A patient with partial-thickness burns covering 15% of the TBSA and a history of diabetes presents with elevated blood glucose and signs of potential infection. Which intervention should the nurse prioritize to address both the burn injury and the patient's diabetic condition?

C) Start fluid resuscitation using the Parkland formula

A) Initiate broad-spectrum antibiotics immediately

B) Administer insulin to manage hyperglycemia

C) Start fluid resuscitation using the Parkland formula

D) Apply topical antimicrobial cream to the burn areas

Mr. Thompson, a burn patient with diabetes, shows signs of systemic inflammatory response and potential infection. Which of the following interventions is most critical to prevent further complications in his condition?

B) Initiating aggressive fluid resuscitation using the Parkland formula

A) Administering broad-spectrum antibiotics to prevent infection

B) Initiating aggressive fluid resuscitation using the Parkland formula

C) Increasing the dose of Metformin to control blood glucose levels

D) Applying topical antibiotic ointments to the burn wounds

Mr. Thompson, a burn patient with a penicillin allergy, has developed a MRSA infection, persistent hyperglycemia, and hyponatremia. Which nursing intervention is the priority to address his current condition?

A) Administer vancomycin as prescribed to treat the MRSA infection.

B) Initiate insulin therapy to manage hyperglycemia.

C) Adjust fluid administration to correct hyponatremia.

D) Monitor vital signs closely to assess for systemic stress.

Given Mr. Thompson's current clinical status with a persistent fever, elevated heart rate, increased respiratory rate, and hyperglycemia, what is the most appropriate nursing intervention to prioritize while the interdisciplinary team revises his care plan?

C) Administer the prescribed insulin regimen to achieve tighter glycemic control.

A) Initiate a cooling blanket to address the fever and prevent further systemic stress.

B) Increase the rate of sodium-containing fluids to correct hyponatremia more rapidly.

C) Administer the prescribed insulin regimen to achieve tighter glycemic control.

D) Implement strict infection control measures to prevent the spread of MRSA.

Considering Mr. Thompson's current clinical presentation and the findings of elevated inflammatory markers and persistent fever, which of the following interventions should the nurse prioritize to address his potential complications?

D) Prepare to assist with the administration of a broader-spectrum antibiotic pending blood culture results.

A) Increase the frequency of vital signs monitoring to every hour to detect changes early.

B) Administer antipyretics as ordered to manage fever and reduce metabolic demand.

C) Collaborate with the dietitian to initiate a high-protein, high-calorie diet to support immune function.

D) Prepare to assist with the administration of a broader-spectrum antibiotic pending blood culture results.

Mr. Thompson, a patient on vancomycin therapy for MRSA infection, shows persistent systemic inflammatory signs including fever and elevated white blood cell count. The healthcare team decides to reassess his antibiotic regimen. Which of the following would be the most appropriate next step in managing his antibiotic therapy?

A) Continue the current vancomycin therapy and add a broad-spectrum antibiotic until blood culture results return.

B) Discontinue vancomycin and start linezolid due to suspected vancomycin-resistant pathogen.

C) Increase the dose of vancomycin based on current renal function and trough levels.

D) Switch to daptomycin as it is more effective for skin and soft tissue infections.

Mr. Thompson's condition has deteriorated despite antibiotic treatment, and a new antibiotic, linezolid, has been added to his regimen. Which nursing intervention is most critical to implement when administering linezolid to manage the risk of potential adverse effects?

C) Regularly check the patient's complete blood count (CBC).

A) Monitor the patient for signs of peripheral neuropathy.

B) Assess the patient for symptoms of serotonin syndrome.

C) Regularly check the patient's complete blood count (CBC).

D) Encourage increased fluid intake to prevent renal impairment.

Mr. Thompson is exhibiting signs of altered mental status following the adjustment of his antimicrobial regimen and surgical intervention. Which of the following should the nurse prioritize in assessing the cause of Mr. Thompson's confusion and disorientation?

B) Review recent medication administration for potential side effects

A) Evaluate for signs of ongoing infection

B) Review recent medication administration for potential side effects

C) Assess for fluid overload contributing to cerebral edema

D) Check serum electrolyte levels for imbalances

Two days after surgical intervention and adjustment of his antimicrobial regimen, Mr. Thompson shows signs of altered mental status, including confusion and disorientation. Considering his recent rise in serum creatinine and elevated respiratory rate, what should be the nurse's priority intervention?

C) Monitor renal function and adjust medication dosages as needed.

A) Increase fluid intake to address potential dehydration.

B) Administer prescribed sedatives to manage agitation.

C) Monitor renal function and adjust medication dosages as needed.

D) Initiate continuous oxygen therapy to address respiratory rate.

Burn - Nursing Case Study

Pathophysiology

• Primary mechanism: Thermal injury leads to direct damage to skin and underlying tissues, causing protein denaturation and cell death, which disrupts skin's barrier function and leads to fluid loss and increased susceptibility to infection.

• Secondary mechanism: Inflammatory response triggers the release of cytokines and histamines, causing vasodilation and increased capillary permeability, resulting in edema and hypovolemia. This can lead to burn shock if not managed promptly.

• Key complication: Systemic inflammatory response may progress to multi-organ dysfunction syndrome (MODS) due to persistent hypoperfusion and immune dysregulation, which can be life-threatening if severe and not addressed with aggressive fluid resuscitation and supportive care.

Patient Profile

Demographics:

34-year-old male, construction worker

History:

• Key past medical history: Hypertension, Type 2 Diabetes

• Current medications: Lisinopril, Metformin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe pain and blistering on the right arm

• Key symptoms: Redness and swelling on the right arm, fever, chills

• Vital signs: Temperature 101.4°F, Heart rate 110 bpm, Blood pressure 140/90 mmHg, Respiratory rate 22 breaths per minute

Section 1

As the case unfolds, the patient, Mr. Thompson, undergoes a series of diagnostic tests to further assess the extent of his injury and the potential for complications. Laboratory results reveal an elevated white blood cell count of 15,000/mm³, indicating an ongoing inflammatory or infectious process. Blood glucose levels are notably high at 240 mg/dL, despite regular doses of Metformin, suggesting stress-induced hyperglycemia due to the burn injury and contributing to impaired wound healing. Serum electrolytes show hyponatremia with a sodium level of 130 mEq/L, which is consistent with the fluid shifts associated with burn injuries and the body's stress response.

On physical examination, the right arm shows significant blistering and partial-thickness burns covering approximately 15% of the total body surface area (TBSA). The edema is pronounced, and there is a noticeable increase in erythema extending beyond the initial injury site, raising concerns for cellulitis. The patient's fever and tachycardia persist, with a repeat temperature of 102.2°F and heart rate of 120 bpm, indicating a possible systemic inflammatory response or developing infection. These findings necessitate close monitoring and a potential adjustment in the treatment plan, including the initiation of broad-spectrum antibiotics, given his allergy to Penicillin.

The healthcare team decides to initiate aggressive fluid resuscitation guided by the Parkland formula, which calculates the fluid requirements for burn patients in the first 24 hours post-injury. This decision aims to address potential hypovolemia and prevent burn shock. Additionally, the patient's blood pressure, although currently stable, is closely monitored for signs of hypotension. The interplay of Mr. Thompson's diabetes and the burn injury requires careful management to prevent further complications such as impaired wound healing and secondary infection, highlighting the need for ongoing assessment and a dynamic approach to his care plan.

Section 2

As the healthcare team continues to manage Mr. Thompson's care, new diagnostic results reveal a concerning development. A wound culture taken from the burn site returns positive for methicillin-resistant Staphylococcus aureus (MRSA), necessitating a change in the antibiotic regimen. Given Mr. Thompson's penicillin allergy, the team initiates treatment with vancomycin and continues to monitor his response closely. Despite the aggressive fluid resuscitation and antibiotic therapy, Mr. Thompson's fever persists, albeit slightly reduced to 101.8°F. However, his heart rate remains elevated at 115 bpm, and his respiratory rate has increased to 22 breaths per minute, suggesting ongoing systemic stress.

In light of these findings, the team revisits Mr. Thompson's comprehensive care plan. The persistent hyperglycemia, now recorded at 250 mg/dL, poses a significant risk for impaired wound healing and further infection. The endocrine team recommends the addition of an insulin regimen to better control his blood glucose levels, aiming for tighter glycemic control. Meanwhile, the fluid management strategy is reassessed, with electrolyte monitoring intensified to address the hyponatremia, which has slightly worsened to 128 mEq/L. The team increases the administration of sodium-containing fluids to correct the imbalance while carefully avoiding fluid overload.

As Mr. Thompson's condition continues to evolve, the healthcare team recognizes the need for vigilant monitoring and dynamic adjustments to his treatment. The new complication of MRSA infection adds a layer of complexity to his care, requiring precise antibiotic stewardship and infection control measures. The interplay between his diabetes management and burn injury underscores the importance of an interdisciplinary approach, combining efforts from wound care specialists, endocrinologists, and infectious disease experts to optimize outcomes and prevent further complications. The focus remains on stabilizing his condition, promoting healing, and preparing for the next phase of his recovery journey.

Section 3

Following the adjustments in Mr. Thompson's care plan, the healthcare team remains vigilant for any changes in his status. On the third day of vancomycin therapy, new diagnostic results reveal a concerning rise in inflammatory markers: his C-reactive protein (CRP) has increased to 15 mg/L, and his white blood cell count is elevated at 17,500/mm³. These findings suggest that systemic inflammation persists, possibly indicating inadequate infection control or additional complications. Furthermore, the wound assessment shows increasing erythema and tenderness surrounding the burn site, raising concerns about the potential spread of the MRSA infection despite antibiotic therapy.

In response to these developments, the team conducts a thorough reassessment of Mr. Thompson's condition. His vital signs reveal a persistent fever of 101.5°F, slight tachycardia with a heart rate of 120 bpm, and mild tachypnea at 24 breaths per minute. Blood cultures are repeated to evaluate for potential bacteremia, and an ultrasound of the abdomen is ordered to rule out any intra-abdominal sources of infection or abscess formation, given the persistent systemic signs and symptoms. The interdisciplinary team revisits the antibiotic regimen to ensure optimal coverage and considers potential vancomycin-resistant pathogens or the need for adjunctive therapies.

The team also explores supportive measures to enhance Mr. Thompson's immune response and promote recovery. Nutritional support is intensified, with a focus on protein and calorie intake to aid in wound healing. The endocrinology team collaborates closely with nursing staff to refine the insulin regimen, seeking tighter control of his blood glucose levels, which remain elevated at 240 mg/dL despite initial adjustments. As the team navigates these challenges, they remain committed to a holistic, patient-centered approach, emphasizing communication and coordination across disciplines to address the complexities of Mr. Thompson's evolving clinical picture.

Section 4

On the fourth day of Mr. Thompson's treatment, the healthcare team notes a significant change in his status. Despite the ongoing antibiotic therapy, his fever has spiked to 102.8°F, and his heart rate has increased to 130 bpm, indicating worsening systemic inflammation. His respiratory rate has also risen to 28 breaths per minute, suggesting increased respiratory effort. The repeated blood cultures return positive for MRSA, reaffirming concerns about the persistence of the infection. However, a new development arises: the blood culture results also indicate the presence of vancomycin-intermediate Staphylococcus aureus (VISA), suggesting reduced susceptibility to vancomycin and necessitating an urgent review of the antimicrobial strategy.

Concurrently, the ultrasound of the abdomen reveals a small, encapsulated fluid collection suggestive of an intra-abdominal abscess, likely contributing to the ongoing systemic inflammatory response. Given these findings, the interdisciplinary team promptly convenes to address these complications. Infectious disease specialists propose the addition of linezolid to the regimen to target the VISA strain, while surgical consultation is sought to evaluate the possibility of abscess drainage to prevent further deterioration. The wound care team intensifies their efforts to manage the burn site, implementing advanced dressings and monitoring for any signs of necrotizing infection.

In light of these developments, the team reemphasizes the importance of optimizing Mr. Thompson's nutritional support and glycemic control to bolster his immune defenses. The endocrinology team adjusts his insulin regimen further to achieve more stringent glucose control, aiming to maintain levels below 180 mg/dL. Despite these challenges, the collaborative approach and swift adaptation to the new clinical information highlight the commitment to improving Mr. Thompson's condition and preventing further complications. The focus remains on stabilizing him and addressing both the local and systemic impacts of his complex clinical presentation.

Section 5

Two days following the adjustment in Mr. Thompson's antimicrobial regimen and surgical intervention to drain the intra-abdominal abscess, the healthcare team notes several key changes in his condition. Initial post-procedural assessments reveal a moderate improvement in his vital signs. His fever has decreased to 100.4°F, and his heart rate has stabilized to 110 bpm, suggesting a positive response to the combined interventions. However, his respiratory rate remains elevated at 26 breaths per minute, prompting continuous monitoring for any underlying pulmonary complications.

Laboratory results provide further insights into Mr. Thompson's evolving clinical picture. His white blood cell count, previously elevated at 18,000 cells/µL, has decreased to 14,500 cells/µL, indicating a potential reduction in systemic inflammation. However, his serum creatinine level has risen to 2.1 mg/dL, pointing to possible renal impairment, likely secondary to the combination of systemic infection and the nephrotoxic potential of prolonged antibiotic therapy. The team considers the need for renal protective strategies and adjusts fluid management accordingly, ensuring careful balance to support his hemodynamic status without exacerbating potential fluid overload.

Despite these improvements and challenges, Mr. Thompson begins to exhibit new signs of altered mental status, with episodes of confusion and disorientation noted during morning rounds. This change prompts an urgent neurological evaluation and further investigation into possible causes, including metabolic disturbances, ongoing infection, or medication effects. The interdisciplinary team remains vigilant in its approach, prioritizing a comprehensive assessment to address this new complication while continuing to support Mr. Thompson's recovery trajectory.