65/45. After administration of intravenous fluids both in the ambulance and hospital, her vital signs stabilized.

 The next day Rachel had almost no pain on her face and arms and couldn’t feel feather light touches to her burnt face. This lasted for a few days. After further treatment of antibiotics and surgery, Rachel was able to leave the hospital. She possessed minor scars where she had been burnt. Slowly her sensation of pain and touch returned to her skin.

 Questions:

 1.      What vitamin would Rachel have produced in greater quantity from her ordeal?

 2.      What condition did Rachel develop that lead her to not sweat despite the elevated temperature?

 3.      Why was it necessary to administer fluids to Rachel and what osmolarity did they most likely administer?

 4.      Describe her most likely distinct abnormal skin colouration of her face and hands when they found (using technical terminology) Rachel in the desert?

 5.      What happened to cause Rachel to temporarily lose her sense of light touch and pain within the burnt parts of her body? Which cell/structures were affected in this loss?

 6.      What is the difference between scar tissue and normal skin tissue? Why where her scars minor.

 7.      Briefly describe the two major layers that make up healthy skin?

 8.      What are first-degree burns and second-degree burns? How many epidermal strata did she lose in the areas of second degree burns.

 9.      Name four cells associated with the skin and the injury that would be active during her recovery process, include their functions.

Answer 1

Ans 1-

After a burn injury, it has been found that patients have reduced levels of iron, zinc, copper and selenium as well as vitamins A, C, E and D. These vitamins and minerals play a role in wound healing, immune response and preventing free radicals from causing damage to the tissues. Decrease of the level of these elements may lead to reduced immune function and poor wound healing.

Ans 2- due to severe dehydration ,there was no sweating as body has already lost lots of water content, the remaining water was to keep her organs hydrated not causing internal traumas also causing her unconsciousness .

Ans 3-

Alternatively, daily maintenance (not including pathologic ongoing loss) fluid requirements may be roughly estimated as follows:

• Less than 10 kg = 100 mL/kg

• 10-20 kg = 1000 + 50 mL/kg for each kg over 10 kg

• Greater than 20 kg = 1500 + 20 mL/kg for each kg over 20 kg

Ans-4 ) rachael had been in sun in dessert for more than 24 hours which means she has got sunburns or sun poisoning that led to red pigmentation on her face ,Sometimes it's difficult to tell the difference between sunburn and sun poisoning. While a sunburn is redness of the skin that will go away after a few days, sun poisoning is a more serious irritation that manifests in hives and blisters. Some people call these hives a “sun rash,” a rash on a sunburn.

Ans 5-)

When the skin is exposed to high levels of sunlight, it may result in hyperpigmentation, which appears as irregular light or dark patches. The body does an excellent job coping with minimal amounts of damage, but if exposure is too great, the body will have difficulty repairing itself. If DNA is damaged and its repair mechanisms are inhibited there is a high chance of developing skin cancer.

Ans-7)

Skin has three layers: The epidermis, the outermost layer of skin, provides a waterproof barrier and creates our skintone. The dermis, beneath the epidermis, contains tough connective tissue, hair follicles, and sweat glands. The deeper subcutaneous tissue (hypodermis) is made of fat and connective tissue.

Ans -8)

First-degree. These burns only affect the outer layer of your skin. A mild sunburn’s one example. Your skin may be red and painful, but you won’t have any blisters. Long-term damage is rare.

Second-degree. If you have this type of burn, the outer layer of your skin as well the dermis – the layer underneath – has been damaged. Your skin will be bright red, swollen, and may look shiny and wet. You’ll see blisters, and the burn will hurt to the touch.

• If you have a superficial second-degree burn, only part of your dermis is damaged. You probably won’t have scarring.
• A deep partial thickness burn is more severe. It may leave a scar or cause a permanent change in the color of your skin