Case Study: Nursing Interventions for Pediatric Burn Injury (Bobby)

This case study focuses on the nursing care of a 10-year-old girl named Bobby who sustained burn injuries. The report details the assessment of the burn's body surface area using the Lund & Browder chart, and explains the rationale behind the use of Cephalosporin antibiotics. It covers wound assessment and treatment in the theatre, emphasizing significant elements like breathing, circulation, and pre-existing conditions. The study differentiates between superficial and deep partial burn wounds, highlighting the importance of fluid balance and the concept of third spacing. It also outlines nursing priorities, pain assessment methods, and the use of back slabs. The case study discusses important referrals, fluid balance, and priorities of care on the first day. Dressing preparation and noticeable concerns at home care, including dietary considerations, are also addressed. The case study is a comprehensive overview of burn injury management from a nursing perspective, offering valuable insights into the multifaceted care required for pediatric burn patients.

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Nursing
Case Study
3-21-2020

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In a study it was recorded that the parents are equally vulnerable with the post
traumatic situation due to the burn injury of their children. Burn is a major health concern as
it is related to deep pain and scary memory. Apart from these, burn care in not cost effective
both financially and physiologically as the child have their life lined up as it may lead to poor
quality of life (Pan, et al., 2015).
This report presents the case study of a 10-year-old girl named a Bobby. She got burn
injury and was referred to the hospital. This discussion talks about the various aspects of
medications and the nursing intervention that must be followed while handling a person with
the burn injury for effective recovery.
Percentage of the body affected in burn injury
According to Lund & Browder burn chart which helps in determining the surface area
which is affected by the burn. Since, it is known through the case study that Bobby is 10
years of age. Hence, applying the calculation from the Lund & Browder chart it can be said
that Bobby’s body is affect by 12.5 percent which can be divided into
1.25+1.25+1.5+1.5+2+2+3.25=12.5 percent (Varun, et al., 2015).
Why cephalosporin antibiotic?
Cephalosporin antibiotics is chosen because it is a broad-spectrum antibiotic which
works against several bacterial diseases that can be caused due to burn. It is having a
prophylactic action in preventing the disease. In a study no side effects were observed when
patient medicated with this drug in the burn. Parallelly it also resulted in improvement in
wounds sepsis (Ramos et al., 2017).
Wound assessment & treatment in theatre?
Theatre provides a safe and sterilized environment for the wound assessment and
treatment. Since, due to burn there are deep wounds which has significantly exposed the
maximum part of under-skin area which is more prone of getting infected due to bacteria. It is
highly recommended to perform the assessment and treatment in the theatre. Apart from that,
there are different tools and methods which are to be used in the treatment are exclusively
present in the theatre such as anesthesia, clear assessment of wound through light and
imagining instruments. This will help in relieving pain and helping the doctors or surgeons to
perform screening in more effective way (Benbow, 2016).
Significant elements while assessing a burn wound?
The significant laments that must be looked down while assessing the burns includes
screening of the upper dermis and epidermis of the effected region. Generally, these two
layers are affected even in the minor cases of burn. SO, they must be carefully observed.

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Assessment of breathing, circulation and the need of fluid must be done. Time of the burn
must be noted down. Pre-existing medication or therapy due to any other disease or
sensitivities must be observed before providing the medication for the burn. Body surface
area which is affected must be calculated on the basis of Lund & Browder chart for easy
treatment. Apart from these elements, look for blisters, redness, pain and other infections near
wound. Assessment of peripheral pulse must be performed using Doppler ultrasound. X-rays
can be performed to look for internal injuries if any. Moreover, basic checkups such as blood
pressure, pulse rate, fever are to be performed regularly to monitor the improvement (Kemp,
Jones, & Maguire, 2015).
Superficial partial vs deep partial burn wound.
Superficial partial burn wounds cause blistering around the effected region and are
very painful and tender. They generally are noted to be healed within three to four weeks
with minimum or no scars been left behind. Whereas deep partial burn wounds are dry in
nature and appears to be ivory or beige in colour. They take longer time to recover and leaves
some scar behind. In this case usually skin grafting is recommended by surgeon or
dermatologist (Crouzet, et al., 2015). Superficial burns are called first degree while partial
burns are called second degree. Partial-thickness burn wounds are more serious than
superficial burns because a deeper layer of the skin is burned in this case and are more
susceptible to get infected easily. If it affects more than 10 percent of the body, the patient
might get into shock due to lose of fluids from the affected area. However, it does not affect
muscle or bones (Summit Medical Group, 2015).
Bio brane
Bio brane is used to protect the wounded part of the skin due to injury or burns. Bio
brane is the synthetic wound dressing made of silicon film which has nylon fabric containing
the peptides derived from the collagen embedded in it. Its application is widely spread in
treating wounds of partial thickness burn injuries. It has been recorded that it decreases the
healing time as well as requirements of analgesics, when compare to traditional dressings
(Johandi, et al., 2018).
Priorities of care as a nurse
Priorities of care includes maintenance of respiratory and airway system as the injured
person feels suffocated. Screening of hemodynamics stability and proper circulation of blood.
Medication and practices to alleviate the pain as the damaged skin cause severe pain.
Emotional support to the patient and the family. Regular updates on the condition and
treatment. Patient is provided with humidified oxygen parallel with monitoring of ABG and

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carboxyhemoglobin level. Respiratory rhythms and pulse rates are to be checked regularly.
Regular intake of nutrient and minerals essential for the body and recovery must be checked
regularly. Monitoring pain and medication with analgesics and intravenous drugs should be
performed immediately. (Urden et al., 2019).
Assessment of Bobby’s pain.
Pain assessment is essential to get a clear idea about the condition of the patients.
Brun injuries are very painful and unbearable due to damage of skin and presence of edema.
The widely accepted pain assessment is done through the verbal report wherein the patients is
asked to rate their pain on a scale of 0 to 10 where 0 indicates no pain with gradual increase
in rate of pain experience till 10 which indicates severe pain. It must be done in interval of
one to four hours right from the admission till the discharge (The Royal Children's Hospital
Melbourne, 2020).
Back slab nursing concerns.
The back slab helps in providing the stabilization in the movement of the injured
moving parts of the body. It also helps in relieving the pain. It also helps in minimizing the
pressure on the effected area. It prevents the moisture as that may result in growth of bacteria
and hence can cause infection on unhealed wounds (Robinson,2017).
Important referrals
Multidisciplinary is recognized as an essential component in treatment and care of the patient
with burn injury. The referrals involve prior steps of communications with the administration
to identify and assess the condition is made and required meetings are scheduled for the
same. The physiotherapist, occupational therapist is also a vital part of this team. The
multidisciplinary team include physician, surgeon, nurses, ward boys. The surgeon performs
the surgery and operations. The physician diagnoses the underlined disease and prescribes
medicine. While the nurses handle the recovery period and additional help such as assistance
to the doctor and physician by taking care of the medical and clinical demands of patient. The
referral to the dentist to check for any damage in mouth or gums as she got burn injury on
face as well. Other referrals can be made to psychiatrist post recovery, if she finds herself in
depression due to the damage on the physical appearance. Hence, to prevent lack of self-
confidence that can results in trauma or depression condition which might cause urge of self-
harm as well (MED Burn, 2019).
Importance of fluid balance?
Fluid Balance is important because Bobby got Oedemic condition in her legs which means
that the body fluid has collected in the cavities of the tissues in the leg. The primary aim of

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fluid resuscitation and management in burn injuries helps in maintaining tissue perfusion in
the burn shock. In case of shock due to fluid imbalance, conditions like hypovolemia occurs
due to extravasation of fluid form intravascular compartment. The seeped-out fluid into the
interstitial space between cells causes the dehydration and electrolyte imbalance in the body.
Maintaining fluid will prevent the chances of shock and cardiac pressure fluctuation.
(Trejnowska, et al., 2019).
Concept of third spacing
Third spacing is the condition when excess body fluid moves from the intravascular
space which includes blood vessels into the interstitial space of the body which can also be
termed as the nonfunctional area between the adjoining cells. It can lead to severe
complications and problems including edema and hypotension. It can even lead to
hypovolemic shock. Increase in fluid volume can cause renal dysfunction and several other
complications are associated with it. (Holcomb, 2020).
Priorities of care on first day.
Monitoring vital urinary output, CVP cardiac output as well as recording levels of
serum electrolyte levels and recognize any imbalance. assessment pain level on a zero to ten
scale. Opioid analgesics are administered intravenously to sooth the pain. Providing
emotional support and reassurance to the patient and family. Monitoring intake of
intravenous and oral fluid which will help in balancing the body functioning. Ensuring intake
of proper calories and nutrients for better recovery and to see effective results of high dosage
medicines. Frequent assessment of discomfort and administration of anxiolytic medicine and
analgesics. Soothing and caressing the patient to make her feel better and comfortable. Music
therapy and visual entertainment can be provided to ease the pain. Distracting the patient
from the pain and the discomforting condition will make her feel relaxed. Regular
reassurance, motivational stories and caressing will calm down her mental stress and would
prevent traumatized situation (Marianne Belleza, 2017).
Dressing preparation with minimum harm
Dressing must be performed in every 24 hours or 48 hours. In this case the dressing is
done on the second day that means within 48 hours. So, it must be done carefully, since the
wounds are still painful and discomforting. To avoid infection risk and pain while dressing,
nurses must carry out the process patiently and calmly. Initially the silver dressing is
moistened with completely sterile water free of chlorine and other cleansing agents then the
new dressing on top of the wound is applied. Then wet gauze and dry gauze is performed.
After that adhesive dressing is performed. In severe case, if the dressing become more

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painful, she can be given anaesthesia and then the dressing can be carried out as use of
narcotics and analgesic frequently can lead to side effects and other complications as she is
too young for heavy medicinal dose (Douglas & Wood, 2017)
Noticeable concerns at home care.
The brother of Bobby is indulged into smoking so it can be the matter of concern. She
must be provided with safe and healthy atmosphere and exposing her to harmful chemicals
such as nicotine and tobacco fumes is harmful. The presence of any children will cause
disturbance in her mental rest. It can interrupt her relaxing time and even sleep cycle. It might
be difficult for her mom to manage her care and work as she is professional and a working
woman. At home there are high chances of irresponsibility and risk. Taking care at home
means, frequent disturbance from the family members or the neighbours which can cause
discomfort. In case of emergency, she would not be able to get urgent medical assistance,
while being at hospital till significant recovery she can seek medical assistance 24*7.
Moreover, this is a matter of concern, whether the mother is getting sufficient support in
resources, professional, personal, medication, recovery aided equipment and finances. In-
house care helps in better recovery only after a certain health condition, when the health is
stable and can barely leads to further deterioration. (Jonathan, 2018).
Concern regarding proper diet.
Proper nutrition is essential due to burn injury. She has dis-balanced fluid in the body
and even loss of skin tissue. Hence, daily nutrition is vital for early recovery and to cope up
with the damage. Since she is on heavy dosage which includes steroids and the analgesics, it
is important for her to take liquid and low calorie and easily digestible diets which might be
not so appealing. Enteral nutrition has sustained to progress in jumps and bounds as clinicians
found malnutrition to be an independent and individual risk factor for deaths and mortality
among patients undergoing treatment. The malnourished patient is more susceptible to
recover late and stay in hospital for a longer period of time or may be in some cases in
intensive care unit (ICU) (Adeyinka & Valentine, 2020).
Reason for NG feeds overnight only.
Overnight NG feeds are preferred because they are less likely rot interrupted. The
patient is under sleep and cannot demand the break in the feeding session. Hence, efficient
supply of food and nutrition can be provided. While feeding in night, the oral feeding in
daytime can be matched. It will provoke the hunger pangs during day, as in case of Bobby
she is reluctant to eat (Adeyinka & Valentine, 2020).

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Respond to Bobby’s questions
Bobby’s statement after looking herself in the mirror is obvious and disheartening as
well. She is a child and in her tender age. She must be made understood about the condition
completely. She must be raised with the self-acceptance, confidence with care and caress. In
need of counselling she must be taken to personality development and child enhancement
counsellors. The need of regular and friendly communication is important. At initial phase it
would be very difficult for her to accept the situation. But gradually with family and peer
support she would imbibe the confidence within herself. Being a nurse, she must be made
comfortable by using statements such as “You are beautiful because the inner beauty matters
the most”, “You are unique and talented out of all” (Jonathan, 2018).

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