Missy is 3 years old. She enjoys being with mom and grandma in the kitchen. She pulls a chair close to the stove, climbs on the chair and looks inside the pot of boiling water. The steam is hot on her face, she steps back and as she falls off the chair, the boiling water is pulled down on her. Missy is rushed to the emergency department. Grandma has put some butter on her fingers, but her face was not treated. Review the Rule of Nines. In the ED, the nurse discovers that her hands, face, chest and arms are burned. The Dr. believes it to be a partial thickness burn, but notes her hands are blistered and very edematous.
Provide nursing care to this young patient that is complaining of pain, crying, and uncooperative. Educate the mother and grandmother on the extent of the burn and the on-going care that will be needed. Include medication you may wish to request from the physician and the dosage.
Answer :
Burns due to hot water and tea, coffee, milk we can called as 'scalds'.
these are mainly observes in below 3 yrs children.
so, now missy had scalds.
mostly rule of nine applicable for children above the 10 yrs.
here we can apply the Rule of five.
* here hands, face, chest and arms burned.
* according to Rule of five each hand and arms 10% burns, so 20 %.
* total head is 20% so here only face so, 10% we can give for face burns.
* chest burns we can give 10 % . Because for total trunk 20 %.
* so finally the percentage of total burns for child is 40%.
partial thick ness burns: also known as superficial burns. It involves the epidermis and superficial layers of dermis.
* it is according to deapth of burn injury.
* according to extent of burn injury, child have hands blisters and very edematus , so it is second degree burns.
Nursing care :
* first assess the vital signs.
* first assess the pain levels by using pain scale.
* whether it is mild, moderate, or severe.
* access the intravenous line.
* administer the fluids, as a fluid replacement therapy.
* by using parkland formulas, and Evans formula.
* maintain airway by oxygen support.
* administer tetanus toxide injection.
Avoid to give intramural injections.
* some clients may need catherization also.
* to reduce pain provide comfortable measurements like bed cradles,
* and administer analgesics.
* provide sedatives
* provide relaxation and divertional therapy , by allowing parents like roomingin.
* maintain input and output chat necessary.
* maintain progress notes.
Education to mother and grandmother :
The extent of burns are second degree burns.
* because here blistered and very edematus ,so the child needs continueous care and treatment to the child. And scarring formation also taken place.
* baby is having burns on face also so nasogastric tube also need to put.
* and education regarding asceptic wound care.
* and regarding gastrointestinal problems, and nutritional supplementations for the child.
* like high caloric and high protein diet and minerals and vitamins should be need to heal well.
Like this we can educate parents.
* medications : morphine can be use like 0.1 Mg/ kg body weight every 5 to 10 minutes to reduce pain and recalling purpose.
* neospirin ointment can use
* and also silver sulphadiazide can use.
* but it can not use on face because it may cause severe occular irritation.
* fluid replacement is very important during in the burns.
* by using some formulas like parkland formula:
According to this first 24 hrs fluid replacement is
* 4 ml ringers lactate multiplies weight in kgs and minus percentage of total body surface area burned.
* in this half amount should be given in first 8 hrs from the time of injury.
* remaining half given next 16 hrs.
* in next 24 hrs 2 ml RL / kg per percentage of burns should be given.
So these all should be explained to her parents and provide psychological support and emotional support to them.
* and educate them regarding taking care of children.
Missy is 3 years old. She enjoys being with mom and grandma in the kitchen. She...