Case Study #13 Burns 1
Burns
Vicki Lee
Case Study #13 Burns
Concordia University
Professor Layton
November 23rd , 2019
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, Case Study #13 Burns 2
Burns
Case Study 5: Burns
A 69-year-old female patient, J.L., is admitted through the ED after she was burned by the explosion of a
paint can thrown into her outdoor burn pile. She is awake and oriented but agitated and unable to report
about the accident. She is reporting severe pain in her face, neck and right arm. Her voice is raspy and
she says she is cold and shivering. Hair on her head and arms are singed. She has areas of redness,
waxiness and blisters covering her face, anterior neck, all of her right arm, chest, abdomen and anterior
surface of her left arm. VS: BP (thigh) 110/52, HR 132, RR 36. Medical history includes MI seven years
ago followed by chronic heart failure. Meds: Accupril 20mg PO QD, Lasix 20mg PO QD, Pravachol
40mg PO QD.
1. For each of the following nursing interventions, write a number in the blank to indicate
the appropriate order of the tasks.
a. Administer IV Morphine: 6
b. Administer IV fluids: 5
c. Administer 100% humidified O2: 1
d. Administer prophylactic tetanus toxoid: 9
e. Establish IV access: 2
f. Initiate appropriate wound care: 8
g. Insert indwelling urinary catheter: 7
h. Prepare for endotracheal intubation: 3
i. Estimate body surface area burned: 4
2. As J.L. is in the ED the nurse is closely assessing each of the following. What abnormalities
in each area would be of high concern for the nurse? Why?
a. Urinary output-Decrease urinary output is commonly caused by decreased cardiac output.
/
Burns
Vicki Lee
Case Study #13 Burns
Concordia University
Professor Layton
November 23rd , 2019
/
, Case Study #13 Burns 2
Burns
Case Study 5: Burns
A 69-year-old female patient, J.L., is admitted through the ED after she was burned by the explosion of a
paint can thrown into her outdoor burn pile. She is awake and oriented but agitated and unable to report
about the accident. She is reporting severe pain in her face, neck and right arm. Her voice is raspy and
she says she is cold and shivering. Hair on her head and arms are singed. She has areas of redness,
waxiness and blisters covering her face, anterior neck, all of her right arm, chest, abdomen and anterior
surface of her left arm. VS: BP (thigh) 110/52, HR 132, RR 36. Medical history includes MI seven years
ago followed by chronic heart failure. Meds: Accupril 20mg PO QD, Lasix 20mg PO QD, Pravachol
40mg PO QD.
1. For each of the following nursing interventions, write a number in the blank to indicate
the appropriate order of the tasks.
a. Administer IV Morphine: 6
b. Administer IV fluids: 5
c. Administer 100% humidified O2: 1
d. Administer prophylactic tetanus toxoid: 9
e. Establish IV access: 2
f. Initiate appropriate wound care: 8
g. Insert indwelling urinary catheter: 7
h. Prepare for endotracheal intubation: 3
i. Estimate body surface area burned: 4
2. As J.L. is in the ED the nurse is closely assessing each of the following. What abnormalities
in each area would be of high concern for the nurse? Why?
a. Urinary output-Decrease urinary output is commonly caused by decreased cardiac output.
/
