NU263 Unit 8 Burn and Inhalation Injury Paper Example

A Saturation of 98 Percent That Could Not Be Trusted: A Burn Resuscitation Paper on a Composite 51-Year-Old Man With Inhalation Injury and Thirty Percent Body Surface Burns, Bracketing the First Day's Estimate and Spending Most of Its Length on Days Two and Three

[Student Name]

Purdue University Global

NU263: Medical-Surgical Nursing III

Unit 8 Burn Resuscitation Paper

[Instructor Name]

[Date]

The patient is composite; values, volumes and times are bracketed where illustrative, and airway, fluid and surgical decisions belong to the burn team.

Arrival

[Mr. J.], composite, 51, [86] kg, was carried out of a burning house after about [ten] minutes inside. Burns: deep partial and full thickness to the chest, both arms and the face, estimated at [30] percent of body surface. He is hoarse, coughing black sputum, with singed nasal hair and soot in the mouth. Heart rate [118], blood pressure [132/80], respirations [26], pulse oximetry [98] percent on a non-rebreather mask, confused.

An Oximeter Fooled by Smoke

Carbon monoxide binds hemoglobin far more tightly than oxygen does, and a standard pulse oximeter cannot tell carbon monoxide-bound hemoglobin from oxygen-bound hemoglobin. A reading of [98] percent can coexist with severe tissue hypoxia. His co-oximetry on an arterial sample showed carboxyhemoglobin of [24] percent (Walker et al., 2015). High-flow oxygen shortens the time carbon monoxide stays bound.

The most reassuring number in the bay was the least trustworthy, because the machine counted carbon monoxide as oxygen.

Cyanide Suspected, Not Proven

House fires release cyanide from burning plastics and furnishings. His lactate was [9] mmol/L and he remained confused despite oxygen. Cyanide levels take hours to return, so the team gave hydroxocobalamin as ordered on suspicion, based on the setting, lactate and mental status (Walker et al., 2015).

An Airway Closing by the Hour

Hoarseness, soot and facial burns signal injury to the upper airway, which swells over the hours after the burn and further as fluid is given. An airway that is open at arrival can become impossible to intubate later. The team intubated him at [hour 1] while it was still straightforward.

A First-Day Number in Brackets

The Parkland formula estimated [4] mL × [86] kg × [30] percent = [10,320] mL of crystalloid over the first day, with the first half planned across the opening eight hours counted from the burn itself. That figure only set the starting rate. Each hour the rate was then adjusted against his urine, aiming for about [43] mL an hour at his weight (Harding et al., 2023).

Day Two and the Rising Total

By hour 24 he had received [14,600] mL, well above the estimate. Inhalation injury often increases fluid needs, and so did his deep burns. But the more fluid given, the greater the swelling everywhere. Burn patients have increasingly received far more fluid than formulas predict, a trend called fluid creep, linked to complications such as abdominal compartment syndrome and respiratory failure (Saffle, 2007). On day two the team added albumin as ordered to reduce the total crystalloid, and the nurse measured bladder pressure every [four] hours as a check on abdominal pressure.

A Chest That Could Not Expand

On day two his peak airway pressures rose from [28] to [40] with no change in settings, and his carbon dioxide climbed. The full-thickness burn around his chest had become a tight, inelastic shell. The surgeons performed escharotomies, incisions through the burned skin, at the bedside, and peak pressures fell to [30] within minutes.

Watching the Limbs

Both arms were burned all the way around. As the tissue under the burns swelled, it could squeeze the arteries in the same way the chest burn restricted breathing. The nurse checked pulses with a Doppler, capillary refill, color and warmth in both hands every hour and reported any loss of signal at once, since escharotomy of a limb is also urgent. Raising the arms on pillows above heart level helped limit the swelling in the hands.

Day Three

Fluid rate falling; urine output steady at [45] to [60] mL an hour; swelling at its peak but abdominal pressure stable; first excision and grafting planned. His family was updated twice daily.

The Family at the Door

His wife and adult son arrived at the burn unit in the first hour, smelling of smoke themselves. They were frightened by his swollen face and the tube. The nurse told them what to expect over the next two days: that the swelling would get worse before it got better, that this was expected and not a sign of failure, and that he would be kept sedated while his airway was protected. She asked whether either of them had been in the house, and arranged for his son, who had been, to be checked for smoke exposure himself.

Nursing Priorities Across Three Days

1. Airway and breathing: tube security as the face swells, airway pressures, carbon dioxide.

2. Circulation and fluids: hourly urine output, rate adjustment as ordered, total fluid tracked against the estimate.

3. Compartments: chest and limb circulation, bladder pressure.

4. Pain, temperature and infection: warm room, analgesia, wound care.

References

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Saffle, J. R. (2007). The phenomenon of "fluid creep" in acute burn resuscitation. Journal of Burn Care & Research, 28(3), 382-395. https://doi.org/10.1097/BCR.0B013E318053D3A1

Walker, P. F., Buehner, M. F., Wood, L. A., Boyer, N. L., Driscoll, I. R., Lundy, J. B., Cancio, L. C., & Chung, K. K. (2015). Diagnosis and management of inhalation injury: An updated review. Critical Care, 19, Article 351. https://doi.org/10.1186/s13054-015-1077-4