Essential assessment data; I put here dry weight, you need to understand what dry weight is particularly with burns. I put in parentheses pre-burn, pre-therapy. This means if you got a patient and you meet them and even when they come in the burn unit they are burned already. So how do you know what their pre-burn weight is because you don’t want to go off of hearsay, of what family members say, if theysay 80 kilos or 160 lbs. whatever it might be, you’re going to have to get a weight as soon as you can before you start all that fluid volume resuscitation, so your earliest weight is going to be your dry weight.And I cannot express enough you’ve got to get that even when critical care errors and we start titrating things like dopamine and levothatathines, patients weight will change daily, especially in these areas where that volume is all over the place, where they are getting it and they are dumping it or they are notdumping it so a lot of the weight that they are gaining are from volume they are not able to eliminate, you really have to have a dry weight to titrate that medication appropriately because otherwise you can be accounting for 5-10 lbs. as far as what is weight based if you are giving them medications, so you startwith the dry weight and start doing those titration medications and those things like that. Need of coursetheir height to help determine their total body surface area, and past medical history whatever that might include. They intensify and maybe exacerbate some things, maybe harder for you to treat them in some ways, and look for additional injuries, like your survey of, you know, what you see vs. what you are going to look for. Make sure there is nothing else going on the way. Inhalation injuries may be hard to see, you may not necessarily have all those big black marks on their skin and things like that so these willbe things that you will get familiar in looking for; singed nasal hairs, black flecks – that is going to be carbon contained in their sputum or they are coughing up black stuff. Probably they have inhaled some things for too long. Septal edema can cause some obstruction, that might be causing some airway disturbance where you see they are tachypnic and their O2 stats are low and they are hypoxic. Injuries like this, inhalation injuries, typically we are going to err on the side of caution, we are going to suspect that they have had an inhalation injury, probably going to get an ABG, go ahead and call a physician and say this is what I see, we’ve got some nasal hairs they’ve got black in their sputum, and most likely they are going to go ahead and prophylactically intubate that patient because the longer you wait, they start to get dyspneic, and tachypnic, and hypoxemic, and then they develop these wheezes and stridor and all
these things, and then you’re not going to nasally or orally intubate, you are going to have to trach them.
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- Winter '16
- Nursing, Injury, full thickness burns, Burn Injury