Client Profile: Julie is a 5 year old girl wholives in North Carolina with her parents and two siblings, a 3 yearold brother and an 18 month old sister. Her father works at abrokerage firm in Raleigh and her mother stays at home to care forthe children. Julie has never had any health problems other thanoccasional episodes of the common cold.
Case Study: Julieand her parents were returning home from a family visit 4 weeks agowhen they were involved in a motor vehicle accident resulting in anexplosion that caused their car to become engulfed in flames.Julie’s mother, who was sitting in the back seat with the children,perished in the fire while trying to save the children. Her fatherand 2 younger siblings escaped serious injury; however, Juliesustained 3rd degree burns over 80% of her body and wasadmitted to the Jaycee Burn Center. She was intubated and placed onmechanical ventilation. Currently she is no longer on mechanicalventilation and has a tracheostomy from which the nursing staffsuctions thick green-yellow secretions every 2-3 hours. Julie isreceiving total parenteral nutrition (TPN) and intralipids (IL)through a central venous access. Julie has severe wounds to herface, neck, left arm (necessitating the amputation of her lefthand), left leg (necessitating a below-the-knee amputation), andback requiring extensive wound and graft care. She is premedicatedwith intravenous Fentanyl prior to each dressing change, and thisprovides adequate pain management during these procedures.
Julie’s father visits frequently.Julie is aware of the death of her mother and tends to be withdrawnand has had episodes of crying during which she could not beconsoled.
Questions:
- Discuss the classifications and types of burns and how burnsare measured to determine the percentage of body surface areainvolved.
- Identify the negative and positive factors affecting Julie’sprognosis and her chances of survival.
- Why is Julie at high risk for developing an infection?
- Discuss Julie’s needs regarding her tracheostomy. (discuss howyou perform cleaning, care, and how you change trach ties)
- Discuss TPN, including general care and special nutritionalneeds of children with burn injuries.
- What is the relationship between Julie’s fluid and electrolytebalance and her burn status?
- Discuss why Fentanyl has been chosen for pain management forJulie’s dressing changes.
- Discuss how Julie’s level of growth and development couldaffect her ability to cope with her mother’s death.
- What nursing intervention could help Julie cope with herhospitalization?
- Discuss how you might feel in this situation if you wereJulie’s father.
