12 Aug Case study: burns
Ms. Champlin is a 52 – year old woman who was cooking New England clam cakes in a skillet filled with hot oil. While she was dropping the dough in the skillet, oil splattered onto the gas stove, catching on fire and filling the skillet with flames. In a panic, Ms. Champlin grabbed the handle of the burning skillet to remove it from the stove, spilling the hot oil all over her right arm and hand. The oil also splashed onto the right side of her face and neck and across her chest, burning her skin through her T-shirt. She is transported to the emergency department by emergency medical technician(EMTs).
Upon arrival at the hospital, she is alert and oriented, without signs or symptoms of respiratory distress. She is screaming in pain. MS. Champlin’s vital signs are BP 130/60, Pulse 94, Respiratory rate 22, and Temperature 97°F (36.1°C). Her oxygen saturation is 99% on 2 Liters of oxygen. She has suffered superficial and superficial partial-thickness burns on her face, neck, and chest, and deep partial-thickness burns over her right arm and hand. The right side of her face and neck and her chest are red with several blisters noted. Her right arm and hand are swollen and have sloughing skin with a mottled appearance of cherry red, tan, and pale areas. The health care provider (HCP) does not observe any discoloration of soot around Ms. Champlin’s nose or mouth, singed nasal hair, or burned eyebrows. Acute care in the emergency department includes oxygen, intravenous (IV) fluids, the insertion of an indwelling urinary catheter, a nasogastric tube attached to low wall suction and the administration of IV morphine sulfate and tetanus toxoid. Ms. Champlin is transferred to a burn unit for continued care.
1. Describe each of the five types of burn injury and provide examples of each. Which type of burn has Ms. Champlin sustained?
2. Describe the appropriate first aid intervention the EMTs will initiate while en route to the hospital.
3. Using the “Rule of Nines” estimates the extent of the client’s burn injury.
4. Why did the HCP assess Ms. Champlin for discoloration around her nose and mouth singed nasal hair, and burned eyebrows? What other related manifestations should be assessed to determine if there is a need for concern?
5. In the emergency department, the treatment of the client included the insertion of an indwelling urinary catheter, insertion of nasogastric (NG) tube, and administration of tetanus toxoid. Provide a brief rationale for each of these interventions.
6. Briefly describe the skin depth and manifestation that define each degree of burn injury (first-, second-, third-, and fourth-degree). What degree(s) of burn injury does Ms. Champlin have?
7. Ms. Champlin cries to the nurse, “It seems as if my arm is getting bigger by the minute! Can’t you do something?” Help the nurse explain to the client what is causing the edema and the expected progression and resolution of the swelling.
8. Ms. Champlin weighs 180 lbs. Using the Parkland Formula below, estimate the IV fluid replacement needs of this client in the first 24 hours following her injury.
Parkland Formula: 2 to 4 ml of solution
x body weight (in kg)
x percent burn
9. Help the nurse identify five priority nursing diagnosis for Ms. Champlin’s plan of care during the acute phase of her treatment.
10. The HCP is concerned that Ms. Champlin may develop a contracture of her right arm because of the burn injury over her right elbow. Discuss what a contracture is and why this client is at increased risk of developing one.
11. The HCP carting for Ms. Champlin tells her that I may become necessary to apply a skin graft to the deep partial-thickness area over her elbow to speed healing and minimize the risk for contracture. Skin grafts are obtained from various sources. Briefly explain these four types of grafts: autograft, allograft, heterograft, synthetic skin substitute graft. Is there any benefit(s) to selectin one type of graft over another? If so, explain.
12. Briefly discuss why environmental temperature control is an important intervention while caring for the client with a burn injury. At what temperature should the nurse maintain the client’s room?
13. Ms. Champlin has asked the nurses that no visitors be allowed in to see her. Briefly discuss Ms. Champlin’s psychological reaction to her burn. How should the nurse respond?
14. Ms. Champlin is being discharged. She will wear a custom-molded hand and arm splint at home. Briefly describe the teaching points the nurse should address regarding limb assessment and proper use of the splint.
15. Ms. Champlin asks the nurse, “I have heard there is a cream you can apply to decrease scarring.” What types of cream might Ms. Champlin be referencing?