Comprehensive Nursing Care for an 18-Year-Old Client with Burns: Critical Interventions and Considerations

QUESTION

You are the nurse that continues to provide care for the 18-year-old client with burns following an aircraft crash involving his family. The client was the only one to survive the crash. The client’s vital signs were grossly abnormal and respiratory distress became evident after the client arrived the emergency department. Upon further examination, it appears that the client has edema of the vocal cords and worsening respiratory distress.

1. What intervention would you expect next?
2. What is the mortality rate associated with clients with inhalation burns versus those that do not have these types of burns?
3. The provider has ordered nebulized heparin sulfate. When you question the order, the provider reassures you that the order is correct? What is the rationale for using this medication in a nebulized form?
4. Which two electrolytes require vigilant monitoring in a burn client, and what is the rationale for this?
5. Identify six specific clinical manifestations associated with sepsis alert in clients with burns.
6. Based on the Advanced Burn Life Support recommendations, what volume of fluid resuscitation would be required for this client in the first 8 hours, 16 hours?
7. If an IV was not placed successfully, what are alternative ways you can manage the client’s severe pain in an efficient way through an alternate route?
8. When caring for the client’s burns, how would you treat the wounds initially while maintaining the client’s body temperature in a normal range?
9. Which topical agent is ideal for preventing fungal and bacterial growth when applying a dressing?
10. Elaborate on the nutritional needs a client will have who has been severely burned. How would you support nutritional needs in a client with facial burns?

ANSWER

Comprehensive Nursing Care for an 18-Year-Old Client with Burns: Critical Interventions and Considerations

Introduction

Providing care for an 18-year-old client with burns following an aircraft crash is a complex and challenging task that requires prompt and evidence-based interventions. This essay outlines the critical nursing interventions and considerations for managing this young patient’s burns and associated complications.

Interventions and Considerations

Immediate Intubation: Given the client’s grossly abnormal vital signs and worsening respiratory distress with edema of the vocal cords, immediate intubation should be the next intervention to secure the airway and ensure adequate oxygenation.

Mortality Rate: Clients with inhalation burns have a significantly higher mortality rate compared to those without these types of burns. Inhalation burns can lead to airway compromise, respiratory distress, and complications like pneumonia, increasing the risk of mortality.

Nebulized Heparin Sulfate: The provider’s order for nebulized heparin sulfate is rational as it acts as an anti-inflammatory and anticoagulant agent, reducing inflammation in the airways and preventing clot formation, which is common in burn-related inhalation injuries.

Vigilant Electrolyte Monitoring: Potassium and Sodium levels require vigilant monitoring in burn clients due to the risk of electrolyte imbalances resulting from fluid shifts and tissue damage.

Clinical Manifestations of Sepsis Alert: Six specific clinical manifestations associated with sepsis alert in burn clients include altered mental status, tachycardia, hypotension, hypothermia, elevated white blood cell count, and increased respiratory rate.

Fluid Resuscitation: Following Advanced Burn Life Support recommendations, fluid resuscitation for the first 8 hours should be 4 mL of lactated Ringer’s solution per kilogram of body weight per percentage of total body surface area (TBSA) burned, and for the next 8 hours, it should be 2 mL/kg/%TBSA.

Managing Severe Pain: If IV access is not successful, pain management can be achieved through alternative routes, such as intranasal or transmucosal routes, as they provide rapid pain relief and are suitable for clients with airway compromise.

Wound Care and Temperature Regulation: Initially, the client’s burns should be treated with a cooling method to maintain body temperature within the normal range while preventing hypothermia. This can be achieved through the application of cool, sterile dressings.

Topical Agent for Dressing: An ideal topical agent for preventing fungal and bacterial growth when applying a dressing is a silver-based dressing, as silver has antimicrobial properties and aids in wound healing.

Nutritional Needs: A client who has been severely burned will have increased nutritional needs to support wound healing and metabolic demands. In a client with facial burns, enteral nutrition via a feeding tube may be necessary to meet nutritional requirements while minimizing the risk of aspiration.

Conclusion

The care of an 18-year-old client with burns requires timely and evidence-based interventions to address the complex challenges associated with burns and inhalation injuries. Implementing the mentioned interventions and considerations will ensure a comprehensive and well-coordinated approach to provide the best possible care for the patient’s recovery and overall well-being.