Major Burn Case Study Worksheet

Front of the face
4.5

Back of the head
4.5

The whole head and face
9

Chest
9

Whole front side
18

Back
9

Whole upper and lower back
18

Anterior right arm
4.5

Posterior right arm
4.5

Posterior right forearm
2.25

Posterior and anterior right forearm
4.5

Whole right arm front and back
9

Anterior right leg
9

Posterior right leg
9

Posterior and anterior right leg
18

Anterior right upper leg
4.5

Genital area
1

Why would a pt be NPO upon admittance with a burn injury?
In order to assess GI motility

They will only be NPO initially, but may be longer if there are no BS heard upon auscultation

Why are patients given morphine sulfate IV when they have been burned?
It will help with decreased absorption from the muscles and stomach due to third spacing

Why do you need to get hourly urinary output on a patient who has been burned?
This is the most sensitive indicator of CO

What kind of things will you see on an EKG?
K+ changes

MI

Electrical burns

How do you want to position the pt
Extended position

Position of comfort is the position of contracture

What is physical therapy used for?
Ambulation strengthens the muscles in order to reduce the risk of long term complications

Depth of a superficial partial thickness burn
The entire epidermis

Has varying layers of the dermis

Depth of a partial thickness burn
Deeper into the dermis

Depth of a full thickness burn
Burn through the subcutaneous layer, muscle and into the bone or through the bone

What is a sign that it is a full thickness burn?
If the hair is easily plucked out of the skin

What is the appearance of a superficial partial thickness burn?
Red, dry, blanches, blisters

What is the appearance of a deep partial thickness burn?
Red, weepy(wet), edematous, blisters

What is the appearance of a full thickness burn?
Dry, leathery, hard, white/eschar, edema

What is the pathophysiology of a burn injury?
First there will be tissue damage

histamine release(larger the burn the more the histamine release)

increased capillary permeability(3rd spacing

decreased CO

decreased tissue perfusion

What type of system alterations are there with burns?
CV

F&E

Pulmonary

Renal

Immunologic

Thermoregulatory

Gastrointestinal

Cardiovascular alterations
Lasts 24-36 hours

Increased capillary refill means that there is excessive fluid loss through the skin

Decreased CO

Can result in hypovolemic shock

Anemia (they will have an increased HH)–>weird but this is because there is not a lot of fluid in their body therefore the HH is not well concentrated

What kinds of treatments are there for the cardiovascular alterations that can occur?
IV fluids

Blood products in order to increase the HH

Fluid & electrolyte alterations
Edema
-local to systemic
-compartment syndrome
-excessive fluid resuscitation

Evaporation losses

Hyponatremia
Hyper–>hypokalemia

What kinds of treatments are there for the fluid & electrolyte alterations that can occur?
Calculate the amount of fluid the patient should be receiving

Calculate the patients amount of hourly UOP

Prevent evaporation losses by covering the wounds up

Monitor and replace the patients electrolytes as needed

Pulmonary alterations
Upper airway
-direct heat, edema
-upper airway obstruction

Inhalation injury
-irritation from the gases (co)
-atelectasis
-carboxyhemoglobin

Restrictive defects
-eschar, edema to neck/chest
-decreased tidal volume
-respiratory distress

What kinds of treatments are there for pulmonary alterations that can occur?
Intubation

Intubation, 100% O2

Escharotomy

Renal alterations

What kinds of treatments are there for renal alterations that can occur?

Immunologic alterations

What kinds of treatments are there for the immunologic alterations that can occur?

Thermoregulatory alterations

What kinds of treatments are there for the thermoregulatory alterations that can occur?

Gastrointestinal alterations

What kinds of treatments are there for the gastrointestinal alterations that can occur

What is the Parkland formula
This is a formula that is used to help figure out the patients fluid resuscitation needs for the first 24 hours

4mL X kg X %TBSA burned

What is an appropriate nursing diagnosis for burns?
FVD

What types of signs and symptoms makes FVD the best nursing diagnoses for a burn patient?
Tachycardia

BP is low

High HH

High urine specific gravity

What are the types of oral nutritional needs for a burn patient?
High calorie, high protein foods

Avoid empty calories

Protein supplements

Ask the patient what their food preferences are.. doesnt really matter what it is, the most important thing you can do is to make sure that they are eating lots of calories and protein

What are the types of enteral nutritional needs for a burn patient?
The patient will have a feeding tube if they are not able to eat the recommended calories to promote healing

The feeding tube should be placed past the pylorus

What types of evaluation are important, or what are some extra ways to care for the patient?
Monitor the serum albumin and protein levels

Calorie needs may be 3-4 times higher than normal

Make sure to count the patients calorie intake, this way you can be sure they are getting enough carbs in

Insulin drips may be administered to the patient in order to keep their BG levels down.

Make sure that you write everything down for the dietician so they can be sure to not leave any nutritional goals out

If the patient starts to loose a pulse and cannot be found by palpation or the use of a dopler. They also lose sensation and the foot turns dusky and cold. What might be going on with the patient?
The patient is suffering from compartment syndrome

What is the assessment that you do for circumferential burns?
The 6 P’s

1. Pulseless (absent or weak)
2. Pallor
3. Paresthesia (altered sensation)
4. Pain
5. Paresis (muscle weakness)
6. Poikilothermia (a cool limb)

What is usually the type of thing that will help restore the 6 P’s and is used for burns?
Escharotomy

Find escharotomy care

Autograft

Cultured skin

Heterograft

Homograft

What type of nursing care should be done for a patient who has a graft?

What are some of the possible coping mechanisms after a burn injury

What type of things can you do in order to help the patient

Contracture prevention

Hypertrophic scarring

Body image

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