Question

Julie and her parents were returning home from a family visit 4 weeks ago when they were involved in a motor vehicle accident resulting in an explosion that cause their car to become engulfed in flames. Julie sustained third-degree burns over 80% of her body and was admitted to the Jaycee Burn Center. She was intubated and placed on mechanical ventilation. Currently she is no longer on mechanical ventilation and has a tracheostomy from which the nursing staff suctions thick green-yellow secretions every 2 to 3 hours. Julie is receiving TPN and intralipids through a central venous access. Julie has severe wounds to her face, neck, left arm, left leg and back requiring extensive wound and graft care. She is premedicated with intra venous fentayl prior to each dressing change, abd this provides adequate pain management for these procedures.

1. Discuss Julie's needs regarding her tracheostomy.

2. Discuss TPN, including general care and special nutritional needs of children with burn injuries.

3. What is the relationship between Julie's fluid and electrolyte balance and her burn status?

Answer 1

1. Tracheostomy is done to clear the obstructed airway , to clean and remove secretions from the airway ,easily and safely and to deliver oxygen to the lungs .

2. Without proper nutrition healing process may slow down , weight loss may occur , and suppress the immune system . Enteral feeding reduce immunological complications , improve nitrogen balance ,reduce hypermetsbolic response. Enteral feeding is safe and beneficial for children as well as adults.

Needs a lot of protein while healing because body will lose protein through the burn wounds .

3. Third degree burns may lead to dehydration. The layers of the skin keep fluids inside the body .In 3 rd degree burn it damages the thickness of the skin and nerve endings . When the protective covering doesn't exist , then fluid seeps from the burned area and cause dehydration and electrolyte imbalance.