1.

The elderly (as well as young children) suffer from a higher incidence of burn injury compared to all
other age groups. What predisposing factors increase the vulnerability for burns in the aging
population?

 Smoking
 Limited mobility
 Slower reaction time
 Sensory impairment
 Decreased coordination
 Side effects of medication
 Cognitive decline

2. When EMS arrived at Grace’s apartment, she was immediately assessed for the total body surface
area (TBSA) burned using the Rule of Nines tool. What percent do you think was reported?

 27%

3. It was stated that Grace experienced second-degree burns. Most health care providers use the term
“burn depth” when classifying the severity. Compare and contrast the three levels using the following
table as a guideline.

Depth of burn Skin involved symptoms Wound appearance

First-degree burn Superficial burn Epidermis Skin redness, Red, non-blistered
pain, swelling skin
Second-degree burn Partial Epidermis and Blisters may Blisters, and some
dermis develop and pain thickening of the skin
can be severe
Third-degree burn Full thickness Epidermis, Numbness Widespread
dermis, thickness with a
subcutaneous white, leathery
tissue appearance

4. Morbidity associated with burns in the elderly is influenced by age-related changes of integumentary
functioning. Briefly explain how alterations in this system may be involved.

Our skin provides an essential protective barrier against the environment, invading microorganisms, and
ultraviolet (UV) radiation. It also functions in regulating body temperature, internal hydration status, and
carries sensory functions in addition to its role in immunologic surveillance. Even so, our skin’s integrity
and function is eventually jeopardized by the process of aging through structural and biochemical
processes, and manifests as impaired neurosensory perception, permeability, and compromised
response to injury and repair capacity.

5. A vital need immediately following a burn is fluid and electrolyte resuscitation. What IV fluids were
initially used for Grace in the ED? Provide the rationale why potassium (K+) excess and sodium (Na+)
deficit occur during the emergent stage of burns.

 Ringer's lactated (RL) solution 4 ml/kg/% burn for adults

  In major burns. intravascular volume is lost in burned and unburned tissues: this process is due
to an increase in vascular permeability, increased interstitial osmotic pressure in burn tissue.
and cellular oedema. with the most significant shifts occurring in the first hours.
Hyponatraemia is frequent, and the restoration of sodium losses in the burn tissue is therefore
essential hyperkalaemia is also characteristic of this period because of the massive tissue
necrosis. Hyponatraemia (Na) (< 135 mEq/L) is due to extracellular sodium depletion following
changes in cellular permeability.

6. What should the nurse do first about this finding?

a. Contact the MD for either a larger dose of the opioid or shorter intervals between doses.

b. Exchange this PCA pump for another; there is an obvious error in this reading.

c. Assess Grace’s understanding of how she uses the PCA pump for pain management.

d. Consider giving Grace her “break-through” dose of Dilaudid (hydromorphone) IV push.

7. Why did the nurse refer to her colostomy as a “blessing”?

 Because colostomy is the reason why she still living her life after being diagnosed with colon
cancer. Without colostomy, for those who has a problem in other part of the organ, there life
will be hard and they will think that it will be the end of their life. But colostomy is a big help to
them that is why for them colostomy is a blessing.

8. As a student observing this event, discuss how you would handle this issue.

 As a student nurse who is observing, I will talk to the nurse who accidentally drop the gauze
dressing to the floor and put it back in a sterile field. Even though the patient didn’t see what
happen, it is your responsibility to do no harm to the patient because you know that sterility is
very important especially in cleaning wounds. The material should be clean and sterile to
prevent microorganism invade the wound because it will lead to infection.

9. Explain why Grace was at risk for these complications following her burn injury.

 Compartment syndrome can arise from three main causes in the burn patient: Formation of

inelastic, circumferential eschars around burned limbs and the associated extravasation of
fluids. Electrical conduction burns leading to muscle and nerve damage and cell death.
 Curling's ulcer is an acute gastric erosion resulting as a complication from severe burns when
reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.

10. What was the likely rationale for significantly increasing her caloric intake post-burn? Select all that
apply.

a. Hypermetabolism occurs with burns

b. Healing of the burn consumes large quantities of energy

c. Increasing fat intake is essential for homeostasis

d. Appetite may be diminished related to pain and/or anxiety

 e. Reserve fat deposits are catabolized

11. What areas of health care not addressed in Grace’s story do you think received attention during the
rehab phase?

 After two weeks of recovery, she should still visit the hospital and have a check-up.