T.J., a 44-year-old Amish woman, was brought to the Emergency Department with extensive full-thickness circumferential burns to her upper body including her chest, back both arms. Her stove exploded while she was manually lighting her oven with firewood and kerosene. She complains of feeling cold; she cannot remember the accident; her voice is hoarse and she has difficulty talking. On physical exam there are dark brown, leathery burns involving the head, neck, chest and arms. Her hair and eyebrows are singed.
What immediate concerns does this vignette raise?
What fluid replacement issues are indicated?
What are the potential issues for referral and transfer?
If transfer occurs to a burn care center, what interventions should occur prior to transfer?
1.A burn can affect any person at any time in any place.it affects people of all age groups and socio economic groups.Those at greater risk are the very young ,the elderly and the very poor.People who live in manufactured homes and rural areas are also at high risk for burn injury.Most burn injuries occur at home,while cooking ,bathing or using electrical appliances in either the bathroom or the living room.The skin in people in these two age groups is thin and fragile ;therefore even a limited period of contact with a source of heat can produce a full-thickness burns .Scald injuries continue to be the most frequent thermal thermal injury among people in these age groups.An inhalation injury is the chief concern.it has asignificant impact on a patients ability to survive.Deterioration in severely burned patients can occur without obvious evidence of a smoke inhalation injury.Even without pulmonary injury ,hypoxia maybe present.Early in the post burn period,catecholamine release in response to the stress of the burn injury alters peripheral blood flow,thereby reducing oxygen delivery to the periphery.Airway obstruction may occur rapidly or develop in hours.Decreased lung compliance,decreased arterial oxygen levels and respiratory acidosis may occur gradually over the first 5 days after a burn.
2 The total volume and rate of IV fluid replacement are gauged by the patients response and guided by the resuscitation formula.The adequacy of fluid resuscitation is determined by monitoring urine output totals,an index of renal perfusion .Urine output totals of 30 to 50ml/hr have been used as resuscitation goals.Other indicators of adequate fluid replacement are a systolic blood pressiure exceeding 100mmHg,a pulse rate less than 110b/mt or both..Within the first 24 hours after injury,if the hematocrit and the harmoglobin levels decrease or if the urinary output exceeds 50ml/hr,the rate of IV fluid administration may be decreased.One goal is to maintain serum sodium levels in the normal range during fluid replacement.With large burns ,there is a failure of the sodium potassium pump at the cellular level.Therefore ,patients with very large burns may need proportionately more millilitres of fluid percent of burn than those with small burns.Factors that are associated with the increased fluid requirements include delayed resucitation,scald burn injuries,alcohol intoxication and chronic diuretic therapy.
3 Family functioning is disrupted with burn injury .The burn injury has tremendous psychological,economic and practical impact on the patient and family .Referrals for social services or psychological counselling should be made as appropriate.
4 Patients who experience major burns are commonly sent to burn cent res far from home.Because burn injuries are sudden and unexpected ,family roles are disrupted .Therefore ,both the patient and the family need thorough information about the patients burn care and expected course of treatment.Patient and family education begins at the initiation of of burn management .Barriers to learning are assessed and considered in teaching.The preferred learning styles of both the patient and family are assessed.This information is used to tailor teaching activities.The nurse assesses the ability of the patient and family to grasp and cope with the information.Verbal information is supplemented by videos,models or printed materials if available.Patient and family education is a priority in the acute and rehabilitation phases
T.J., a 44-year-old Amish woman, was brought to the Emergency Department with extensive full-thickness circumferential burns...
T.J., a 44-year-old Amish woman, was brought to the Emergency Department with extensive full-thickness circumferential burns to her upper body including her chest, back both arms. Her stove exploded while she was manually lighting her oven with firewood and kerosene. She complains of feeling cold; she cannot remember the accident; her voice is hoarse and she has difficulty talking. On physical exam there are dark brown, leathery burns involving the head, neck, chest and arms. Her hair and eyebrows are...
Mrs. J. is a 70-year-old woman who sustained a thermal burn injury in a house fire. An electric heater ignited her bedspread while she was asleep. She was trapped in the room for approximately 15 minutes before being rescued by firefighters. Questions 1. Once Mrs. J. is removed from the fire, what priorities are essential in her initial management? 2. She has singed nose hair and is coughing up sooty sputum. The emergency department is 15 minutes away. Based on...