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    NCP (Burn)

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    Maricel R. Manabat
    Craig Howard, a 39-year-old truck driver, was admitted to the hospital with burns covering 36% of his total body surface area after his truck cab caught on fire. On admission, he was diagnosed with deep partial thickness and full thickness burns to his chest, arms, and hands. He required fluid resuscitation, respiratory treatments, and escharotomies of his arms to improve tissue perfusion. His condition improved with treatment, as evidenced by stabilized vital signs, improved breathing, urine output, and circulation in his extremities.

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    NCP (Burn)

    Uploaded by

    Maricel R. Manabat
    156 views2 pages
    Craig Howard, a 39-year-old truck driver, was admitted to the hospital with burns covering 36% of his total body surface area after his truck cab caught on fire. On admission, he was diagnosed with deep partial thickness and full thickness burns to his chest, arms, and hands. He required fluid resuscitation, respiratory treatments, and escharotomies of his arms to improve tissue perfusion. His condition improved with treatment, as evidenced by stabilized vital signs, improved breathing, urine output, and circulation in his extremities.

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    NCP(BURN)

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    Craig Howard, a 39-year-old truck driver, was admitted to the hospital with burns covering 36% of his total body surface area after his truck cab caught on fire. On admission, he was diagnosed with deep partial thickness and full thickness burns to his chest, arms, and hands. He required fluid resuscitation, respiratory treatments, and escharotomies of his arms to improve tissue perfusion. His condition improved with treatment, as evidenced by stabilized vital signs, improved breathing, urine output, and circulation in his extremities.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    156 views2 pages

    NCP (Burn)

    Uploaded by

    Maricel R. Manabat
    Craig Howard, a 39-year-old truck driver, was admitted to the hospital with burns covering 36% of his total body surface area after his truck cab caught on fire. On admission, he was diagnosed with deep partial thickness and full thickness burns to his chest, arms, and hands. He required fluid resuscitation, respiratory treatments, and escharotomies of his arms to improve tissue perfusion. His condition improved with treatment, as evidenced by stabilized vital signs, improved breathing, urine output, and circulation in his extremities.

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    Nursing Care Plan The Client with a Major Burn

    Craig Howard, a 39-year-old truck driver, is admitted to the hospital following an accident in which the cab of his truck caught on fire. He was freed from the truck by a passing motorist,who stayed with him until the rescue team arrived and transported him to a local ED.Mr.Howards wife, Mary, and twin daughters, Jessica and Jane, age 10, have been notified.

    ASSESSMENT

    On his admission to the ED, Mr. Howard is diagnosed with deep split-thickness and full-thickness burns of the anterior chest, arms, and hands.A quick assessment based on the rule of nines estimates the extent of his burn injury at 36% of TBSA.His vital signs are as follows: T 96.2F (35.6C),P 140,R 40,and BP 98/60.In the field,the paramedics had inserted a large-bore central line into Mr.Howards right subclavian vein and started the rapid infusion of lactated Ringers solution. Mr. Howard is receiving 40% humidified oxygen via face mask.Initial ABGs are:pH 7.49,PO2 60 mmHg,PCO2 32 mmHg,and bicarbonate 22 mEq/L. Lung sounds indicate inspiratory and expiratory wheezing, and a persistent cough reveals sooty sputum production. A Foley catheter is inserted and initially drains a moderate amount of dark, concentrated urine. A nasogastric tube is connected to low-intermittent suction.Mr.Howard is alert and oriented and complains of severe pain associated with the burn injuries.The burn unit is notified, and Mr.Howard is transferred there.

    DIAGNOSIS

    Risk for ineffective airway clearance, related to increasing lung congestion secondary to smoke inhalation Deficient fluid volume, related to abnormal fluid loss secondary to burn injury Risk for ineffective tissue perfusion, related to peripheral constriction secondary to circumferential burn wounds of the arms

    EXPECTED OUTCOMES

    Demonstrate a patent airway, as evidenced by clear breath sounds; absence of cyanosis; and vital signs, chest X-ray findings, and ABGs within normal limits. Demonstrate adequate fluid volume and electrolyte balance,as evidenced by urine output, vital signs, mental status, and laboratory findings within normal limits. Demonstrate adequate tissue perfusion, as evidenced by palpable pulses, warm extremities, normal capillary refill, and absence of paresthesia.

    PLANNING AND IMPLEMENTATION

    Prepare for prophylactic nasotracheal intubation to maintain airway patency. Initiate fluid resuscitation therapy using the Parkland/Baxter formula to calculate intravenous fluid rate for the first 24 hours postburn. Assist the physician to perform escharotomies of both upper extremities.

    EVALUATION

    The nurse anesthetist inserted a nasotracheal tube and connected Mr.Howard to a T-piece delivering 40% oxygen.Vigorous respiratory toileting has significantly improved his ABGs.Bronchodilators have been parenterally administered and mucolytic agents added to his respiratory treatments. His tracheal secretions have begun to show evidence of clearing. Hourly urine outputs indicate adequate fluid resuscitation. Urine output has been maintained at 50 mL/h, and color and concentration have improved. CVP readings have been maintained at 6 cm H2O, and blood pressure has

    increased to 100/64.The pulse rate has decreased to 100. To improve tissue perfusion of both arms, the physician has performed bilateral escharotomies and the wounds are dressed, using sterile procedure. The extremities have demonstrated improved circulation.

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