Case Scenario:

Mr. D, male, 38-year-old was rushed to the emergency room of FUMC Antipolo, with burn of half of the face and half of the posterior head manifested by severe erythema without blisters patient is
complaining of painful sensation with tingling. Upon assessment of the trunk nurse C, saw a large blister over his anterior and posterior trunk with broken epidermis and with wet, shiny, and weeping surface, with
edema and painful sensation. His right arm’s wound surface is red and dry with moderate edema. Mr D’s both lower extremities appear black and with absent sensation on the injured area. Peripheral IV access
was initiated on the left arm, and vital signs monitored closely. The nurse assessed patient for hoarseness in voice, harsh cough, neck swelling and stridor when auscultated. A conservative approach was employed
to treat the burned face and head.
Doctor’s order:Start IV-line PLR 1L, monitor vital signs Q1 hour, insert a foley catheter connected to urine bag,prepare intubation set, maintain on NPO status, insert NGT, monitor intake and urine output at
least at minimum, monitor daily weight, suggest escharotomy
Therapeutics:Give tetanus IM as prophylaxis, administer Gentamycin Sulfate TIV, administer tramadol TIV, administer Ranitidine TIV, apply Silver SulfadiazineTopical, apply Neosporin Topical.
Laboratories:Carboxyhemoglobin, Serum Na and K, CBC, Urinalysis, ECG, Stools for occult blood, CBG.

NURSING
DRUG NAME MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECT
CONSIDERATION
Generic name: Histamine H2 blockers are Ranitidine is used to treat ulcers No contraindication given in the No side effects given in the Monitor vital signs
Ranitidine Hydrochloride competitive blockers of of the stomach and intestines scenario scenario
histamine. As such they inhibit and prevent them from coming Assess for history of allergy to
Brand name: all phases of gastric acid back after they have healed. Possible Contraindications: Possible Side Effects: ranitidine, impaired renal or
There is no brand name given in secretion including that caused - Hepatic Disease - Erythema hepatic function.
the scenario but the common by histamine, gastrin and - Renal Disease, Failure - Constipation
brand name is Zantac muscarinic agents. and Impairment - Nausea and Vomiting Monitor other CNS symptoms
- H2 Blocker - Diarrhea and such as confusion,
Classification: Hypersensitivity Abdominal Pain hallucinations and headache.
Histamine H2 Blockers - Infection - Headache and Dizziness Excessive or prolonged CNS
- Malaise symptoms may require a
Dosage: - Bradycardia or reduction in dose.
Not given in the scenario Tachycardia
- Pain at injection site Assess stomach pain, noting
Frequency: - Local burning or itching characteristics, frequency of
Not given in the scenario (IV use) occurrence and things that alter
- Fever it.
Route: - Rash
IV If patient experience headache
adjusts lights and temperature
and avoid noise.
Enlargement of breast may
occur. Symptoms of breast
tenderness will usually
disappear after several weeks;
report if persistent and evaluate
length of therapy.

Advise patient to avoid alcohol

and foods that may cause an
increase in GI irritation

Maintain adequate hydration

Report any evidence of yellow

discoloration of skin or eyes, or
diarrhea.

Document indications for

therapy, onset/characteristics of
symptoms, other agents used
and anticipated treatment
period.

Arrange for regular follow-up

including blood test, to evaluate
effects.
 NURSING
DRUG NAME MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECT
CONSIDERATION
Generic name: Silver sulfadiazine disrupts This medication is used with No contraindication given in the No side effects given in the Administer drug as indicated
Silver Sulfadiazine Cream bacteria by damaging the cell other treatments to help scenario scenario
membrane and the cell wall prevent and treat wound Monitor any new or increased
Brand name: rather than by inhibiting folic infections in patient with Possible Contraindications: Possible Side Effects: skin reactions at the site of
There is no brand name given in acid synthesis. serious burns. - Sulfonamide - Pain, burning or itching application, including rash,
the scenario Hypersensitivity of the treated skin burning, itching, pain and
- Skin and mucous necrosis. Report any suspicious
Classification: membrane (such as skin reactions to the physician.
Sulfa Antibiotics gums) may become
blue or gray Implement wound care
Dosage: - Easy bruising/bleeding procedures as needed to
Not given in the scenario cleanse burns and ulcers. Make
sure the drug is reapplied and
Frequency: dressings are changed according
Not given in the scenario to the recommended
procedures.
Route:
Topical Check that the patient
understands topical application
and wound care procedures and
adhere to the recommended
dosing schedule

Instruct patient and

family/caregivers about
prevention of other types of
skin ulcers and the need for
visual inspection to prevent
recurrence or development or
new ulcers.
 NURSING
DRUG NAME MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECT
CONSIDERATION
Generic name: This product contains neomycin, This medication is used to No contraindication given in the No side effects given in the Before you apply this
Not indicated in the scenario bacitracin and polymyxin, prevent and treat minor skin scenario scenario medication, clean the skin
antibiotics that work by infections caused by cuts, surface then dry it thoroughly.
Brand name: stopping the growth of bacteria. scrapes or burns. Possible Contraindications: Possible Side Effects:
Neosporin Topical Ointment - Aminoglycoside - Other types of skin Apply topical drug as indicated.
Hypersensitivity infections (fungal or If necessary, a bandage may use
Classification: - Neomycin other bacterial to cover the area
Antibiotics Hypersensitivity infection)
- Polymyxin Do not apply the ointment over
Dosage: Hypersensitivity large skin areas
Not given in the scenario - Ophthalmic
administration Clean the wound and use a new
Frequency: bandage each time you apply
Not given in the scenario the medicine.

Route: Use the ointment for as many as

Topical recommended on the label or
by your doctor, even of your
symptoms start getting better.