Elisabeth Fandrich

12/03/08
307,O’N,B

Chemical Burns
307,O’N,B, a 91 year old woman, presented to the ER via ambulance with confusion and fecal
matter draining from uncovered colostomies. She had been found by neighbors after apparently
having fallen in her home. Ostomy care was not being done, and the draining fecal matter
caused extensive 2nd and 3rd degree (partial thickness and full thickness) chemical burns to the
skin 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 appears
reddened, blanches with pressure, mild to moderate pain and involves only the epidermis. A
superficial 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 the
skin will have a pale white or yellow color. The pain sensation will be absent. The most
damaging of the burn categories are also the least painful, as the nerve endings have been
destroyed. A full thickness burn (3rddegree) involves all levels of the dermis along with the
subcutaneous fat. The skin may appear leathery and wrinkled and without capillary refill. A 4th
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 approximately
the 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. A
variety of therapists, nursing staff and the physician are involved. This type of injury can be
catastrophic 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 important
focuses in treatment are the promotion of comfort, prevention of complications, and
implementation 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 optimal
quality of life for this woman.

References:
Elisabeth Fandrich
12/03/08
307,O’N,B

Sommors, M., & Johnson, S. (2007). Diseases and disorders: A nursing therapeutics
manual.Philadelphia: F.A. Davis.
Ignatavicius, D., & Workman, M. (2006). Medical-surgical nursing: Critical thinking for
collaborative care.St. Louis: Elsevier Saunders.
United Ostomy Association, Inc.. (2005). Ileostomy/Colostomy Guide [Brochure]. Fairview,
TN: Jan Clark, RNET, CWOCN