Initial Management of a Patient with Burns

Initial Management of a Patient with Burns

Patient Profile

M.J. is a 23-year-old white woman transferred via ambulance to the hospital after a fire in her apartment. She was asleep when the fire started and managed to make her way out of the apartment through the smoke. She sustained second-and third-degree burns over the right side of her face and neck, the right side of the anterior trunk, two-thirds of the lower right thigh, and the right arm. In the emergency department, she received a tetanus shot, morphine for pain, and 2 L of IV fluids.

 

Subjective Data

  • Single; lives alone
  • Attends local college part-time while working full-time as a server
  • Denies tobacco, alcohol, and drug use

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Objective Data

Physical Examination

  • Blood pressure 190/80, pulse 88, temperature 99°F, respirations 28
  • Height 5’4″, weight 180 lb
  • Voice is hoarse; singed nose hair
  • Productive cough with moderate amounts of gray sputum
  • Pupils equal, round, reactive to light and accommodation; right eye swollen
  • Heart rate and rhythm regular; no murmur
  • Lungs with wheezes throughout
  • Bowel sounds diminished in all four quadrants
  • Restless, states the pain is at a level 10 on 10-point-scale
  • Urinary catheter draining burgundy-colored urine
  • Nasogastric tube is draining yellow-green drainage

Question 1

What is the priority of care for S.N. and why?

Question 2

What is the extent of M.J.’s burn injury, and how is it determined?

Question 3

What is the stage classification of her burn injury? How do you make this determination?

Question 4

Calculate M.J.’s fluid requirements for the first 24 hours using the Parkland formula.

Question 5

The nurse is concerned about smoke inhalation. What assessment findings would support her concerns?

Question 6

M.J.’s pain level is a 10. Outline a pain management plan for M.J. at this time.

Question 7

Describe other nursing and interprofessional management that is important during this phase.

Question 8

Because of her injury, M.J. is at high risk for infection. What measures will the nurse implement to reduce the risk of infection?

Question 9

What interventions can the nurse use to address the emotional needs of a burn patient?

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