1) A 10-year-old girl admitted for severe second- and third-degree burns followi

Question

1) A 10-year-old girl admitted for severe second- and third-degree burns following her rescue from a burning house.

Angela, a 10-year-old female, was transported by ambulance to the emergency room after being rescued from her burning house. She was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, she had suffered severe burns and excessive smoke inhalation.

In the emergency room, Angela was unconscious. She had second-degree burns over 5% of her body and third-degree burns over 15% of her body -- both covering her thoracic and abdominal regions and her right elbow.

Her vital signs were quite unstable:

blood pressure = 55 / 35

heart rate = 210 beats / min

respiratory rate = 40 breaths / min.

She was quickly deteriorating from circulatory failure. Two IVs were inserted and fluids were administered through each. Her vital signs stabilized and she was transported to the pediatric intensive care unit (ICU).

Angela regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.

Angela began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers (bedsores). She lost 9 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse.

a) List the two layers of the integument and list the layer found below the integument that supports the structure and function of the integument

b) Describe the differences between first, second, and third degree burns.

c) What are two serious complications of third degree burns and what was Angela’s complication(s)?

d) If you were Angela’s parent what are some things you would want or need for support through this challenging time of recovery?

Explanation / Answer

Question A) List the two layers of the integument and list the layer found below the integument that supports the structure and function of the integument

Answer- Integument comprises of skin and its appendages. Skin consist of epidermis and dermis. Epidermis is the outer layer while dermis consist of 2 sections , papillary and reticular layers which contains connective tissue, etc etc including the sensory nerve endings. Dermis is mainly responsible for Structure, support and function of integument.

Question b) Describe the differences between first, second, and third degree burns.

Answer-

Superficial

Epidermis Only

Involves epidermis and part of dermis

Involves epidermis, dermis and some part of subcutaneous tissue

Red &

painful

site apperas white and chart

There may be less pain as nerve endings are damaged.

Its not surprising that Angela was having only minimal pain, as 15% burns were third degree and nerve endings must have been burnt hence less pain.

Question c) What are two serious complications of third degree burns and what was Angela’s complication(s)?

Answer) Complications are

1) Infections

2)Fluid loss and Hypovolemia

3) Hypothermia

4) Scarring

Compartment syndrome may also occur.

Angela had Fluid loss and Hypovolemia with BP 55/35 as an acute complication

While she also had secondary staphylococcal infection

and Scarring for which Grafting was done.

Question D)If you were Angela’s parent what are some things you would want or need for support through this challenging time of recovery?

Answer- As a parent emotional as well as physical support is needed.

Daily change of dressing is difficult for parents, nursing support is needed

Adequate diet and nutrition is needed.

Scarring may be emotionally challanging for Angela as well as parents, emotional support is needed.

Cosmotologist support and rehab support is also needed.

Difference between degrees of burns Type First degree Second Degree Third Degree Depth

Superficial

Epidermis Only

Involves epidermis and part of dermis

Involves epidermis, dermis and some part of subcutaneous tissue

Symptoms

Red &

painful

Swollen, red painful with blisters

site apperas white and chart

There may be less pain as nerve endings are damaged.

Healing Complete with no scar Some chances of scarring and graft may be needed Scarring always present, Surgical intervention needed.

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