M3D1: Caring for a client with a burn injury Third-degree burns involve total epidermis and dermis destruction and, in some cases, tissue destruction (Hinkle & Cheever, 2014). The burn appears to be leathery, it has destroyed hair follicles and sweat glands. The patient may or may not suffer from pain (Hinkle & Cheever, 2014). What are the pathophysiological changes associated with severe burns? The pathophysiology of burns is characterized by a severe alteration of homeostasis due to an inflammatory reaction that results in rapid edema formation due to increased microvascular permeability, vasodilatation and increased extravascular osmotic activity due to heat effects and chemical inflammation mediators (BA, 2017). In the initial stage of the traumatic event histamine is released which produces many varied effects, including smooth muscle contraction in the lungs, stomach and blood vessel dilation, which increases permeability and thus reduces perfusion and oxygen delivery. Damage to the cell membrane from tissue damage is caused in part by oxygen-free radicals released from granular leukocytes and activates enzymes that catalyze prostaglandin precursor hydrolysis, resulting in rapid prostaglandin formation. Prostaglandin inhibits the release of norepinephrine into the bloodstream to work alongside epinephrine to give the body energy in a time of stressful situations, also known as the flight and fight response (Hinkle & Cheever, 2018). When Mr. Mason enters the Acute/ intermediate phase of his recovery what are three possible complications? As Mr. Mason enters the acute / intermediate phase of his recovery (48 to 72 hours after injury), he faces many complications, here are three as his nurse is thought to be the top three;1. Pulmonary Complications-Assessment and maintenance of respiratory status. The obstruction of the upper airway may be caused by edema and may take up to 48 hours to develop, and the assessment of stridor and dyspnea is a late sign of impending obstruction of the airway. In my experience, most burn patients with significant burns were intubated with an NG or OG tube that was placed to decompress the stomach, and then pulled after swelling began to recede, thus maintaining a patent airway. 2. Circulatory complications. Assessment and maintenance of fluid and electrolyte balance for a shift in potassium and sodium within the burn patient’s circulatory system. Capillaries recover their integrity after the burn for 48 hours or longer. To measure the output against intake, a Foley should have been placed, so fluid overload does not occur. Fluid overload can cause inadequate functioning of the kidneys and heart.3. Infection Complications-Infection prevention (wound care) to include; wound cleaning and debridement, antibacterial treatment (topical, IV medications), wound grafting, and application of dressings. Burn patients are at a higher risk for hospital-acquired infections, due to the loss of the skin acting as barrier protection from invading microorganisms and the necrotic tissue combined with serum proteins produce an ultimate environment for bacterial growth. Infections obstruct wound healing and promote excessive inflammation and further damage tissue and increase the risk of sepsis. For one of the complications what nursing diagnosis would you identify as a priority and why? Risk for Infection as evidence by the loss of intact skin related to third degree burn (Ladwig, G., Ackley, B., & Makic, 2017). In burn patients, the most common cause of morbidity and mortality is an infection. Burn infection management remains challenging due to burn injuries ‘ physiological characteristics. Many factors increase the risk of a burn patient developing infections and those that sustain severe burns have a high risk of developing sepsis. Burns is an appropriate site for bacterial multiplication such as Staphylococcus because it is often the most isolated pathogens in the community and in the hospital setting. (Hinkle & Cheever, 2018). The patient should have a clean environment. The isolated patient is protected against other patients. The surroundings and environment of patients should be free from contaminants that increase the risk of infection. Patients should be taught not to touch wound areas. Soiled linen should be regularly changed, which helps reduce infection. Using gowns, gloves, eye protection, and mask is used as barriers to support practices for infection control. Practices of hand hygiene should be followed. Regular baths of unaffected areas should also be done (Hinkle & Cheever, 2018, p. 1866). Fresh flowers, plants, and fresh fruit baskets are not allowed due to the risk of microorganism growth (Hinkle & Cheever, 2018, p. 1867). Care must be taken when routinely changing invasive lines and tubing. If they are no longer needed, catheters should be removed.

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