solved

Part 1
Anna Sites was cooking a meal for her boyfriend. She was frying bacon to add to a pasta dish when the grease from the bacon caught fire. Anna panicked, grabbed the boiling pasta water on the stove, and dumped it on the grease fire. The fire exploded into a raging fire ball, scalding Anna’s face, and hair, and catching Anna’s shirt on fire.
Luckily, Anna’s boyfriend Eric walked in right after the explosion. Grabbing Anna, he rolled her on the floor, quickly extinguishing the flames. He grabbed some baking soda, threw it on the fire to extinguish the flames, and called 911.
The 911 dispatcher sent emergency response personnel, including EMTs, Paramedics, and firefighters to the site. Anna was still conscious and in a great deal of pain. Keeping Eric on the phone, the dispatcher asked Eric to gently turn Anna on to her back and tilt her head to one side. He then told Eric to elevate her legs to treat for shock.
Firefighters and paramedics arrived quickly on the scene. Emergency responders placed Anna on 100% oxygen, put her in a neck brace as a precautionary measure, carefully moved her on a gurney, and loaded her into the ambulance. During transport, paramedics started an IV and began administering Lactated Ringer’s solution to replace lost fluid volume. They also cut away her burnt clothing and placed a light blanket over her to preserve her body temperature.
What does the emergency management entail for a patient after a burn? Why is Lactated Ringer’s solution the IV-solution of choice?
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2. How does the administration of Lactated Ringer’s help with a burn patient?
Because Anna lived within 30 minutes of a major burn center, she was transported directly there. Upon arrival, the physician, and nursing personnel quickly assessed the extent of the burn and determined if any other injuries were present. The patient presented with tachypnea and tachycardia but remained conscious.
Vital signs were taken and recorded:
Temperature: 38.5 C (101.3 F) Normal 37 degrees C (98.6 F)
Blood Pressure: 95/60 mmHg Normal: 120/80 mmHg
Pulse: 130 bpm Normal: 60-100 bpm
Respirations: 24 breaths/minute Normal: 16-20 breaths/minute
3. Her temperature is elevated. What is the function of the hypothalamus in temperature management and how does it maintain temperature?
4. Why is her BP low?
5. Why is her pulse elevated?
Anna had burns on the anterior head and neck, anterior trunk, and both anterior and posterior arms.
The depth of the burns was also assessed. Full-thickness or third-degree burns were present on the right shoulder, upper anterior right arm, and part of the anterior trunk. Second-degree burns were present on the remaining burn areas.
6. When utilizing the Rule of Nines what is the total percentage of her burns?
7. Define full thickness and second-degree burns
8. Burns on what part of the body may cause swelling and obstruction of the airway?
9. List two other types of burns beside thermal burns.
10. What is the best treatment for minor burns?
11. What are areas of concern regarding the patient’s health status at present? What would you want to evaluate (labs, treatment) immediately on arrival to the hospital and why?
Part 3
The patient was started on an IV drip of 3-5 mg/10 minutes of morphine. The head was elevated to maintain an open airway but stridor was noted. Anna was intubated (see endotracheal intubation) and placed on mechanical ventilation to maintain an open airway. Respiratory therapists will monitor mechanical ventilation if Anna needs airway support.
12. What causes stridor and why connect her to a mechanical ventilator?
13. What is the purpose of administering Morphine in the patient?
Part 4
Lab tests were ordered including a CBC, chemistry panel, urinalysis, and carboxyhemoglobin.
Lab Results
BC Patient Normal Range
WBC (per mm3) 15,000 5.000-10,000
RBC 4.2 x 106/uL 4.2-5.4 x 106/uL
Hgb 12 g/dl 12-16 g/dl
Hct 48% 37-45% (female)
45-54% (male)
Neutrophils 70 40-65
Lymphocytes 29 20-40
Monocytes 1 5-10
Platelets (per/mm3) 250,000 120,00-440,000
Chemistry Panel
Sodium 137 \35-145 mEq/L
Potassium 3.6 3.5-5.5 mEq/L
Chloride 105 98-106 mEq/L
Glucose 140 80-120 mg/dl
Creatine Kinase 550 units/L 96-140 units/L
BUN 24 mg/dl 7-20 mg/dl
Creatinine 0.9 0.5-1.2 mg/dl
Total Protein 4.0 gm/dl 6.0-8.4 gm/dl
Albumin 2.7 gm/dL 3.4-5.4 gm/dl
Globulin 1.3 gm/dl 2.3-3.5 gm/dl
Results from the x-ray were negative for respiratory damage. The problems with Anna’s airway are most likely due to the edema in her neck and face obstructing the airway.
Anna’s wounds were gently cleaned and wrapped with a silver, antimicrobial dressing. Patient was also stared on enteral feedings to assist with nutrition.
14. What are common complications associated with burn wounds and how is it prevented?
15. Why do patients need extra protein when healing from a burn?
16. Why do patients need extra carbohydrates when healing from a burn?
Part 5
Seven days following Anna’s admission to the burn unit, her vitals are stable, and kidney function is returning to normal. Anna’s wounds have been rinsed daily with warm water and rebandaged. Her doctors are now preparing for surgery and skin grafting. Two months after the accident, Anna returned home. She meets with a physical therapist daily who helps her increase mobility. She also meets with an occupational therapist that helps her learn to manage day-to-day living. Contractures are a common result from severe burns. Anna will have several more surgeries with plastic surgeons who will release contractures over joints, modify severe scarring, and continue to reshape severely burned areas of her head and neck. She will need to use creams such as lanolin daily to protect the burned areas from further drying and cracking. She is also meeting with a psychiatrist, to help her heal emotionally and learn to live a productive life, despite the disfigurement. A recovering burn patient experiences anxiety, terror, pain, sadness, and depression. Antianxiety medication and antidepressants are usually recommended to help the patient heal mentally. Psychotherapy allows the patient to heal mentally and learn coping skills to accept their new condition and learn to fully function.
Counseling is also provided to the patient’s family. Anna’s boyfriend continues to be supportive, in fact, they were recently married in a hospital wedding (all good stories must end as happily ever after)!
Assignment Requirements
Please make sure that you respond in detail to the case questions listed.
Provide references for the assignment
Provide 2 questions for clarification and discussion in class (peer responses are not required for the assignment)

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