Create a concept map using case scenarios as a guide. A conceptual map should include pathophysiology,…
Create a concept map using case scenarios as a guide. A conceptual map should include pathophysiology, medical diagnosis, signs and symptoms, and risk factors if any. Nursing diagnosis, nursing interventions, medical management (medication and procedures), expected outcomes.
Abe, a 14-year old boy who stoked a fire in a wood-burning stove and was hurt by a subsequent explosion. He was transported to the local burn ICU (BICU). He sustained an 82% total body surface area (TBSA) thermal burn. Abe’s burns included bilateral full-thickness circumferential burns to his legs and feet, arms, and hands, genitalia, and deep partial-thickness burn to his head and anterior trunk.
Before Abe’s arrival to the BICU, the medical team stabilized Abe by initiating cervical spine precautions, endotracheal intubating him, and providing fluid resuscitation and sedation and analgesia with I.V. propofol and morphine via two large-bore peripheral venous catheters.
Once Abe was admitted to the BICU, a right brachial arterial line was placed along with right internal jugular central venous catheter. Initial I.V. fluid resuscitation was calculated based on Abe’s weight of 79 lbs (36 kg), a urinary catheter was placed, and a tetanus injection was administered. The morphine drip was discontinued, an I.V. ketamine drip was started, and wound care began.
Upon reassessment, the nursing staff noted that Abe’s pedal and radial pulses were absent bilaterally, and emergent bilateral upper and lower escharotomies were performed. At this point of care, Abe’s clinical status was critical but stable.
After escharotomies were completed and Abe was stable, and enteral nasogastic tube was placed in the left nares and feedings began. Abe received standard wound dressing with silver sulfadiazine until his burn wounds were grafted (with the exception of his genital burns).
Abe experienced a slow recovery. Within 72 hours of his admission to the BICU, the first surgical excision and grafting onAbe’s hands, feet, head, and neck were completed. His anterior trunk also required surgical excision and grafting at this time. Nurses explained to Abe’s parents that further excisions and grafting procedures would be performed until all of Abe’s burn wounds were closed. The excisions and grafting on Abe’s arms and legs were completed over the next month. A conservative approach was employed to treat Abe’s genital burn. Initially, all obvious retained material (loose debridement) and contaminated remnants of Abe’s clothing were removed.
Next, the BICU nurses completed a prolonged cooling down procedure with water. During the duration of Abe’s admission, topical antibiotic ointments such as Mupirocin were impregnated into gauze and applied over the perineal area and changed every bowel movement. Scheduled as P.R.N. cleansing as accomplished using 4% chlorhexidine skin wash.
This approach led to the successful healing of Abe’s genital burns. Abe was weaned from the ventilator on the third attempt during his second week in the BICU, and solid foods were introduced gradually.