Ashley LaVenture Case Study 2, Chapter 57, Management of Patients With Burn Injury Objective: 3, 4 You are assigned

to care for a 34-year-old female patient who has sustained second- and third-degree burns over her neck, chest, abdomen, and left arm. The burn injury occurred in her home; her spouse did not survive the fire, but, due to the patients critical condition, she is not aware of his death. She is currently in the surgical intensive care unit. Her vital signs are 36.6-126-12; 104/60. She is sedated with a continuous infusion of Propofol and is intubated and on a mechanical ventilator. She has a right femoral triple lumen catheter and a right radial arterial line. The patient weighs 50 kilograms. Using the rule of nines, calculate the patients total body surface area burned.
Neck- 4.5% Chest- 9% Abdomen- 9% Left Arm- 9% Total- 31.5%

Based on a calculation of 31.5% body surface area burned, and using the Parkland Formula, how much fluid resuscitation should the patient receive in the first 8 hours?
4 mL x 50 Kg x 31.5% TBSA= 6,300 mL of crystalloid fluids. Give 3,150 mL within the first 8 hours of being burned.

What clinical manifestations would be expected based on the extent and location of her burn injuries?
Second Degree burns are like a deep partial thickness burn, where there is destruction of the epidermis and upper layers of the dermis, and injury to deeper dermis tissue. Here, capillary refill follows tissue blanching, but the hair follicles will still be intact. The Signs and symptoms of deep partial thickness burns include modeled red bases with a weeping surface, blisters and edema. This patient will still feel a great amount of pain, and the burnt skin will be very sensitive to temperature changes. These burns will take 2-4 weeks to heal, and some scarring and depigmentation can be expected. It is important to monitor these burns even 72 hours after the initial burn, as the severity can change allowing contractures and infections to change this burn into a full thickness burn. Third degree burns are a lot like full thickness burns in that there is a total destruction of the epidermis and dermis. In many cases with full thickness burns, even the underlying tissue, muscle, and bone can be destroyed. The color of a third degree burn can range anywhere from a pale white to red-brown, and even black. Hair follicles and sweat glands will be destroyed entirely, along with nerve endings that have been burned off. Therefore, a patient with full thickness burns will not feel any sensations of pain. Broken skin with fat exposed can be expected, along with severe amounts of edema. If this patient underwent an electrical burn then the nurse must assess for an entrance and exit wound. Contractions, scarring, loss of function, digits, and even extremities may occur depending on the depth and amount of surface body area that was burned. These burns will require grafting to heal properly. Both of these types of burns can cause a great amount of fluid loss (hypovolemia=decreased cardiac output=tissue hypoperfusion=Increased HR/Decreased BP); infection/compromised immunity; hypothermia; scarring; and changes in function, appearance, and body image. LabsHyponatremia/Hyperkalemia/Thrombocytopenia.

Prioritize nursing diagnoses and collaborative problems for this patient.

Nursing Diagnoses 1. Impaired Gas exchange r/t carbon monoxide poisoning, smoke inhalation, and upper airway obstruction. 2. Ineffective airway clearance r/t edema and effects of smoke inhalation. 3. Fluid volume deficit r/t increased capillary permeability and evaporative losses from the burn wound. 4. Decreased cardiac output r/t hypovolemia and reduced venous return. 5. Hypothermia r/t loss of skin microcirculation and open wounds. 6. Pain r/t tissue and nerve injury and emotional impact of injury.

Complications: Burn Shock Distributive Shock/Sepsis Infection is the most common complication of burns and is the major cause of death in burn victims. Compromised immune System Respiratory complications including inhalation injuries; bacterial pneumonia; pulmonary edema; post injury respiratory failure; and direct-inhalation injuries, such as carbon monoxide poisoning. Electrolyte & lab Imbalances-hyponatremia/hyperkalemia/thrombocytopenia Acute Renal Failure Compartment Syndrome Hypothermia Paralytic Ileus/Curlings Ulcer Pain Functional (contractures) or cosmetic damage (scarring) Increased risk of developing cancer at the burn site Adrenal Insufficiency Anxiety/PTSD/Pre-morbid psychiatric disorder The list of complications truly could go on as burn injuries can be devastating to individuals both physically and mentally depending on extent & location of injury.