AUBREY ROSE A.

VIDON

BSN 3Y1 - 2

Create a conceptual map using the case scenarios as guide. Conceptual map should include
pathophysiology, medical diagnosis, signs and symptoms, and risk factors, if any. Nursing diagnosis, nursing
interventions, medical management (medication and procedures), expected outcomes.

Abe, a 14-year old boy who stoked a fire in a wood burning stove and was hurt by a subsequent explosion. He was
transported to the local burn ICU (BICU). He sustained an 82% total body surface area (TBSA) thermal burn. Abe’s
burns included bilateral full thickness circumferential burns to his legs and feet, arms, and hands, genetalia and
deep partial thickness burn to his head and anterior trunk.

Before Abe’s arrival to the BICU, the medical team stabilized Abe by initiating cervical spine precautions,
endotrachealy intubating him, and providing fluid resuscitation and sedation and analgesia with I.V. propofol and
morphine via two large-bore peripheral venous catheters.

Once Abe was admitted to the BICU, a right brachial arterial line was placed along with right internal jugular central
venous catheter. Initial I.V. fluid resuscitation was calculated based on Abe’s weight of 79 lbs. (36 kg), a urinary
catheter was placed, and a tetanus injection was administered. The morphine drip was discontinued, an I.V.
ketamine drip was started, and wound care began.

Upon reassessment, the nursing staff noted that Abe’s pedal and radial pulses were absent bilaterally, and
emergent bilateral upper and lower escharotomies were performed. At this point of care, Abe’s clinical status was
critical but stable.

After escharotomies were completed and Abe was stable and enteral nasogastic tube was placed in the left nares
and feedings began. Abe received standard wound dressing with silver sulfadiazine until his burn wounds were
grafted (with the exception of his genital burns).

Abe experienced a slow recovery. Within 72 hours of his admission to the BICU, the first surgical excision and
grafting on Abe’s hands, feet, head, and neck were completed. His anterior trunk also required surgical excision
and grafting at this time. Nurses explained to Abe’s parents that further excisions and grafting procedures would
be performed until all of Abe’s burn wounds were closed. The excisions and grafting on Abe’s arms and legs
were completed over the next month. A conservative approach was employed to treat Abe’s genital burn. Initially,
all obvious retained material (loose debridement) and contaminated remnants of Abe’s clothing were removed.

Next, the BICU nurses completed a prolonged cooling down procedure with water. During the duration of Abe’s
admission, topical antibiotic ointments such as Mupirocin were impregnated into gauze and applied over the
perineal area and changed every bowel movement. Scheduled as P.R.N. cleansing as accomplished using 4%
chlorhexidine skin wash.

This approach led to the successful healing of Abe’s genital burns. Abe was weaned from the ventilator on the third
attempt during his second week in the BICU, and the solid foods were introduced gradually. 
 Abe, a 14-year old boy who stoked
a fire in a wood burning stove and
CONCEPTUAL MAP was hurt by a subsequent
explosion.

BURN
INJURY

PATHOPHYSIOLOGY
Tissue destruction results from
coagulation, protein
denaturation, or ionization of
cellular components.
Local response - Burns that do
not exceed 20% of TBSA
according to the Rule of Nines
produces a local response.
Systemic response. Burns that
exceeds 20% of TBSA according
to the Rule of Nines produces a
systemic response.
The systemic response is caused
by the release of cytokines and
other mediators into the
systemic circulation.
The release of local mediators
and changes in blood flow, tissue
edema, and infection, can cause
progression of the burn injury.
MEDICAL DIAGNOSIS SIGNS AND SYMPTOMS
(TBSA) thermal burn  Blisters.
 Pain (The degree of
Genital Burn pain is not related to
the severity of the burn,
as the most serious
burns can be painless.)
 Peeling skin.
 Red skin.
 Shock (Symptoms of
shock may include pale
and clammy skin,
weakness, bluish lips
and fingernails, and a
drop in alertness.)
 Swelling.
 White or charred skin.
RISK FACTORS
 There are a number of
other risk factors for
burns, including:
 occupations that
increase exposure to fire;
 poverty, overcrowding
and lack of proper safety
measures;
 placement of young girls
in household roles such
as cooking and care of
small children;
 underlying medical
conditions, including
epilepsy, peripheral
neuropathy, and physical
and cognitive disabilities;
 injury.
alcohol abuse and
smoking;
 easy access to chemicals
used for assault (such as
in acid violence attacks);
 use of kerosene
(paraffin) as a fuel source
for non-electric domestic
appliances;
NURSING DIAGNOSIS
Impaired gas exchange related to
carbon monoxide poisoning, smoke
inhalation, and upper airway
obstruction.
Ineffective airway clearance related
to edema and effects of smoke
inhalation.
Fluid volume deficit related to
increased capillary permeability and
evaporative losses from burn wound.
Hypothermia related to loss of skin
microcirculation and open wounds.
Pain related to tissue and nerve
Anxiety related to fear and the
emotional impact of burn injury.
NURSING
INTERVENTIONS
- Check/Monitor the vital signs
- Monitor the pedal and radial
pulses
- Provide immediate fluid
resuscitation and sedation and
analgesia with I.V
-Administered a tetanus injection
urinary catheter
- Perform wound care
- Perform enteral nasogastric
tubing
MEDICAL EXPECTED OUTCOMES
MANAGEMENT
- Those approaches led
- An I.V. ketamine drip was to the successful
started, and wound care.
healing of Abe’s genital
- Escharotomies burns. Abe was weaned
from the ventilator on
- Surgical excision and grafting
on Abe’s hands, feet, head, and the third attempt
neck
during his second week
- A prolonged cooling down in the BICU, and the
procedure with water solid foods were
introduced gradually.
- Topical antibiotic ointments
such as Mupirocin were
impregnated into gauze and
applied over the perineal area
and changed every bowel
movement.

 inadequate safety
measures for liquefied
petroleum gas and
electricity.

OTHER NURSING
INTERVENTIONS:

 Promoting Gas
Exchange and Airway
 Minimizing Pain and
Anxiety.
 Monitoring and
Managing Potential
Complications.
 Restoring Normal fluid
Balance. Clearance.
 Restoring fluid and
Electrolyte Balance.
 Maintaining Normal
Body Temperature.