Brief Patient History
Ms. J is a 40-year-old victim of a car crash. She was found conscious at the scene and pulled out of a burning car to safety by a passerby. The paramedics at the scene reported her as awake but disoriented and anxious. She is otherwise healthy and is the mother of a 5-year-old child, who was also rescued at the scene with no injuries.
Clinical Assessment
Ms. J is sent from the emergency department to the trauma unit. She is intubated and sedated on arrival. She has partial-thickness burns covering her face, including her nose, lips, and neck. She has areas of partial-thickness and full-thickness burns to both her hands and to her chest and left leg. Her breath sounds are auscultated as present bilaterally, but she is wheezing, and her sputum has a dark carbon appearance. She has a triple-lumen catheter in her right femoral vein with good blood return to all ports.
Diagnostic Procedures
Ms. J has a carboxyhemoglobin level of 3.4% and arterial blood gas values as follows: pH of 7.27, arterial partial pressure of carbon dioxide of 29 mm Hg, arterial partial pressure of oxygen of 313 mm Hg, bicarbonate of 14 mEq/L (mmol/L), and oxygen saturation of 88% on 100% fraction of inspired oxygen. Her serum cyanide level is 45 mmol/L. The chest radiograph obtained on arrival in the emergency department was normal. Blood pressure is 85/50 mm Hg, heart rate is 136 beats/min (sinus tachycardia), respiratory rate is 14 breaths/min, and temperature is 96.3°F.
Medical Diagnosis
Ms. J is diagnosed with burns covering 40% of total body surface area, inhalation injury, and cyanide toxicity.
Questions
1. What major outcomes do you expect to achieve for this patient?
2. What problems or risks must be managed to achieve these outcomes?
3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
5. What possible learning needs do you anticipate for this patient?
6. What cultural and age-related factors may have a bearing on the patient’s plan of care?
Q. No. 1. Answer :
* due to inhalation burns there is a chance to development of pulmonary edema, pneumonia, and respiratory failure, so first we need to concentrate on respiratory interventions.
* already she is having wheezing and her sputum has dark carbon appearance.
* so the expected out come is maintainance of normal respiratory functions.
* by maintaining this automatically the ABG levels also come to normal and we can maintain normal and levels.
* next outcome is maintainance of normal blood pressure by adequate fluids administration, because fluids loss is there in burns.
* maintainance of normal temperature, because client is having hypo thermia.
These are the three out comes has to see.
Q. No 2 and 3. Answer :
* To maintain adequate respiratory functions in inhalation burns, we need to keep prone position to the client.
* Extracorporeal membrane oxygenation should be given.
* Broncho dilators and mucolytic agents should be given.
* Non conventional ventilatory modes should be follow.
* bicarbonates should be administered to maintain normal because here the patient is having only 14 meq/ lit, normal is 22-28 meq/ lit.
And to maintain normal blood pressure adequate fluids administration should be done.
Foot end elevation should be keep.
To maintain normal temperature, provide wormth and comfortable environment.
And there is a risk to respiratory failure so maintain adequate ventilation support to the lungs.
Intake and output chat should be maintained to know positive and negative balance.
ABG monitoring should be done daily to know improvement.
Position changing also important.
Keep alphabed to prevent frictions.
Q. No 6. Answer :
Here age of the client is 40 years old.
It is one of the vulnerable factor to heal of the client early.
Because as age increases the recovery capacity decreases by decreased organic functions.
According to there cultural factors like socioeconomic factors also affect the patient plan of care due to lack of economical support.
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