Full thickness thermal burns Essay Example
THE CARE OF FULL THICKNESS THERMAL BURNS
Thermal burns are classified into three groups, with increasing levels of complexity (Coban, 2012, Leseva et al., 2013 & Villani & Zanone, 2007). Full thickness thermal burns are the worst forms of burns on the human body, according to medical professionals (Villani & Zanone, 2007). These burns, depending on the percentage of spread, lead to the destruction of the dermis and the epidermis layers of the skin, and the skin cells cannot regenerate without operative procedures (Villani & Zanone, 2007). Due to the burn wounds, a patient is susceptible to other infections, either opportunistic or hospital-acquired, just like Hattie in this case. Infections in wounds are among the leading causes of death and morbidity in burn patients (Leseva et al., 2013 & Coban, 2012). Most thermal burns also lead to the loss of sensation due to neurological effects.
SYMPTOMATOLOGY AND PATHOPHYSIOLOGY
Hattie has suffered from full thickness thermal burns, and the wounds may well serve as entry ports for bacteria and other infectious agents. Nosocomial Infections (NIs) affect patients due to the availability of at least three conditions; source of infecting agent/disease-causing organism, availability of a route of transmission and susceptibility of the patient (Leseva et al., 2013). In Hattie’s case, the burnt skin is the portal of entry, with the hospital environment serving as the fertile source of infection. The leading causes of nosocomial infections are bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa .The nosocomial infections may present with, but not related to the following symptoms;
Purulence/formation of pus in infected area (mostly greenish discharge)
Oedema/swelling of the infected region
Increasing levels of pain and heat
Reddening of the skin
Purplish discoloration of the wound, if swelling is present
Increased thickness of the burn into deeper skin
Sustained hyper metabolism (Rowan et al., 2015)
The case requires urgent measures to manage. The patient (Hattie) and the mother who is directly involved in her care need the necessary help to contain social and psychological issues that they may have, especially trauma due to increased pain on Hattie’s side. Several interventions could be put in place;
Decolonization; most infections are caused by bacteria (Leseva et al., 2013). The bacteria may be found in colonies that, unless managed, may lead to resistance and acute proliferation. Several medications are used to manage Staphylococcus aureus. The muciprocin ointment may be used to decolonize/remove bacterial cells in the nasal region. Hattie may also be washed gently with 4% Chlorhexidine (Leseva et al., 2013). This treatment is only possible for gram positive bacteria, however.
Environmental measures; Aseptic techniques should be employed to mitigate the infection and its effects (Coban, 2012). The beddings in the hospital and the surroundings of Hattie should be washed with disinfecting agents and the wound treated with antiseptics to prevent further infection. The items Hattie uses in the hospital should also be sterilised every short period to reduce the microbial load.
Nutrition; the main aim of nutrition is not to overfeed Hattie but to stimulate the formation of proteins for the growth of cells to cover the burnt area and prevent the proliferation of bacteria (Nielson et al., 2017). Enteral nutrition is used with a high carbohydrate concentration (82%) to increase insulin formation and production of lean body mass (Nielson et al., 2017). Increased protein level is beneficial to the patient.
Antimicrobial stewardship; microorganisms are managed by the use of antimicrobials, but the doses have to be restricted to appropriate amounts (Leseva et al., 2013 & Coban, 2012). Surgical prophylaxis may be employed, especially grafting, to prevent further spread of toxins (Nielson et al., 2017). For this management protocol, determination of primary and secondary treatments for patients with severe infections with unknown pathogens is paramount.
Education and Counseling; Hattie’s case is not only affecting her but also the hospital fraternity and her mother as well. Education may be offered to the hospital staff on antimicrobial stewardship and environmental management (Leseva et al., 2013). Psychological counselling to Hattie and her mother will help stabilise her condition and restore hopes in the mother. An occupational therapist may come in handy to help Hattie achieve a considerable level of independence, and her mother the stability of mind (McGourty et al., 1985). The social life should also achieve stability more rapidly.
Wound coverage and grafting; open wounds are the leading causes of infection, and unless they are dressed, the infections may be acute (Rowan et al., 2015). Debridement is the first step towards preventing the spread of infections, especially tetanus (Rowan et al., 2015). Covering the wound is a process that prevents further infection.
COLLABORATIVE ROLE OF NURSES
The management of burn wounds, especially so when they are infected, requires extensive efforts by the family, doctors, nurses and other key players in the hospital setting. The stakeholders collaborate with to ensure that the patient has optimal health (Greenfield, 2010). The dietitian has a role to ensure that the patient gets the food required for their health. The nurse has a role not only in medical care but also in the psychological assessment of the patient and family(Greenfield, 2010). The nurse collaborates with other players. Nurses are the overall care takers of the patient. They coordinate activities with physical and occupational therapists (Rowan et al., 2015 & Greenfield, 2015). Wound care is also a responsibility of the nurse, and the nurses are also collaborating with doctors for nursing research (Greenfield, 2010). The nurse works with the family to note subtle changes and attend to them.
Greenfield, E. (2010). The pivotal role of nursing personnel in burn care. Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India, 43. Accessed on August 4, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038394/
Rowan, M. P., Cancio, C., Elster, A., Burmeister, M., Rose, F., Natesan, S., … Chung, K. K. (2015). Burn wound healing and treatment: review and advancements. Critical Care, 19, 243. Accessed on August from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464872/
Leseva, M., Arguirova, M., Nashev, D., Zamfirova, E., & Hadzhyiski, O. (2013). Nosocomial infections in burn patients: aetiology, antimicrobial resistance, means to control. Annals of Burns and Fire Disasters, 26(1), 5–11. Accessed on August 4, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741010/
Coban, Y. K. (2012). Infection control in severely burned patients. World Journal of Critical Care Medicine, 1(4), 94–101. http://doi.org/10.5492/wjccm.v1.i4.94. Accessed on August 4, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953869/
Nielson, B., Duethman, Nicholas C., Howard, M., Moncure, M., Wood, G., (2017). Burns: Pathophysiology of Systemic Complications and Current Management. Journal of Burn Care and Research. Accessed on August 4, 2017, from http://journals.lww.com/burncareresearch/Fulltext/2017/01000/Burns___Pathophysiology_of_Systemic_Complications.67.aspx
Villani, J., & Zanone, J. (2007). Evaluation and Management of Thermal Burns; Hospital Physician. Emergency Medicine Board Review Manual. Accessed on August 4, 2017, from http://www.turner-white.com/pdf/brm_EM_V9P4.pdf
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