Elisabeth Fandrich12/03/08307,O’N,B
Chemical Burns
307,O’N,B, a 91 year old woman, presented to the ER via ambulance with confusion and fecalmatter draining from uncovered colostomies. She had been found by neighbors after apparentlyhaving fallen in her home. Ostomy care was not being done, and the draining fecal matter caused extensive 2
nd
and 3
rd
degree (partial thickness and full thickness) chemical burns to theskin of the patient’s back, buttocks, thighs, perineal area, and lateral aspects of the torso.The severity of a burn is determined by its characteristics. A superficial epidermal burn appearsreddened, blanches with pressure, mild to moderate pain and involves only the epidermis. Asuperficial partial thickness burn has blisters, redness, and severe pain (exposed nerve endings).A deep partial thickness burn involves the reticular dermis. Blisters will be apparent, and theskin will have a pale white or yellow color. The pain sensation will be absent. The mostdamaging of the burn categories are also the least painful, as the nerve endings have beendestroyed. A full thickness burn (3
rd
degree) involves all levels of the dermis along with thesubcutaneous fat. The skin may appear leathery and wrinkled and without capillary refill. A 4
th
degree full thickness burn involves all levels of the dermis as well as fascia, muscle, and bone.The majority of the burns sustained by 307,O’N,Bare partial thickness. An area approximatelythe size of a softball on the patient’s sacral area is a full thickness burn.Care of the patient with a burn is a complex arrangement of overlapping collaborative care. Avariety of therapists, nursing staff and the physician are involved. This type of injury can becatastrophic to all systems of the body.307,O’N,Bis malnourished as a result of poor dietary intake and increased caloric demand for tissue repair. She also shows signs of renal failure. It is unclear if the renal failure is a pre-existing condition, or if it is an indirect result of the burn process.Treatment focuses on maintenance of a patent airway, breathing and circulation. Other importantfocuses in treatment are the promotion of comfort, prevention of complications, andimplementation of strategies to reduce stress and anxiety.307,O’N,Bis being treated with hydrotherapy debridement by a physical therapist, application of silver sulfadiazine and pain management.Careful management of the patient’s colostomies is imperative for the patient’s recovery and prevention offuture injuries. Skilled nursing care will play an important part in ensuring optimalquality of life for this woman.References:
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Chemical Burns Patho
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| Upload Date: | 05/14/2009 |
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