Question

Mr. J. is a 30-year-old electrical line worker brought to the emergency department by ambulance. Emergency medical service (EMS) personnel report that he was in a cherry picker which came in contact with an overhead 70,000-volt power line. He was unconsciousness at the scene, was apneic and intubated by EMS. On presentation to the ED, Mr. J. is noted to have areas of black charring on his right arm, axilla, and upper thighs.

1. Issue Identification.

Based on the above description of Mr. J identify three (3) priority nursing diagnosis he has experienced as a result of this incident?

2. Evidence and Support.

What patient data is identified or needed to support your nursing diagnosis?

3. Context and Assumptions.

3a. Does your priority nursing diagnosis correlate with critical care resources used in this course? (Cite source).   Support your answer.

3b. What are the nursing diagnoses (contexts and assumptions) that you identified for the initial and secondary management priorities for Mr. J.?

4. Perspective, Thesis/Hypothesis

4a. What two nursing diagnosis (or hypothesis) can you infer from your assessment data that relates to the potential causes of Mr. J.'s loss of consciousness?

4b. An indwelling urinary catheter is inserted. Dark red-brown urine is returned. Describe the pathophysiology causing the dark red urine. Describe the appropriate treatment(s) and rationale for implementation of these treatments.

4c. During wound assessment, you note some moist, red areas and some dry, black, charred-appearing areas of the inner aspect of Mr. J.'s right hand, right arm, right axilla, and bilateral anterior thighs. What is the depth and extent (%TBSA) of each of his burn wounds? How does a high-voltage electrical injury impact your calculation of burn wound extent?

4d. Discuss the types of wound care and/or surgical treatment expected during the resuscitative phase and in the acute care phase.

4e. Mr. J. weighs 82 kg. What is his estimated fluid requirement during the first 24 hours? Are there any special considerations and assessments? If so, why?

5. Conclusions, Consequences and Implications

5a. Name three short- and three long-term sequelae and/or complications that can develop with electrical burn injuries.

5b. In addition to nurses and physicians, what multidisciplinary team members should be involved in Mr. J.'s care? When and why should they be involved?

5c. What type and route of pain medication should be administered to Mr. J.?

5d. What kind of nutrition plan should be implemented for Mr. J.?

5e. What conclusions, consequences and implications would reflect effective nursing interventions?

5f.    Will nursing interventions differ if patient was a 2 year old? If so, why and how?

5g. Mr. J.’s Glasgow Coma Scale is unchanged. What possible neurological complications is he experiencing? List three possible complications and the cause of each.

Answer 1

Issue identification:
Nursing diagnosis:
-Ineffective airway clearance
-Sensory impairment
-fluid volume deficit
Evidence and support:
-There will be ineffective airway clearance due to loss of conscious and apneic conditions
-There will be sensory impairment due to electrical shock over the head
- fluid volume deficit due to thermal burns on the body
Context and Assumptions:
3a, Yes, It will correlate with critical care resources. Ineffective airway clearance due to unconscious state and apneic condition due to inflammation in the lungs and major blood vessel and there is kidney damage need immediate fluid volume replacement to preventing further complications and hypovolemia. Impaired gas exchange should be cleared when the patient is in a mechanical ventilator.
3b, Initial management priority for apneic condition and fluid volume balance as a secondary management priority to stabilize patient hydration state.
4a, Head injury due to electric shock on the head cause nerve damage and thermal injury due to black charring (burn) on his body cause alter mentation and peripheral neuropathy.
4b, Electric burn injury pass through the body and damage the deep tissue and superficial skin. Black charring causes dark black urine when the kidney is affected. It can be treated with IV fluid to maintain urine production and prevent kidney injury. Dialysis can be helpful and antibiotics can treat UTI and further infection.