Question

Initial Management of a Patient with Burns (Q: 8, 9)

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, 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

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 pain is at a level 10 on 10-point-scale
• Urinary catheter draining burgundy-colored urine
• Nasogastric tube is draining yellow-green drainage

Discussion Questions

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?

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

Answer 1

8.Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the infection

9.Supportive psychological interventions should focus on immediate concerns, such as sleep, pain control, and protecting patients' coping strategies. Non-pharmacological approaches to pain control, such as hypnosis and relaxation, can be effective.