Case Study: Burn Injury and Prognosis of Julie

Classification and Types of Burns and Measuring the Body Surface Area

Client Profile:

Julie is a 5 year old girl who lives in North Carolina with her parents and two siblings, a 3 year old brother and an 18 month old sister.  Her father works at a brokerage firm in Raleigh and her mother stays at home to care for the children.  Julie has never had any health problems other than occasional episodes of the common cold.

Case Study

Julie and her parents were returning home from a family visit 4 weeks ago when they were involved in a motor vehicle accident resulting in an explosion that caused their car to become engulfed in flames.  Julie’s mother, who was sitting in the back seat with the children, perished in the fire while trying to save the children.  Her father and 2 younger siblings escaped serious injury; however, Julie sustained 3rd degree burns over 80% of her body and was admitted to the Jaycee Burn Center.  She was intubated and placed on mechanical ventilation.  Currently she is no longer on mechanical ventilation and has a tracheostomy from which the nursing staff suctions thick green-yellow secretions every 2-3 hours.  Julie is receiving total parenteral nutrition (TPN) and intralipids (IL) through a central venous access.  Julie has severe wounds to her face, neck, left arm (necessitating the amputation of her left hand), left leg (necessitating a below-the-knee amputation), and back requiring extensive wound and graft care.  She is premedicated with intravenous Fentanyl prior to each dressing change, and this provides adequate pain management during these procedures.

Julie’s father visits frequently.  Julie is aware of the death of her mother and tends to be withdrawn and has had episodes of crying during which she could not be consoled.

Questions

1.Discuss the classifications and types of burns and how burns are measured to determine the percentage of body surface area involved.

2.Identify the negative and positive factors affecting Julie’s prognosis and her chances of survival.

3.Why is Julie at high risk for developing an infection?

4.Discuss Julie’s needs regarding her tracheostomy.  (discuss how you perform cleaning, care, and how you change trach ties)

5.Discuss TPN, including general care and special nutritional needs of children with burn injuries.

6.What is the relationship between Julie’s fluid and electrolyte balance and her burn status?

7.Discuss why Fentanyl has been chosen for pain management for Julie’s dressing changes.

8.Discuss how Julie’s level of growth and development could affect her ability to cope with her mother’s death.

9.What nursing intervention could help Julie cope with her hospitalization?

10.Discuss how you might feel in this situation if you were Julie’s father.