Reference no: EM133297364

Case Study

David Newton, age 54, was smoking a cigarette and fell asleep, dropping the cigarette and igniting his bed linens. A neighbor discovered the fire and called 911, and Mr. Newton was rescued by the fire department. He sustained full-thickness burns over the upper half of his chest and back and the posterior aspects of both upper arms. He also sustained superficial partial-thickness burns to his anterior and posterior head and neck.

Mr. Newton was initially treated in the local emergency department and then transported via life flight to the specialized burn unit located 150 miles from his home. Upon his arrival in the burn unit, 5 hours after injury, the nurse notes the presence of a Foley catheter that is draining burgundy-colored urine. Mr. Newton also has a nasogastric tube that is draining dark yellow-green liquid. He was intubated in the emergency department and is now placed on a ventilator in the burn unit. Upon admission to the burn unit, his vital signs are: temperature 99.9°F oral; pulse 100 bpm; respirations 24/min; BP 96/56 mmHg. His pain level is reported as a 9 on a 1-10 scale, and he is medicated with morphine sulfate 10 mg IV as per the physician's order.

Question 1 The initial assessment in the emergency department is that Mr. Newton has sustained burns over 36% of his body. Using the rule of nines, how does the nurse analyze this total percentage?

Question 2 Mr. Newton is in the phase of burn shock. His urinary output for the past 5 hours has been 150 mL. On the basis of his urinary output and vital signs, what is the nurse's explanation for the physiology of shock related to a major burn injury?

Question 3 Burn injuries to Mr. Newton's chest place him at risk for at least three post-burn complications. What are they? What assessment findings would confirm the development of these complications?

Question 4 Describe the wound care Mr. Newton should receive before he is transferred to a burn unit.

Question 5 How will pain/comfort be addressed while caring for Mr. Newton?

Question 6 Mr. Newton's diagnosis is Impaired Gas Exchange related to swelling secondary to inhalation injury manifested by need for intubation and mechanical ventilation. Why was intubation necessary for Mr. Newton? What important nursing interventions are related to this? Discuss the concept of Clinical judgment related to the interventions.

Question 7 Why was Mr. Newton's Foley catheter draining burgundy-colored urine at the time of admission to the burn unit?

Question 8 Mr. Newton is put on enteral feeding during the recovery phase of the burn injury, and the nursing diagnosis established is Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolic and catabolic stage secondary to a major burn. What is the rationale for this diagnosis?