Question

ZEL (S#78 iniu rreiter Patients with Multiple Disorders 10 Student Case Study 98 TGA Name C oupe Class/Group _ Group Members Jacken Morgan ggo Domerz Megar Starzoni Cheeses Jugusor - Dayzha Hayden Name Date argel white Scenario You are working in the emergency department (ED) of a community hospital when the ambulance arrives with A.N., a 28-year-old woman who was involved in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at 15 L/min per non-rebreather mask and started a 16-gauge IV with lactated Ringer's solution. On arrival in the ED, her vital signs are 100/66, 125, 34, Spo, 93%. She appears anxious and in pain. 1. Describe the interventions needed to care for A.N. on her arrival in the ED.

Answer 1

1) Emergency department Interventions for a burn patient follow the ABCDE system(Airway, Breathing, Circulation, Disability, Extent) .Using this system , the first action is to evaluate patency of her airway and continue humidified oxygen therapy at 15L through a non- rebreather mask. Have equipment readily available for endotracheal intubation or tracheostomy.Initiate pulse oximetry and continue ECG monitoring.Intiate a second large bord IV line.Perform cardiovascular and peripheral vascular and neurologic assessment . Obtain baseline blood work and patient weight . Administer pain medication. Initiate wound care. Insert a Foley catheter and nasogastric tube if ordered. Provide psychological support to A.N and her family.

2)The rule of nines helps in asssessing the percentage of burn.

Head and neck - 9%

Upper limbs :- 9% each

Trunk :- 36 %

Genitalia :- 1%

Lower limbs :- 18% each

Calculation of Burn in A.N. burn's injury :-

% of burn on Rt.anterior leg = 9%

% of burn in Lt.anterior and posterior leg = 18%

% of burn in anterior torso = 18%

Total percentage of burn = (9 + 18 + 18)% = 45 %

3) c) The wounds have severe edema, pain may or may not be present and the colour varies.

4)We will assess A.N. for burns to the face and neck, singed nasal or facial hair, dry cough, copious sputum with or without evidence of charcoal or soot, smoke odour.

- Inspect the oropharynx and vocal cords for redness, ulceration, swelling and blisters.

- Observe A.N.for increasing restlessness, dyspnea, difficulty swallowing, increasing hoarseness, stridor, wheezing and nasal flaring.

- Monitor vital signs for tachycardia, a decrease in oxygen saturation and rapid shallow respiration.

- Monitor arterial blood gases and carbon monoxide levels when ordered.

5) The Hgb and Hct levels increase to above normal because of hemocontration from the large fluid shifts and resulting vascular dehydration. Hct levels of 50% to 55% are expected during the first 24 hours after injury which return to normal by 36 hours after injury.

- Na and Cl levels are low because of massive fluid loss associated with burn injury and the retention of sodium that is present in the interstitial spaces.

- BUN is slightly elevated because of fluid loss.

- Hyperglycemia occurs during the acute phase because of lipolysis, gluconeogenesis, glycogenolysis and relative insulin insensitivity.