Transcript
Chapter 35: Acute Burn Injury
Critical Thinking Checkpoint Case Studies
Ms. P. is a 86-year-old who was found unresponsive in an apartment fire. She is transported to the nearest hospital. Upon arrival, she has burns to the anterior trunk, anterior lower limbs bilaterally, and to her left anterior arm.
This activity contains 5 questions.
1. Calculate the percent of TBSA of burn injury using the rule of nines.
Answer: Anterior trunk burn (18%) + Anterior lower limbs bilaterally (9% + 9%) + left anterior arum (4.5%) = 40.5% TBSA burn.
2. Her left arm is erythematous, and has brisk capillary refill and blisters. Her anterior chest is dry, leathery, and white. Her lower extremities are pale and dry; there are no blisters and capillary refill is absent. Based on these descriptions, identify the depth of burn of each area.
Answer: Her left arm is consistent with findings associated with a superficial partial-thickness burn.
Anterior chest is consistent with findings associated with full-thickness burn. Lower extremity burn injuries are consistent with deep partial-thickness burn.
3. Using the Parkland formula, calculate the fluid requirements for the first 24 hours, based on a weight of 100 kg.
Answer: Fluid requirements for the first 24 hours are calculated with the Parkland formula:
4 mL Ringer's lactate x TBSA % burned x patient weight (kg)
200 mL total fluids in 24 hours with 8,100 mL given in the first 8 hours and 8,100 mL to be given over the remaining 16 hours
4. Burn injuries to Ms. P.'s chest place her at risk for at least three complications post-burn injury. What are they? What assessment findings would confirm the development of these complications?
Answer: Full-thickness burns to the chest result in eschar formation, which does not allow for adequate expansion of the chest. This makes ventilation difficult and increases the risk for respiratory distress. An escharotomy may be required to allow movement of the chest wall and restore adequate ventilation. If she is breathing spontaneously, an increase in work of breathing would be apparent. If she were on the ventilator, high peak pressures would be noted. She is at risk for inhalation injury because she was found unresponsive in a confined burning environment. She should be assessed for clinical indicators of inhalation injury, including: carbonaceous sputum, wheezing or rhonchi on auscultation, stridor, cough, tachypnea, singed nasal hair, altered level of consciousness, elevated carboxyhemoglobin levels, and abnormal arterial blood gases. She is at risk for carbon monoxide poisoning, as she may have been exposed to byproducts of combustion in her confined apartment. Signs to assess for include high serum carboxyhemoglobin, headache, malaise, nausea, difficulties with memory, personality changes, and gross neurologic dysfunction.
5. Ms. P. will be transferred to a burn center. What wound care should be performed before she is transferred?
Answer: First, the nurse must ensure that the burning has stopped by removing all clothing. The extremities should be elevated to decrease edema formation. The wounds should be cleaned with sterile saline and covered with a clean, dry sheet. Hypothermia should be avoided.
