Question about a pt I had with burns

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Specializes in Cath Lab, OR, CPHN/SN, ER.

Hello! I helped care for a patient this week in clinicals, and she had second degree burns over on her arms and scalp, roughly 6% TBSA. She was involved in a house fire, and was burned trying to save a loved one, in which she was unsuccessful. I saw her the first day (one day post burns), and she seemed very flat, but we could get an occasional smile out of her. I put her with an awesome student nurse, because I thought the SN really has the personality to help her heal mentally (or at least get her on the track to healing). I came in the next morning to get report from the charge nurse (I was team leader for two students, two RN's, and 8 patients this week...we're doing leadership clinicals). The leaving CN reported she went psychotic during the night. Trying to climb over bed rails, refusing treatments, and combative. They were able to sedate her with 5mg haldol, and had orders for restraints if needed. I also found out then she has a significant psychiatric history, and was released last week from a mental health care facility (reason for admission then is unknown to me).

Ok, now to the questions! Is this a common thing you've seen with post-traumatic injuries? How do you handle it if it occurs?

Thanks in advance for your comments! -Andrea

PS- There have been several structure fires in the region lately, and tried to research this particular event, and was unable to find info on it, but did find info on other fires. Please do not assume you know who I am talking about... So sad that this is happening so frequently lately.

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Sometimes in burn pts, the worst is brought out in them. She problay blames herself for not being able to help out the loved one, psych should of been consulted that same day she came into your unit. At least to eval her and her condition, I do agree with you about putting a student nurse with her, but you just never know. We try not to treat our pts with Haldol to much only if they are REALLY BAD, the rest would of been in place cause you never know what she would do even with 5 mg of Haldol, psych is the best person to see her to find out what med she is on to cont them, and to make sure she is no harm to herself or others, where she may require a sitter. Where is was burned at is a pretty bad area, esp on the scalp, people have that image thing still, so she may still have a long, NO she will have a long road to recover, maybe a support group for her would help, but only thing you can do is reassure her that she is going to be ok, and that the burns will heal in time with the proper care. Sorry for your student and the nurse she went off on-Sara

Hello! I helped care for a patient this week in clinicals, and she had second degree burns over on her arms and scalp, roughly 6% TBSA. She was involved in a house fire, and was burned trying to save a loved one, in which she was unsuccessful. I saw her the first day (one day post burns), and she seemed very flat, but we could get an occasional smile out of her. I put her with an awesome student nurse, because I thought the SN really has the personality to help her heal mentally (or at least get her on the track to healing). I came in the next morning to get report from the charge nurse (I was team leader for two students, two RN's, and 8 patients this week...we're doing leadership clinicals). The leaving CN reported she went psychotic during the night. Trying to climb over bed rails, refusing treatments, and combative. They were able to sedate her with 5mg haldol, and had orders for restraints if needed. I also found out then she has a significant psychiatric history, and was released last week from a mental health care facility (reason for admission then is unknown to me).

Ok, now to the questions! Is this a common thing you've seen with post-traumatic injuries? How do you handle it if it occurs?

Thanks in advance for your comments! -Andrea

PS- There have been several structure fires in the region lately, and tried to research this particular event, and was unable to find info on it, but did find info on other fires. Please do not assume you know who I am talking about... So sad that this is happening so frequently lately.

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Specializes in Cath Lab, OR, CPHN/SN, ER.

The incident occured when we were not there. I decided to remove the student from the care of the patient, placed her with another patient nearby. I didn't feel it was safe for her. -Andrea

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Almost all of the patients we see on our burn unit are automatically set up with consults and visits from our psych team. A student nurse, or even a seasoned RN is not the person to handle this problem. They can, however, offer support. IMHO

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Ok, now to the questions! Is this a common thing you've seen with post-traumatic injuries? How do you handle it if it occurs?

Thanks in advance for your comments! -Andrea

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I really dont know if it is common.

I am a former burn patient. Burned 60% in a house fire trying to rescue my children. I was the only survivor.

I think personality has a great deal to do with dealing with tragedy. I am a firm believer that attitude is a choice.

Truly what it comes down to is making a choice to go on.

I died that day and I have become a differant person for it. Hopefully, a better one.

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