Carol Mitchell aged 64 was admitted to

Carol Mitchell aged 64 was admitted to the burns unit after sustaining burns to the front and back of her left lower leg and foot. Carol had been cooking in her kitchen when she accidentally knocked a saucepan full of hot oil over herself. Carol’s husband drove her to the nearest medical centre where Carol’s burn was treated and then she was transported by ambulance to the hospital for further assessment. In the emergency room, Carol was conscious and in evident distress. Her admission notes were areas of variable depth of injury over her posterior lower leg and foot only; dark pink discoloration with sluggish capillary refill, blistering is evident; an area on her inner left ankle has an area of blotchy red/white with sluggish to absent capillary refill, patient is complaining of pain on her lower leg, but states that her ankle is somewhat pain free. After consultation with the Burns team, the burns are to be surgically debrided, and a small skin graft will be applied to her inner ankle injury. Case Study 1 – Short answer questions Read each question carefully and ensure you answer each part. The wound healing process commences when any damage to the skin has occurred. Once the skin is impaired and a wound is created the healing process begins. This is a dynamic and complex process. It consists of four stages. Match the four stages listed below with the physiological and biochemical processes (no reference required for this question): Stages: haemostasis – stage 1, inflammation phase – stage 2, proliferation or reconstruction phase – stage 3, maturation phase – stage 4 Stage Physiological and Biochemical Processes During this phase tissue is temporarily replaced and the area is cleaned up by macrophages which digest the dead bacteria and debris. New blood capillaries are developed, and granulation tissue (mainly collagen) is laid down. As granulation tissue continues to be laid the epithelium thickens to 4 to 5 layers forming the epidermis. The wound contracts and becomes smaller. This stage can take from 2 to 24 days Process of the wound being closed by clotting. Starts when blood leaks out of the body. The first step is when blood vessels constrict to restrict the blood flow. Next, platelets stick together in order to seal the break in the wall of the blood vessel. Finally, coagulation occurs and reinforces the platelet plug with threads of fibrin which are like a molecular binding agent, this stage happens very quickly Vasodilation of surrounding tissues occurs due to the release of histamine and other vasoactive chemicals. This increases blood flow to the surrounding areas which leads erythema, swelling, heat and pain. White blood cells descend into the area as a defense response. This phase lasts approximately three days The wound and surrounding tissue is gradually remodeled and the collagen cells laid down are strengthened. This stage can last from 24 days to approximately one year. During this stage the wound is still at risk and should be protected. a) Skin Assessment – outline the steps of the skin assessment for Carol’s burn that would be carried out immediately on admission to the emergency department. b) In relation to Case Study One, use the Rule of Nines to identify the extent of Carol’s burn (no reference required for this question) Burn percentage 20% approx. Burn percentage 9% approx. Burn percentage 27% approx. Burn percentage 0.7% approx. c) When a patient suffers a burn injury it is important to classify the wound. Provide a description for each of the classifications in the table below. Classification Description Superficial Partial thickness Full thickness Using the information from the case study regarding Carol’s wound, identify the likely classification/s which may apply. For your answer provide a rationale for your choice/s. d) When undertaking a wound assessment, the main purpose is to optimise the healing process and to produce a baseline status against which the healing process can be measured Outline four (4) aspects you may consider when conducting a holistic wound assessment. Provide a reason for each of your choices. a) As stated in the case study, Carol is complaining of pain From the following strategies identify the four correct methods to provide comfort to Carol? (no reference required for this question) Provide pain relief Provide distraction therapy Ensure bed comfort Assess stress / anxiety levels and look at reducing these Inform Carol that pain is a normal aspect of a burn and there is not much that can be done to reduce all pain b) Describe an appropriate pain assessment tool. Explain why it is important to reduce pain levels in patient with wounds? 4. It was noted in the case study for Carol that she required “surgical debridement” to her burns Define surgical wound debridement. Why is debridement undertaken?

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