Case study Essay Example

Question 1a.

Airway Management: Nurse the patient in semi fowler’s position and insert an oropharyngeal airway to prevent blockage of airway due to swelling.

Breathing: Administer 15 Liters per Minute oxygen with an aim to reach Spo2 of 94-08%.

Circulation: Keep the patient warm and administer three liters of crystalloids in 24hours while monitoring the Blood pressure every 15 minutes. Elevate patient legs.

Disability: Remove patient clothing and apply dermazine cream on the burnt areas.

Exposure: Perform a secondary thorough assessment of the patient to determine presence of signs for associated pathologies. Evaluate presence of inhalation injury, corneal burns and examine for carbon-monoxide intoxication. Obtain blood samples for electrolyte analysis.

Question 1b

1. Morphine-For management of acute pain.

2. Dopamine infusion-It restores splanchnic and renal blood flow.

3. Silver sulfadiazine cream-It is applied to prevent infections through the wound. 


4. 5% albumin-administered to restore the lost intravascular protein levels.

5. Tetanus Immunization-Protects the patient from tetanus infection through the wounds.

Question 1c

Chest 9%, abdomen 9% and forearm 4.5 % making a total of 22.5% burns.

Question 1d

The parkland formula of fluid resuscitation for 24 hour is4ml x TBSA (%) x body weight (kg). The patient has TBSA of 22.5% and a weight of 80 Kgs.Therefore, the total fluid required is 4 X 22.5 X 80. The total is 7200 ml

Question 1e

The 50% of 24 hours fluid regimen is administered in the first eight hours while the rest is administered in the next 16 hours. If the total fluid regimen for 24 hours is 7200, then 3600 ml would be administered in the first eight hours and 3600 ml in the next 16 hours.

Question 1f

Ibuprofen 400 mgs eight hourly will be used to manage pain. The patient will also be on prophylactic antibiotic (ampicillin).

Wound dressing

The management of partial burns will involve use of occlusive dressing that provides the right moisture and environment for tissue growth. Full thickness burns will be dressed with administration of topical antimicrobial gels such as Silver sulfadiazine.

Physiotherapy

There will be thrice a week physiotherapy involving forearm to prevent immobilization of joints as well as improve blood circulation.

Nutrition

A high calories and a high protein diet will be recommended.

Infection control

The patient will be nursed in a bed cradle to prevent infections.

Surgical management

Surgical debridement and skin grafting will be done basing on patient progress.

Health education

Patient will be educated on the pathophysiology of burns, management of burns, infection control practices as well the need for high calorie and high protein diets.

Question 1g

1. Respiratory distress-This can result from and breathing compromise due to injury of the chest wall muscles and possible inflammation of the airway following burns.

2. Compartment syndrome-Forearm burn can result to inflammation of tissues beyond the elastic levels of the tissue resulting to pressure and subsequent compromise of the arteries and nerves. This results to loss of blood supply to the arm.

3. Cellulitis and Sepsis-Due to loss of skin barrier, infectious organisms can easily pass from the surrounding environment to the tissues resulting to cellulitis. Besides, they can enter into the blood stream and lead to sepsis.

4. Circulatory Shock-Burn injury results to increased permeability of capillary walls thus resulting to massive loss of body fluids to surrounding tissues. This can lead to circulatory shock.

Question 2

1. Initial management of this patient

The patient should be placed in a semi-fowler’s position to maintain the airway’s patency. The patients oxygen concentration should be monitored to establish and intervene on any abnormalities. Arresting the bleeding and administration of intravenous fluids will be useful in maintaining the patient’s circulatory functions following blood loss. The amputated site should be cleaned surgically and sterile dressing applied on the stump. A secondary assessment should be undertaken to rule out any exposures by the patient to toxic chemicals used in the machines

2. Medications that are appropriate for the management of severe pain

1. Pethidine

2. Morphine

3. Fentanyl

4. Meperidine

3. Principles of haemorrhage control and their application to this patient

In the management of haemorrhage, it is important to apply the standard precautions. As a general principle, applying sustained pressure on or around the wound directly or indirectly is useful in controlling external bleeding in emergencies. In addition, you should elevate the bleeding part and restrict movements to minimize further bleeding. Immobilization of the wounded part reduces further injury and destruction of blood vessels. It is also important to advise the victim to remain at still and avoid movements that could exacerbate the bleeding. You should administer pain medication if available to promote the patient’s calmness during the period of transfer to the hospital for advanced care. In addition, administration of intravenous fluids to maintain circulation and continuous monitoring of the vital signs is useful in detecting any signs of circulatory collapse.

4. Stage of hypovolaemic shock the patient is presenting with

5. Five (5) principles of managing an amputated part

In the first place, you should apply aseptic techniques when handling a patient with an amputation to prevent introduction of infections. Secondly, the amputation site should be monitored for bleeding to prevent hypovolemia. In addition, fluid therapy to replenish any lost blood volume is essential to maintain circulatory functions. The patient should be provided with a diet rich in proteins to promote healing. Repositioning the client every two hours is essential to prevent additional complications. In case, the patient has a drain in situ, it should be monitored and recordings of the drainage evaluated

6. Five potential problems that this patient is at risk of developing

Infection: This occurs when microbes gain access to the wound site causing an infection. They may also travel into the blood stream leading to septicemia

Pneumonia: This occurs mainly due ineffective airway clearance associated with poor positioning following an amputation

Circulatory collapse: Continuous blood loss without fluid therapy leads to hypovolemia that causes circulatory collapse.

Embolism: Fragments of adipose tissue or air molecules may enter the blood stream from the fracture site and migrate to smaller vessels causing occlusion that may be fatal.

Deep vein thrombosis: Thrombus formation may occur in the deep veins leading to swelling, pain, engorgement of superficial veins, redness, and warmness.

Stump and phantom limb pain: This is where the patient experiences pain sensations from an amputated limb. This pain is imaginary and may range from mild to severe pain.

7. “Golden Period”

This is the period of time that is considered best for fitting prosthetics on a fractured limb in most cases within the first thirty days following a fracture.