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Nursing 4143: Holistic Nursing Care in Acute Illness II and End of Life Winter 2013-2014 Learning Plan Thermal Injury !"er"ie#: Major thermal injurie are a !hallen"e to treat# Burn injurie re$uire !om%le& treatment 'y a !olla'orati(e team ma)e u% o* a (ariety o* health team mem'er # To %ro(i)e a)e$uate treatment nur e mu t 'e a'le to a)e$uately a e the e(erity o* the 'urn # It i e ential that nur e un)er tan) the %atho%hy iolo"y+ % y!ho o!ial i ue + !olla'orati(e inter(ention + an) %re(ention o* %otential !om%li!ation # !$%ecti"e of t&e Course'Co()etenc*: 1+ Integrate and s*nt&esi,e -no#ledge gained fro( )re"ious course#or-+ ,no-le)"e an) .ill lea)in" to ma tery o* thi !om%eten!y/ a# Inte"rate theorie an) !on!e%t *rom li'eral e)u!ation into nur in" %ra!ti!e# '# Synthe i0e theorie an) !on!e%t *rom li'eral e)u!ation to 'uil) an un)er tan)in" o* the human e&%erien!e# !# Im%lement holi ti!+ %atient1!entere) !are that re*le!t an un)er tan)in" o* human "ro-th an) )e(elo%ment+ %atho%hy iolo"y+ %harma!olo"y+ me)i!al mana"ement an) nur in" mana"ement a!ro the li*e %an in the emer"ent an)2or a!ute health!are ettin" # 3+ Create an artistic inter)retation of a nursing care )ractice t&at illu(inates t&e co()* of )ro"iding nursing care for clients and t&eir fa(il*+ ,no-le)"e an) .ill lea)in" to ma tery o* thi !om%eten!y/ a# E&%lain the interrelation hi% amon" theory+ %ra!ti!e an) re ear!h# '# I)enti*y the )imen ion o* !ri i an) the nur in" a!tion that %romote a)a%ti(e !o%in"# !# Summari0e the im%a!t o* illne an) ho %itali0ation on %atient an) their *amilie # )# Re!ommen) !arin" an) healin" te!hni$ue that %romote a thera%euti! nur e1%atient relation hi%# e# Inter%ret !om%a ionate+ %atient1!entere)+ e(i)en!e1'a e) !are that re %e!t %atient an) *amily %re*eren!e )urin" an emer"ent an)2or a!ute !are e&%erien!e# /+ A))l* t&eor*-$ased decision (a-ing in t&e deli"er* of safe0 co()etent and culturall* congruent nursing care to clients in t&e acute care setting+ ,no-le)"e an) .ill lea)in" to ma tery o* thi !om%eten!y/ a# A%%ly .no-le)"e o* o!ial an) !ultural *a!tor to the !are o* )i(er e %o%ulation # '# I)enti*y *a!tor that !reate a !ulture o* a*ety#

!# Re!o"ni0e $uality an) %atient a*ety a !om%le& y tem i ue -hi!h in(ol(e in)i(i)ual + *amilie an) other mem'er o* the health!are team# 1+ Criticall* e"aluate and utili,e relati"e finding of nursing researc& in )lanning 2ualit* )atient care+ ,no-le)"e an) .ill lea)in" to ma tery o* thi !om%eten!y/ a# U e .ill o* in$uiry+ analy i an) in*ormation litera!y to a))re %ra!ti!e i ue # '# A!$uire an un)er tan)in" o* the %ro!e *or ho- nur in" an) relate) health!are $uality an) a*ety mea ure are )e(elo%e)+ (ali)ate) an) en)or e)# Learning Acti"ities: Le-i + 3eit.em%er+ 4ir. en+ O5Brien+ Bu!her 67899:/ Cha%ter 7;< %%# 9=>819=>9 6*ro t'ite: htt%/22---#atite tin"#!om o RN Re(ie- Mo)el ? 7898 E)ition ? A)ult Me)i!al Sur"i!al Nur in" RN Ver ion =#8 Cha%ter =@ ,a"an+ R#+ A Smith+ S# 67888:# E(aluation an) treatment o* thermal injurie # Dermatology Nursing+ 126;:+ >>B# Retrie(e) *rom CINA3L Plu -ith Cull Te&t )ata'a e# O 'orn+ ,# 6788>:# Criti!al !are# Nur in" 'urn injurie # Nursing Management+ 346;:+ BD# Retrie(e) *rom CINA3L Plu -ith Cull Te&t )ata'a e# Eie'elhau + P#+ A 3an en+ S# 67889:# Mana"in" 'urn emer"en!ie # Dimensions of Critical Care Nursing+ 206B:+ 71=# Retrie(e) *rom CINA3L Plu -ith Cull Te&t )ata'a e# 3e"ie#: Burn Sur(i(or Re our!e Center htt%/22---#'urn ur(i(or#!om2'urnFty%e #html Co(e to class )re)ared to discuss: Burn o Ty%e Chemi!al 'urn Smo.e an) inhalation injury Ele!tri!al injury o Burn !la i*i!ation o Burn mana"ement Col) thermal injury o Cro t'ite Su%er*i!ial 4ee% Post-class/

Burn Ca e Stu)y Learning !$%ecti"es 9# Com%are the ty%e o* 'urn injurie # 7# 4i !u the %rimary an) e!on)ary ur(ey a e ment )urin" re u !itation an) the a!ute %ha e o* 'urn mana"ement# ># Relate the nur in" )ia"no e + out!ome + an) inter(ention *or the 'urne) %atient# B# E&%lain *lui) an) ele!trolyte hi*t )urin" the emer"ent an) a!ute 'urn %ha e # ;# 4e !ri'e the nutritional thera%y o* the 'urn %atient )urin" the three 'urn %ha e # G# 4e !ri'e the a e ment+ an) !are o* *ro t'ite# @# 4i**erentiate 'et-een the *in)in" an) treatment o* u%er*i!ial an) )ee% *ro t'ite#

4urn Case 5tud* 6irections: Eor. -ith a %artner to !om%lete thi !a e tu)y# Rea) the entire %atient !enario 'e*ore you 'e"in< %ro(i)e !on!i e an -er in the !onte&t o* thi %atient ituation# Thi a i"nment -ill a%%ly in*ormation *rom !urrent an) %re(iou rea)in" in a)ult health+ %harma!olo"y an) %atho%hy iolo"y# Pa%er Gui)eline / Li t $ue tion num'er an) enter an -er -ith rationale# Plea e u e ta'le -hen re$ue te)# ;8 %oint # John, a 28-year-old male is brought to ER by EMS personnel. He was at home welding in his shop when a fire erupted and ui!"ly destroyed the premises. #ssessment re$eals e%tensi$e burns !o$ering the ma&ority of his anterior arms, hands, fa!e and upper anterior !hest. 'he burns are a !ombination of inta!t and open blisters with reddened bases and shiny weepy surfa!es. John is alert and oriented (). He !omplains of se$ere pain * sensiti$ity to !old air. +ou note that nasal hairs are singed as well as his eyebrows and eyelashes. His spee!h is hoarse and he has a brassy sounding !ough, nonprodu!ti$e. 'he paramedi!s obtained the following history in route. He has a history of seasonal allergies. ,o allergies ha$e been identified. He has no s!heduled medi!ations, but ta"es o!!asional 'ylenol for heada!hes. He had his 'etanus immuni-ation ) years ago. 9# E timate the %er!enta"e o* 'urn the %atient ha E&%lain ho- you )eri(e) your an -er# u taine)+ u in" the rule o* nine +

7# ABG on a)mi ion are %3 @#;8+ PaCO7 7D+ PaO7 =7+ 3CO> >8# Inter%ret the e re ult # In!lu)e %o i'le etiolo"y *or thi *in)in"# ># Clui) re u !itation i a %riority *or thi %atient# Thi %atient -a a)mitte) at 99>8 *ollo-in" an injury that o!!urre) at 8DB;# Utili0e the TBSA you !al!ulate) in $ue tion 9 an) Hohn5 re%orte) -ei"ht o* 9@7 l' to !al!ulate the *ollo-in"/ a# U e the Par.lan) *ormula an) !al!ulate the amount o* IV *lui) to 'e a)mini tere) in the *ir t 7B hour 6 ho- !al!ulation : '# The %hy i!ian or)er La!tate) Rin"er a the IV olution# Ehy i thi the 'e t !hoi!e )urin" thi %ha e o* injuryI !# Ehat -ill 'e the rate o* in*u ion in the *ir t = hour # B# Ehat %atient *a!tor -ill you a e to )etermine i* a# The rate o* the in*u ion i 'ein" tolerate) '# The *lui) re%la!ement i a)e$uate ;# Burn %atient are at ri . *or a num'er o* !om%li!ation )urin" thi %ha e o* injury# Ba e) on Hohn5 %re entin" i"n an) ym%tom + -hat .ey !om%li!ation+ other than 'urn ho!.+ !an o!!urI

a# Ehat e(i)en!e u%%ort the %o i'ility o* thi !om%li!ation )e(elo%in"I '# Ehat i the %atho%hy iolo"y o* the !om%li!ationI !# 3o- -ill you inter(ene i* thi %ro'lem o!!ur I 6In!lu)e anti!i%ate) or)er an) nur in" inter(ention :# G# Ba e) on a e ment in*ormation %ro(i)e)+ -hat ty%e o* 'urn )i) the %atient li.ely e&%erien!eI In!lu)e u%%ortin" e(i)en!e *or your a e ment# @# Li t in )riorit* or)er+ the .ey !urrent nur in" )ia"no i *or thi %atient# 6Minimum o* ;: Nursing 6iagnosis 3ationale for Priorit* Place(ent

=# 4urin" the early emer"ent %ha e+ -hat )o you anti!i%ate *or la' re ult *or the *ollo-in" te t / 3!t+ erum o)ium+ erum %ota ium+ 'loo) "lu!o e+ %e!i*i! "ra(ityI In)i!ate i* (alue -ill 'e 6N: normal+ 6I: in!rea e)+ or 64: )e!rea e) an) %ro(i)e an e&%lanation o* the la' (alue # 6U e Ta'le *ormat# A)ju t i0e a nee)e):# La$ 7alue: N0 I0 or 6 3!t Serum NA Serum , Bloo) Glu!o e S%e!i*i! Gra(ity D# Prior to tran *er to the ICU+ %ro%hyla!ti! intu'ation -ill 'e )one# Ehat i the rea on *or intu'ation %rior to any a!tual i"n 2 ym%tom o* a!ute re %iratory %ro'lem I 8o&n is ad(itted to t&e 4urn IC9 at 1300+ He was intubated in the ER and stabili-ed prior to transfer. His wife Sarah has arri$ed and you as" her to wait until you ha$e assessed John. E.)lanation of La$ 7alues

#ssessment findings in!lude. hypoa!ti$e bowel sounds, e%tensi$e fa!ial and body edema, upper body s"in that is taunt and shinny in appearan!e, radial pulses diffi!ult to palpate /left radial pulse is 201) and a 2oppler is re uired to obtain pulse on right arm. He denies numbness or tingling in arms. 98# Ehat i the rea on *or the e&ten i(e e)ema Hohn i e&%erien!in"I 3o- -ill you %re%are hi -i*e *or thi (i itI 99# Gi(en hi !urrent a e ment+ li t the one %riority Nur in" 4ia"no i an) the .ey %otential !om%li!ation *or thi %atient# 3t is 4566 and John is s!heduled for the hydrotherapy tan" for wound !leansing. 97# The %hy i!ian ha or)ere) mor%hine ul*ate ; J 98 m" IVP $ 91> hour %rior to hy)rothera%y an) *or %ain# Prior to a)mini terin" thi me)i!ation+ -hat -ill you nee) to )oI 9># 3o- -ill you monitor thi %atient )urin" hy)rothera%yI 9B# A*ter the !om%letion o* hy)rothera%y+ -hat )o you anti!i%ate *or imme)iate -oun) !areI 7n Johns se!ond day in the 389, a feeding tube is pla!ed in the &e&unum and he is started on tube feedings. Camily mem'er a . you -hy he ha not re!ei(e) any nutrition 'e*ore# 3o- -ill you re %on) to thi $ue tionI 9;# Ehy i* the *ee)in" tu'e in the jejunum an) not the toma!hI 9G# 3o- -ill you )etermine i* the tu'e *ee)in" are meetin" 4ale5 meta'oli! nee) I John mo$es into the a!ute phase of in&ury with mobili-ation of fluids and diuresis. 2uring the ne%t four wee"s he has surgi!al debridement and s"in grafting /autograft: on his right hand and arm. 7ther burn in&uries !ontinue to heal with hydrotherapy !leaning and pres!ribed topi!al agents. 9@# Ehy mi"ht Hohn ha(e re$uire) .in "ra*tin" an) )e'ri)ement *or 'urn -oun) on hi ri"ht han) an) armI 9=# Ehat %atient e)u!ation -oul) you ha(e %ro(i)e) re"ar)in" "ra*t ite ele!tion an) !are a*ter "ra*tin"I 9D# Re(ie- Hohn5 ho %ital !our e# Ehat %o i'le !om%li!ation6 : remain )urin" 'oth the a!ute an) reha'ilitation %ha eI Pro(i)e Rationale# 6Minimum o* > %otential !om%li!ation :#