224048971 case-study-on-burns

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INTRODUCTION
A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. Burns that affect only the
superficial skin are known as superficial or first degree burns. When damage penetrates into some of the underlying layers, it is a
partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-
degree burn additionally involves injury to deeper tissues, such as muscle or bone.
The characteristics of a burn depend upon its depth. Superficial burns cause pain lasting two or three days, followed by peeling of
the skin over the next few days. Individuals suffering from more severe burns may indicate discomfort or complain of feeling
pressure rather than pain. Full-thickness burns may be entirely insensitive to light touch or puncture. While superficial burns are
typically red in color, severe burns may be pink, white or black. Burns around the mouth or singed hair inside the nose may indicate
that burns to the airways have occurred, but these findings are not definitive. More worrisome signs include: shortness of breath,
hoarseness, and stridor or wheezing.Itchiness is common during the healing process, occurring in up to 90% of adults and nearly all
children. Numbness or tingling may persist for a prolonged period of time after an electrical injury. Burns may also produce
emotional and psychological distress.
The size of a burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full thickness
burns. First-degree burns that are only red in color and are not blistering are not included in this estimation. Most burns involve less
than 10% of the TBSA.
There are a number of methods to determine the TBSA, including the "rule of nines", Lund and Browder charts, and estimations
based on a person's palm size. The rule of nines is easy to remember but only accurate in people over 16 years of age. More
accurate estimates can be made using Lund and Browder charts, which take into account the different proportions of body parts in
adults and children. The size of a person's handprint (including the palm and fingers) is approximately 1% of their TBSA.
Resuscitation begins with the assessment and stabilization of the person's airway, breathing and circulation. If inhalation injury is
suspected, early intubation may be required. This is followed by care of the burn wound itself. People with extensive burns may be
wrapped in clean sheets until they arrive at a hospital. As burn wounds are prone to infection, a tetanus booster shot should be
given if an individual has not been immunized within the last five years. In those with poor tissue perfusion, boluses of isotonic
crystalloid solution should be given. In children with more than 10-20% TBSA burns, and adults with more than 15% TBSA burns,
formal fluid resuscitation and monitoring should follow. The Parkland formula can help determine the volume of intravenous fluids
required over the first 24 hours. The formula is based on the affected individual's TBSA and weight. Half of the fluid is to be
administered over the first 8 hours, and the remainder given over the following 16 hours. The time frame is calculated from the time
at which the burn occurred, and not from the time at which fluid resuscitation was begun. Children require additional maintenance
fluid that includes glucose. Additionally, those with inhalation injuries require more fluid.
Early cooling (within 30 minutes of the burn) reduces burn depth and pain, but care must be taken as over-cooling can result in
hypothermia. It should be performed with cool water 10–25 °C (50.0–77.0 °F) and not ice water as the latter can cause further
injury. Chemical burns may require extensive irrigation. Cleaning with soap and water, removal of dead tissue, and application of
dressings are important aspects of wound care.
Common medications for burns are analgesic, antibiotics, antipyretics if there is fever, vitamin C to boost the patient’s immune
system and multivitamins.

Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small full thickness burn) should be dealt
with as early as possible. Circumferential burns of the limbs or chest may need urgent surgical release of the skin, known as
anescharotomy. This is done to treat or prevent problems with distal circulation, or ventilation. It is uncertain if it is useful for neck
or digit burns. Fasciotomies may be required for electrical burns.
PATIENT’S PROFILE
PATIENT’S INITIAL: O.F
AGE: 22
DATE OF BIRTH: April 10, 1992
GENDER: Male
BIRTH PLACE: Antipolo City
ADDRESS: Antipolo City
HEIGHT: 5’5
WEIGHT:73kg
DIALECT:Tagalog
CIVIL STATUS: Single
EDUCATIONAL ATTAINMENT: High School Graduate
RELIGION: Roman Catholic
NATIONALITY: Filipino
OCCUPATION: Construction Worker
CHIEF COMPLAINT: Electrical Burn
DATE OF ADMISSION: May 01, 2014
TIME OF ADMISSION: 12:51 PM
INITIAL DIAGNOSIS: Electrical Burn
SOURCE OF INFORMATION: Patient, Chart

NURSING HEALTH HISTORY
History of Present Illness
Few hours prior to admission, O. F was holding a rod and accidentally hit the open wire that causes his burn. Immediately
after the incident, his co-worker brought him to Saint Dominic Hospital but the institution has no Burn Unit, so they transferred him
at Philippine General Hospital unfortunately there was no Burn Unit again. There were no interventions done on both hospitals so
they transferred again at Jose R. Reyes Memorial Medical Center, where he is currently admitted.
History of Past Illness
Patient O.F. has no known allergy to any food or medications. He completed his vaccines or immunizations during his childhood
and there is a scar of BCG vaccine in his right deltoid. The patient experienced childhood illnesses such as cough and colds, chicken
pox and mumps. No past history of any confinement or hospitalization because of any diseases or vehicular accidents. He stated that
he is healthy and uses over the counter medications such as alaxan for pain, paracetamol for fever, solmux for cough and neozep for
colds. He does not use any vitamin supplement.
Family Health History
The patient is the second childamong his five siblings. No family history of hypertension, diabetes mellitus, drug addiction/drug
dependency, asthma and cancer. His parents are still alive and healthy according to the patient.

GORDON’S 11 FUNCTIONAL PATTERN
HEALTH PERCEPTION- HEALTH MANAGEMENT PATTERN
BEFORE HOSPITALIZATION
According to the patient being healthy is tantamount to being able to perform his role unaided and being strong. He stated that
he is compliant with regards to his health as he says “Kailangankongmagingmalakas, mahirapkasiangmaging construction worker”.
He also claims that whenever he experiences common diseases such as fever, cough and body ache, he uses over the counter drugs
such as alaxan for pain, paracetamol for fever and solmux for cough. Whenever he feels something wrong with his health, he usually
manages his condition at home and rarely goesfor consultation.
DURING HOSPITALIZATION
According to the patient he is no longer able to do all his routine activities due to his present disease condition. He also added that
his disease truly affected his activities of daily living.He is given antibiotics, pain reliever and multivitamins as prescribed by his
physician. His body parts that are affected are regularly cleansed and frequently changed the dressing.
NUTRITIONAL METABOLIC PATTERN
Patient eats three times a day with snacks in between. His breakfast usually composed of a cup of coffee, 1 to 2 cups of rice,
hotdog or fried egg. For his lunch and dinner he usually consumes 2 to 4 cups of rice, 2 to 4 glass of water and vegetable cooked in
fish sauce (dinengdeng). The patient prefers water and fruit juices for his beverage and he seldom eats meat. He drinks liquor
occasionally in a maximum of 1 bottle and he usually smokes 9 stick per day. He does not take any vitamin supplement. No difficulty
in chewing and swallowing. He weighs73 kg and stands approximately 5’5” tall.
Patient eats what the staff of the dietary department offered him which is a high protein diet. His regular breakfast is composed
of 1 piece of bread, boiled egg and 1 cup of rice. His lunch and dinner usually composed of meat or a piece of fried fish, 1 cup of rice
anda slice of fruit or a piece of banana. He usually drinks approximately 1.5 liters of water per day. He seldom drinks juice. No
difficulty in chewing and swallowing. He has difficulty in feeding himself by his own due to the discomfort he feels when moving.
ELIMINATION PATTERN
The patient stated that he usually urinates 3 to 5 times a day with an amount of approximately 700-1200 ml a day, with a light
yellow to amber colour and aromatic odor. No episodes of painful and difficulty in voiding. The patient regularly defecates once a
day with yellow -orange to light brown incolor, bulky in consistency and no difficulties in defecation. He does not use enema,
suppositories and laxative to aid in defecation.

Currently, the patient is catheterized. According to the patient he doesn’t feel any burning and painful urination. He stated
the his voiding and defecating habits, frequency and routine including the color and consistency of the feces and the color, odor of
the urine are the same as what he has before the hospitalization.
ACTIVITY- EXERCISE PATTERN
As a construction worker the patient need to be physically fit and he considered his work as an exercise because his work
includeslifting bricks, rods and mixing cements. According to him doing this work makes him feel better because it does not only
make him fit but it helps a lot in their financial needs. During his free time, he used to watch dramas over the television and play
basketball.
Due to this condition the patient cannot do his routine activities or exercises. He entertains himself by chatting to his
roommates, watching TV and listening to music.He is able to do his ADL’s such as eating, going to the comfort room for toileting and
self-care activities but he needs some assistance. Helies on hisbed almost all the time to have a sufficient rest to conserve his energy
but sometimes he perform active range of motion to prevent contractures.
SLEEP-REST PATTERN
Before hospitalization, the patient had 8 hours of sleep and he feels satisfied with those ample hours of sleeping. According
to him, “natutulogakomga 9 nggabipagnagsawanaakosapinapanuodkotaposgumigisingako at around 5 nangumagaparamagtrabaho”.
He doesn’t have difficulties or disturbances with regards to his sleeping pattern. He takes daytime nap during his free time. He does
not use any sleeping pills, no special rituals before sleeping. According to him he preferred to sleep with lights off and easily fall
asleep.
According to him, he sleeps most of the time in the hospital to divert the pain and to have enough rest but it is interrupted
due to an every hour vital signs monitoring and giving medications . He does not use any sleeping pills and no rituals to aid in
sleeping.
COGNITIVE- PERCEPTUAL PATTERN
The patient has no problem with his senses, can remember recent memories such as what is the content of her breakfast
today and he can remember remote memories such as who is the first female president of the Philippines. The patient stated that
he has no problem in perception of things, can reason out himself and happenings, he can think clearly and can decide critically
related situation. No episodes of forgetfulness and hearing or seeing things that are not seen by others.
The patient has no problem with his five senses. The patient is in pain with pain scale of 6/10. No changes in the cognitive
status and perception ability of the patient. According to him there are no changes as what he had before hospitalization and what
he has during hospitalization.
SELF PERCEPTION - SELF CONCEPT PATTERN
According to him, he considers himself as a strong and healthy person because he is able to perform his responsibilities as an
individual. He is satisfied on his body figure and appearance. He stated that he loves to chat with others and he rarely gets into
trouble or conflicts with other people. He prioritizes what his parent’s opinions on every matter.
The client had a multiple burn injuryon the posterior and anterior chest and abdominal area, left arm and both left and right
lower extremities; with dry and intact dressing and can’t move freely. He said that his disease condition affects him a lot. He thinks
that he is now unhealthy because he is not able to do the things that he wants to do. He thinks that because of his condition, he is a
burden in their family.
COPING - STRESS PATTERN

The patient manages stress in the work area by sleeping or listening to music. He rarely open work related stress to his family
because he does not want his family to worry. According to him sleeping gives him the time to think on what to do. When the stress
is somehow personal involving the family, then that is the time to talk together and settle the problem. He stated that during
decision making his parents do almost the final decision but sometimes he makes decisions by his own.
According to the patient this is one of the most severe stress he had encounter so far in his entire life because he cannot
help his family for their daily needs. The patient manages stress and boredom by chatting to the person near his bed (roommate),
but the most effective so far that can remove his stressis by sleeping or sometimes watching television.
ROLE-RELATIONSHIP PATTERN
According to the patient he is a supportive to his parents and siblings. He provides them the emotional and financial needs
they needed. He had never been into conflicts with his parents because as a son he needs to bend his head forward to his parents,
as a way of giving respect. According to the patient they don’t have any misunderstanding with his siblings.
According to him, he helps his family for their daily needs. He says that temporarily, he can’t perform his full duty as a
responsible son to his parents and a helpful brother to his siblings due to his condition.
SEXUALITY REPRODUCTIVE PATTERN
The patient is satisfied with his sexuality being a man. He believes that he fulfils the role of a man. According to him to be
able to provide for your own family and be independent in life is one of the characteristics of being a man. According to him he had
been circumcise at the age of 10 in their province. He has no known STDs and any reproductive related diseases.
The patient says being able to be strong despite what happened is still tantamount to being a great man.
VALUE BELIEF PATTERN
Patient is a Roman Catholic. He has a great faith in God. He seldom goes to church with his family but he often ask on his own
for the protection of his family. He believes that everything happens have a purpose.
According to patient, the condition he had now made his faith to Almighty God stronger and considers this as a test of life.He
prays more often to Him that he can recover faster and may that his family be safe always.

PHYSICAL ASSESSMENT
Date of Assessment: May 6, 2014
Time of Assessment: 6:00 PM
General Appearance:
The patient is dressed with patient’s gown, sitting on bed, conscious and coherent with ongoingvenoclysis of PLRS 1L
X30gtts/min at 150cc level infusing well at the right brachial, with Indwelling Foley Catheter connected to urine bag and with an
intact and dry dressings at the arm, trunks, leg and feet. His fingernails are well trimmed and kempt.
Mental Status:
The patient is oriented to time, place, and person. He maintained eye contact and very cooperative with the student nurses.
He talks in a clear, understandable and moderate tone of voice.
Vital Signs during Physical Assessment:
Temperature: 38.4° C
RR: 23 cpm
BP: 100/60 mmHg
PR: 96 bpm
AREA
ASSESSED
METHOD
USED
NORMAL FINDINGS ACTUAL FINDINGS REMARKS
SKIN
Color Inspection Varies from light to deep
brown (depending on
race)
Light to deep brown Normal
Uniformity Inspection Generally uniform except
in areas exposed to sun;
areas of lighter
pigmentation are palms,
lips, nail beds in dark
skinned people
Uniform, except in areas exposed to
sun
Normal
Integrity Inspection Intact skin 36% TBSA disrupted Due to electrical burn
Moisture Palpation Moisture in the skin folds
and axilla (varies with
environmental
Moisture in the skin folds and axilla ,
varies with environmental
temperature and humidity , feels
Normal

temperature and
humidity, body
temperature and activity)
feels smooth & firm with
even surface
smooth and firm with even surface.
Texture Palpation Feels smooth & firm with
even surface
Feels smooth and firm with even
surface
Normal
Skin
Temperature
Palpation Warm to touch Very warm to touch Increased temperature due to
pathophysiologic changes
caused by disruption of the skin
and alterations to the tissue
beneath the surface causing lose
of normal functioning of the skin
Turgor Palpation When pinched, skin
springs back to 1-2
seconds
Skin springs back 1 to 2 seconds when
pinched
Normal
Edema Palpation No edema Peripheral edema (on left hand) Decreased blood flow
Lesions Inspection No lesion and abnormal
discolorations
With lesion Due to wound burn
HEAD
Size and
circumferenc
e
Inspection Appropriate to body size
and age
Appropriate to body size and age Normal
Shape Inspection Round and symmetrical,
no bulging and swelling
Round and symmetrical, no bulging
and swelling
Normal
Hair Inspection Equally distributed Equally distributed Normal
HAIR
Color Inspection Depends on race Black Normal
Distribution Inspection Evenly distributed hair Evenly distributed hair Normal
Texture Palpation Silky, shiny, and resilient Silky, shiny and resilient Normal
Presence of
infestation
and flakes
Inspection ( - ) infestation no flakes (-) infestation no flakes Normal
SCALP
Symmetry Inspection Symmetrical Symmetrical Normal
Appearance Inspection Absence of seborrhoea
and lesions
Absence of seborrhoea and lesions Normal
FACE
Symmetry,
movements
Inspection Symmetrical features,
symmetrical at rest
Symmetrical features, symmetrical at
rest
Normal
Color Inspection Varies from light to deep
brown
Brown Normal
Presence of
facial
periorbitalede
ma
Inspection
Palpation
Absent Absent Normal
Distribution
of hair
Inspection Presence of beard
(for male)
Presence of beard
(for male)
Normal
EYEBROWS
Distribution Inspection Hair evenly distributed;
skin intact
Hair evenly distributed; skin is intact Normal
Alignment Inspection Aligned Aligned Normal
EYELIDS
Ability to
blink
Inspection Has the ability to blink
bilaterally: 15-20
blinks/min
Has the ability to blink bilaterally; 20
blinks/ minute
Normal
Surface
characteristic
Inspection Skin intact, no discharge,
no discoloration
Skin is intact, no discoloration, no
discharge
Normal

EYELASHES
Direction of
curl
Inspection Slightly curled outward Slightly curled outward Normal
Distribution Inspection Equally distributed Equally distributed Normal
EYES
Conjunctiva Inspection Pink palpebral conjunctiva Pink Normal
Sclera Inspection White White Normal
Cornea Inspection Transparent Transparent Normal
PUPILS
Color Inspection Black Brown Normal
Reaction to
light
Inspection PERRLA PERRLA Normal
Visual field Inspection When looking straight
ahead can see objects in
the periphery
When looking straight ahead can see
objects in the periphery
Normal
Visual acuity Inspection Able to read newspaper
with small fonts at a
distance of 14 inches
without the help of visual
aids (eyeglasses, contact
lenses)
Can read letters, the smallest font
size on his cell phone at a distance of
14 inches without any visual aids.
Normal
EARS
Symmetry in
size
Inspection Symmetrical to the head
and face. Equal in size.
Symmetrical to the head and face.
Equal in size
Normal
Color Inspection Same with the color of
the face
Same with the color of the face Normal
Presence of
cerumen,
lesions and
pus
Inspection Absence of cerumen,
lesions, pus
Absence of cerumen, lesions, pus Normal
Ability to hear Inspection Can hear sound (soft and
loud)
Can hear sounds soft and loud Normal
NOSE
Symmetry Inspection At midline of the face,
nares are symmetrical
At midline of the face, nares are
symmetrical
Normal
Color Inspection Same with the color of
the face
Same with the color of the face Normal
Discharge/
flaring
Inspection No discharge/ flaring No discharge and flaring Normal
Tenderness Palpation Not tender; no lesions Not tender; no lesions Normal
MOUTH
Lips Inspection Uniform pink color
(varies)
soft, moist and smooth in
texture
Uniform, pink in color, soft, moist and
smooth in texture
Normal
Ability to
purse lips
Inspection Can purse lips Can purse lips Normal
Buccal
mucosa
Inspection Moist, smooth, soft and
glistening, pink in color
Moist, smooth, soft and glistening,
pink in color
Normal
Teeth Inspection Teeth are white, no
tartars , no dental caries,
complete set of adult
teeth(32)
With dental caries
( 2 molars)
Due to poor hygiene
Gums Inspection Pink in color, moist and
firm
Pink Normal
Tongue Inspection Freely moving; centered
roughened from papillae,
no lesions
Freely moving; centered roughened
from papillae, no lesions
Normal
Uvula Inspection Uvula is positioned in the
midline
Uvula is positioned in the midline Normal

NECK
Position Inspection Centrally located between
the shoulders
Centrally located between the
shoulders
Normal
Mobility Inspection Can move spontaneously
in all directions
Can move spontaneously in all
directions
Normal
Lymph nodes Palpation No tenderness or
inflammation present; no
pain during palpation
No tenderness or inflammation
present; no pain during palpation
Normal
THORAX AND LUNGS
>Posterior
Thorax
Symmetry
Inspection Chest symmetric in size Chest symmetric in size Normal
Scapula Inspection Symmetrical Symmetrical Normal
Spinal column Inspection Straight; vertically aligned Straight; vertically aligned Normal
Chest wall Inspection Intact; no tenderness; no
masses
Intact, no tenderness, no masses Normal
Chest
expansion
Palpation Full and symmetric chest
expansion
Full and symmetric chest expansion Normal
Anterior
Thorax
Symmetry
Inspection Chest expands
symmetrically during
respiration; effortless
respiration
Chest expands
symmetrically during respiration;
effortless respiration
Normal
Breathing
pattern
Inspection No difficulty
Breathing
No difficulty
Breathing
Normal
Rate Inspection 12- 20 cpm 23 cpm
Rhythm Inspection Regular Regular Normal
Breath
sounds
Auscultation Bronchovesicular breath
sounds
Bronchovesicular breath sounds Normal
HEART
Cardiac rate Auscultation 60-100bpm 91bpm Normal
Heart sounds Auscultation No murmurs No murmurs Normal
ABDOMEN
Skin condition Inspection Brown or follows general
body color
Follows general body color Normal
Lesions and
discolorations
Inspection No lesion or discoloration Wound on the left side of the
abdomen
Due to electrical burn
Integrity Inspection Intact skin Wound on the left side of the
abdomen
Due to electrical burn
Abdominal
contour
Inspection Flat, round, scaphoid Flat Normal
Umbilicus Inspection Midline & inverted , no
sign
of discoloration
Midline & inverted , no sign
of discoloration
Normal
UPPER EXTREMITIES
Skin color Inspection Tan; depends on race Brown Normal
Skin
characteristic
Inspection
Palpation
Warm and equal
temperature; no edema
,tenderness and bruises
Very warm temperature, with wounds
and edema on left hand
Increased temperature due to
Symmetry Inspection Symmetrical Left hand slightly bigger Decreased blood flow
Hair
distribution
Inspection Evenly distributed Evenly distributed Normal
Lesion and
discoloration
Inspection Absence of lesion and
discolorations
With lesion on the left arm and palm Due to wound burn
ROM Inspection Full ROMwithout pain Full ROMwithout pain Normal

LOWER EXTREMITIES
Skin color Inspection Tan; depends on race Brown Normal
Skin
characteristic
Palpation Warm and equal
temperature; no edema
and tenderness and
bruises
Very warm temperature and wounds Increased temperature due to
Symmetry Inspection Symmetrical Left leg is slightly bigger than the
right leg
Decreased blood flow
Hair
distribution
Inspection Evenly distributed Evenly distributed Normal
ROM Inspection Full ROMwithout pain Limited ROM on the left leg and foot Due to pain caused by wound
burn
NAILS
Shape Inspection Convex curvature; angle
of nail plate about 160
Convex curvature; angle of nail plate
about 160
Normal
Texture Palpation Smooth Smooth Normal
Color Inspection Highly vascular and pink
in light-skinned clients;
dark-skinned clients may
have brown or black
pigmentation in
longitudinal streaks
Pink Normal
Tissues
surrounding
nails
Inspection Intact epidermis Intact epidermis Normal
Capillary Palpation Prompt return of pink or
usual color generally less
than 3 seconds
NEUROLOGIC
Level of
consciousness
Inspection 15, alert and completely
oriented; express ideas
logically
15,responds to stimuli including
verbal commands
Normal
MENTAL
STATUS:
ORIENTATIO
N
Time Inspection Oriented Oriented Normal
Place Inspection Oriented Oriented Normal
Person Inspection Oriented Oriented Normal
CEREBELLAR
FUNCTION
Posture Inspection Good posture Slouch posture Due to pain
Motor
function
Inspection Good Decreased Due to pain
Balance Inspection Good balance Uncoordinated Due to pain
Muscle tone Inspection Normal muscle tone Decreased Due to pain
Speech Inspection Has the ability to
comprehend spoken and
written language, speech
is fluent
Has the ability to comprehend spoken
and written language (Tagalog,
English)
Normal

ANATOMY AND PHYSIOLOGY
The integumentary system consists of the skin, hair, nails, the subcutaneous tissue below the skin and assorted glands.The most obvious
function of the integumentary system is the protection that the skin gives to underlying tissues. The skin not only keeps most harmful
substances out, but also prevents the loss of fluids.
A major function of the subcutaneous tissue is to connect the skin to underlying tissues such as muscles. Hair on the scalp provides
insulation from cold for the head. The hair of eyelashes and eyebrows helps keep dust and perspiration out of the eyes, and t he hair in our
nostrils helps keep dust out of the nasal cavities. Any other hair on our bodies no longer serves a function, but is an evolutionary remnant.
Nails protect the tips of fingers and toes from mechanical injury. Fingernails give the fingers greater ability to pick up small objects.
There are four types of glands in the integumentary system:
Sudoriferous glandsare sweat producing glands. These are important to help maintain body temperature.Sebaceous glands are oil
producing glands which help inhibit bacteria, keep us waterproof and prevent our hair and skin from drying out. Ceruminous gl ands produce
earwax which keeps the outer surface of the eardrum pliable and prevents drying. Mammary glands produce milk.
Skin is an organ of the integumentary system made up of a layer of tissues that guard underlying muscles and organs. It plays the most
important role in protecting against pathogens. Its other main functions are insulation and temperature regulation, sensation and vitamin D
and B synthesis. Skin is considered one of the most important parts of the body.
Skin has pigmentation, melanin, provided by melanocytes, which absorbs some of the potentially dangerous radiation in sunlight.
The skin has two major layers which are made of different tissues and have very different functions.

Skin is composed of the epidermis and the dermis.The outermost epidermis consists of stratified squamous keratinizing epithelium with an
underlying basement membrane. It contains no blood vessels, and is nourished by diffusion from the dermis. The main type of c ells which
make up the epidermis are keratinocytes, with melanocytes and Langerhans cells also present. The epidermis can be further subdivided
into the following strata (beginning with the outermost layer): corneum, lucidum, granulosum, spinosum, basale.
The dermis lies below the epidermis and contains a number of structures including blood vessels, nerves, hair follicles, smooth muscle,
glands and lymphatic tissue. It consists of loose connective tissue otherwise called areolar connective tissue - collagen, elastin and reticular
fibers are present. Erector muscles, attached between the hair papilla and epidermis, can contract, resulting in the hair fiber pulled upright
and consequentially goose bumps. The main cell types are fibroblasts, adipocytes (fat storage) and macrophages.
The dermis is made of an irregular type of fibrous connective tissue consisting of collagen and elastin fibers. It can be split into
the papillary and reticular layers. The papillary layer is outermost and extends into the epidermis to supply it with vessels. It is composed of
loosely arranged fibers. Papillary ridges make up the lines of the hands giving us fingerprints. The reticular layer is more dense an d is
continuous with the hypodermis. It contains the bulk of the structures (such as sweat glands). The reticular layer is compose d of irregularly
arranged fibers and resists stretching.
The hypodermis is not part of the skin, and lies below the dermis. Its purpose is to attach the skin to underlying bone and muscle as well as
supplying it with blood vessels and nerves. It consists of loose connective tissue and elastin. The main cell types are fibroblasts,
macrophages and adipocytes (the hypodermis contains 95% of body fat). Fat serves as padding and insulation for the body
PATHOPHYSIOLOGY

LABORATORY RESULTS
May 01, 2014
TEST NORMAL VALUES RESULTS INTERPRETATION
Hemoglobin 14.1 – 18.1 g/dl 6.7 Decrease due to blood loss.
Hematocrit 43.5 – 53.7 47 % Normal
RBC 4.7 – 6.1 x 108/uL 5.48 Normal
MCV 80 – 97 fL 86.1 Normal
MCH 27 – 31 pg 30.6 Normal
MCHC 31.8 – 35.4 35.5 Normal
WBC 4.6 – 10. 2 x 103/uL 23.95 Increase may be due to infection.
Differential count

Neutrophils % 37- 80 82.4 Increase due to possible infection
Lymphocytes % 10- 50 8.6 Decrease due to possible infection
Basophils % 0-1.5 .2% Normal
Monocytes 0-14 8.2 Normal
Eosinophils 0-7 0.6 Normal
Platelet 130-140 x 103/uL 297 x 103/uL Normal
May 01, 2014
URINALYSIS
TEST NORMAL VALUES RESULT INTERPRETATION
Color Yellow/amber Yellow Normal
Characteristics clear clear Normal
PH 5 – 6 5.5 Normal
Specific Gravity 1.015– 1.030 1.025 Normal
Protein Negative +1 Abnormal may be to increased systemic capillary
permeability
RBC 0 – 2/hpf 2-4/hpf Normal
WBC 0-5.hpf 0-1 Normal
May 01, 2014
Creatinine 45-104 umol/L 79.5 Normal
Sodium 135-143 mmol/L 138.40 Normal
Potassium 3.4- 4.82 2.9 Normal
May 02,2014
Potassium 3.4- 4.82 3.99 Normal
DRUG STUDY

NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
“
masakityungmgapasoko
kungnagagalawo
napwepwersa”,as
verbalizedbythe
patient.
Objective:
 Painscale of
6/10 ( 10 being
the highest
painand 1
beingthe
lowest).
 Facial grimacing
whenburnarea
istouch or
Alterationinbody
comfort:Acute pain
relatedtotraumatized
nerve endingsecondary
to electrical burn.
After30 minutesof
nursingintervention
the patientwill
reportrelievedof
painfrom 6/10 to
2/10 or below.
Providedcomfort
measuressuchas touch
and offeredcompany.
Instructedinand
encourageduse of
relaxationtechniques
such as focused
breathingordeep
breathingexercisesand
listeningtolight.
Promotedless
stimulationinthe
affectedside during
vital signsmonitoring.
To promote non
pharmacological pain
management.
To distract attentionand
reduce tension.
To decrease frictionor
pressure appliedonthe
affectedarea.
Goal met:
After30 minutesthe
patientverbalizeda
decreasedinpain
scale from6/10 to
2/10 as evidencedby
decrease inepisode
of facial grimacing.

whenhe
moves. AdministeredTramadol
50 mg/ IV as ordered.
For past relievedof pain.

224048971 case-study-on-burns

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