Medical-Surgical Nursing 9th Edition by Sharon Lewis ,Shannon Ruff Dirksen,Margaret McLean Heitkemper,Linda Bucher

Exercise 1

Patient Profile
G.M., a 52-year-old married white man, arrives at the emergency department with burns to his face, neck, chest, right arm and hand, and right foot. He was burning brush on his farm when the fire went out of control. He has an 18-gauge IV with NSS running at 100 mL/hr, and he is receiving 100% humidified O₂ by mask.
Subjective Data
• Complains of blurry vision and trouble swallowing
• States his burns are painful and that he is scared
• States he is a "diabetic" and has "high blood pressure"
Objective Data
Physical Examination
• Is awake, alert, and oriented, but in some distress
• Eyes are red, irritated
• Voice is hoarse; nasal hair is singed
• Face is reddened with blisters noted on the nose and forehead
• Right arm, right hand, chest, neck, and right foot have shiny, bright red, wet wounds
• Patient is shivering
1. Priority Decision: What are the priorities of care in the prehospital environment How should his airway, breathing, and circulation be managed
2. Priority Decision: What factors place G.M. at high risk for an inhalation injury What priority interventions can be anticipated
3. What pain medications might be considered to relieve his pain
4. Which of the criteria for burn center referral does G.M. meet for admission to the hospital burn unit
5. What metabolic disturbances would be expected soon after G.M.'s admission Explain the physiologic basis for these changes.
6. How might G.M.'s co-morbidities affect his burn care and rehabilitation
7. What measures should be taken to support G.M.'s caregivers
8. Priority Decision: Based on the assessment data presented, develop three priority nursing diagnoses. Identify any collaborative problems.
9. Evidence-Based Practice: What are the most effective wound care strategies to manage G.M.'s burn wounds