Question

A child sustains second- and third-degree burns to the upper torso and face.

1. What should be done on admission to the hospital?

2. What type of care should this child receive?

Answer 1

Ans) 1) Assessment of the child to be done on admission to the hospital by taking vital signs T, P, R, BP, Pain assessment, skin assessment, wound assessment, HGT & clearly should be documented in the nursing records.

- Assessment of the functional status, nutrition, mobility, hydration status .

- Ask how the injury occurred, causative agent, temperature of the burning agent, duration of contact, thickness of the skin

- Assess -Depth of burn, Extent of total body surface area affected, Location of the burn, Patient risk factors
Calculate percentage of the body surface area which is burned.

- Inform to the doctor for deviation in the vital parameters.

2) Care for the child with burns:

Goals:

-Prevention
-Lifesaving measures for critically burned patients
-Prevention of disability through early individualized treatment
-Rehabilitation

Care:1) Airway
-100% oxygen
-Provide airway/respiratory support as needed
-Watch for signs & symptoms of inhalation injury
2) Breathing
-Respiratory rate/effort (looking for crackles)
3) Circulation
-P, Capillary refill, HR, BP
4) History of how injury occurred
-Time, Place, Source, Tx, Hx of fall
5) PMH, Current medications, & allergies
6) Assessment of TBSA & burn depth
7) Large gauge IV
8) Foley
9) Baseline height, weight, labs
10) Tetanus
11) EKG

ABC's FIRST then wound care!!!
-Airway, adequate circulation, & adequate fluid replacement are established BEFORE wound care is initiated.
-Cleansing & debridement
-May need to be done in the OR
-Loose necrotic skin is removed.
-Transfer to burn center

Wound care:

-Prevent infection by cleansing & debriding the area of necrotic tissue that would promote bacterial growth
-Promote wound re-epithelialization &/or successful skin grafting
-Daily observation
-Assessment
-Cleansing
-Debridement
-Dressing reapplication

Pain management:

1) Opioids
-Morphine
-Fentanyl
(IV route most effective)
-PCA pump
2) Nonpharmacologic

Nutrition:

-Meeting daily caloric requirements is crucial
-High-protein, high-carbohydrate, high caloric foods
-High calorie
-Enteral feedings started as soon as possible
-Favorite foods from home

Discharge planning:

-Multidisciplinary team approach
-PT/OT/Mental health/speech
-Nutrition
-Financial assessment
-Wound care management
-Medical equipment
-Home health services