Need help with HW!

RNNPICU, BSN, RN · Apr 22, 2017

Wow, I can't believe you have to include humor? Sorry. Include the Parkland formula. In the ICU I have done burn care on kids. All of the burn cases I have seen are just sad, the worst one was a child that had been burned by their parent. Nothing funny about burns

Here.I.Stand, BSN, RN · Apr 22, 2017

Thank you guys for your responses. as for the complications, what is the most likely complication for this kind of patient? is inhalation injury possible?
After maintaining pt's ABCs. what do we do next? How would doctor's orders look like? do we need BMPS? ABGs?

Yes, absolutely inhalation injury can happen with burns to the face -- hence the need to protect their airway. And so yes, ABGs will be important.

Yes too on the BMPs. Think about all of the functions our skin serves: aids in thermoregulation (along with the subq fat), is a barrier against pathogens, is a sensory organ. Now think about losing 40% of it. What could happen without that large amount of skin, based on what the skin does? Also, that size of wound will allow lots of fluids and electrolytes to leak onto the Chux. See then why BMPs would be useful? What can happen with low concentrations of electrolytes? With hypovolemia?

Thinking more long-term, nutrition. What might a pt need to heal a 40% TBSA wound?

after intubation he was given paralytics.

Just an FYI about this detail -- paralytics are guven before the intubation and after a sedative. Post-intubation they are used in severe pulmonary failure (think ARDS), for high ICPs in neurotrauma pts not responsive to other interventions, to prevent shivering with therapeutic hypothermia...that kind of thing. But as part of the intubation, it is given so the pt can't struggle and delay the airway/injure themselves. Sedative is given first though -- how terrifying would that be, to be aware and not even able to breathe or blink??

vanilla bean · Apr 22, 2017

yes i do! I can make up my own patient and own story. i could use a real story but not required.

OK, I completely agree with the group consensus on here that there is no way to make a realistic scenario about a burn victim humorous. If it's important to you to try to fulfill this part of the assignment, then why not consider creating a fictitious scenario with a funny premise like a cartoon would do? Set the scene for your case study/victim with a little back story about, perhaps, two feuding neighbors where something goes terribly wrong in their feud and one of them ends up badly burned (by fireworks or dynamite), then reveal them to be Wile E Coyote and the Roadrunner, or Cruella de Vil tried to trap dalmation puppies in a room and burn the house down and ends up badly burned herself, or Gargamel tries to burn down a smurf village... you get the idea. You could then accurately present pathophysiology and therapies and conclude the story with some sort of ironic or funny ending.

bgxyrnf, MSN, RN · Apr 22, 2017

In the first few hours after the burn, one big risk is compartment syndrome - particularly in circumferential burns.

Also, anything applied circuferentially to the patient -- ET ties, ID bands, etc -- can become so tight as to impair circulation.

Very quickly post-intubation, the patient needs a G tube... and NG is preferred because the tube will remain long after the patient is extubated and awake... it needs to be dropped quickly, before the swelling makes it impossible.

The patient's eyes need to be protected if they've been exposed.

Renal failure is a huge risk due to the massive amounts of protein that will end up in the urine... Fluid resuscitate to adequate urinary output (~100 cc/hr)

Infection, infection, infection... strict reverse isolation.

And more so than most other patients... protect that endotracheal tube... if it gets pulled somehow, the patient quite likely will die because their airway has swollen shut.

Nothing even remotely humorous pertaining to burns.

Nursing_excellence, ADN, BSN · Apr 22, 2017

OK, I completely agree with the group consensus on here that there is no way to make a realistic scenario about a burn victim humorous. If it's important to you to try to fulfill this part of the assignment, then why not consider creating a fictitious scenario with a funny premise like a cartoon would do? Set the scene for your case study/victim with a little back story about, perhaps, two feuding neighbors where something goes terribly wrong in their feud and one of them ends up badly burned (by fireworks or dynamite), then reveal them to be Wile E Coyote and the Roadrunner, or Cruella de Vil tried to trap dalmation puppies in a room and burn the house down and ends up badly burned herself, or Gargamel tries to burn down a smurf village... you get the idea. You could then accurately present pathophysiology and therapies and conclude the story with some sort of ironic or funny ending.

That is a really great idea! I would do the smurf village thing. I have two more weeks before my presentation so I have enough time to prepare for my presentation.

Thank you guys for all your help. I'm only in my first year so i dont really have much clinical exposure. And you know how different they are in real life versus behind the screen and by reading.

Nursing_excellence, ADN, BSN · Apr 22, 2017

is parkland formula the one recommend by ABA?

what i have is 4ml/kg/%TBSA

1/2 is given in 8h

the other half is given in next 16 h

Why is there a 900 seconds wait to comment? :wtf:

Julius Seizure · Apr 22, 2017

is parkland formula the one recommend by ABA?
what i have is 4ml/kg/%TBSA
1/2 is given in 8h
the other half is given in next 16 h
Why is there a 900 seconds wait to comment?

Yes this is the parkland formula. %TBSA is based on only the 2nd and 3rd degree burns, dont include the BSA of 1st degree burns.

Julius Seizure · Apr 22, 2017

It seems a shame to give nursing students a project where a large aspect of it is to add humor to their presentation about something like this. Sure, gallows humor is a part of being a nurse but as a nursing student the focus should be on learning how to care for ill and vulnerable patients. Shouldn't the students time be spent on learning disease processes and interventions, not how to make funny stories about sick people?

Maybe I take being a student too seriously?

TriciaJ, RN · Apr 22, 2017

i understand what you mean. i was in tears watching cases of burn patients. and yeah im almost done with my case study. i jsut dont know how or when i can incorporate humor in my presentation.

You can't. My dad had the best sense of humour in the world. But when he went into septic shock and died from his burn injuries, he wasn't his witty self. The rest of us were at a bit of a loss as well.

dishes, BSN, RN · Apr 22, 2017

The point of the presentation is to make it interesting so that the audience will be engaged, you do not HAVE to use humour to make a presentation engaging and interactive. You can make the presentation fun by creating a game for the audience to participate in such as; Millionaire game (see freenursetutor.com for examples) or create a Jeapordy style game, play the game immediately after your presentation so that the information is fresh and the students will know the answers.

saskrn · Apr 22, 2017

Hello!
Hi, I'm supposed to make a case study presentation about burn victims with complications! I would love to hear your experiences about burn complications and how you handled the situations. The hardest part of this assignment is that we should use humor in presentation and that is where I am gonna need help.
Any help would be appreciated. For those who's gonna call me lazy student, you're not being helpful. I do my readings I just want to come up with a realistic story and one with HUMOR..

I almost died from playing with matches and lighting myself on fire when I was a child. I wasn't supposed to live, lost a breast, lost the ability to have children, and I'm still dealing with the ramifications and 3rd degree scars 44 years later. My first hospital stay was 2 years long, and there were countless stays and surgeries for many years afterwards, and still ongoing.

Please tell your instructor/school that there is NOTHING humorous about a burn patient. Or better yet, let ME tell them.

I realize that I am very biased, but the HUMOR component of this assignment seems insulting, unprofessional and irrelevant.

Trauma Columnist · Apr 22, 2017

Moved to another forum for more answers.