could you help me please
Client Profile: Julie is a 5 year old girl who lives in NorthCarolina with her parents and two siblings, a 3 year old brotherand an 18 month old sister. Her father works at a brokerage firm inRaleigh and her mother stays at home to care for the children.Julie has never had any health problems other than occasionalepisodes of the common cold.
Case Study: Julie and her parents were returning home from afamily visit 4 weeks ago when they were involved in a motor vehicleaccident resulting in an explosion that caused their car to becomeengulfed in flames. Julie’s mother, who was sitting in the backseat with the children, perished in the fire while trying to savethe children. Her father and 2 younger siblings escaped seriousinjury; however, Julie sustained 3rd degree burns over 80% of herbody and was admitted to the Jaycee Burn Center. She was intubatedand placed on mechanical ventilation. Currently she is no longer onmechanical ventilation and has a tracheostomy from which thenursing staff suctions thick green-yellow secretions every 2-3hours. Julie is receiving total parenteral nutrition (TPN) andintralipids (IL) through a central venous access. Julie has severewounds to her face, neck, left arm (necessitating the amputation ofher left hand), left leg (necessitating a below-the-kneeamputation), and back requiring extensive wound and graft care. Sheis premedicated with intravenous Fentanyl prior to each dressingchange, and this provides adequate pain management during theseprocedures. Julie’s father visits frequently. Julie is aware of thedeath of her mother and tends to be withdrawn and has had episodesof crying during which she could not be consoled.
Questions:
5. Discuss TPN, including general care and special nutritionalneeds of children with burn injuries.
6. What is the relationship between Julie’s fluid andelectrolyte balance and her burn status?
7. Discuss why Fentanyl has been chosen for pain management forJulie’s dressing changes.
8. Discuss how Julie’s level of growth and development couldaffect her ability to cope with her mother’s death.
9. What nursing intervention could help Julie cope with herhospitalization?
10. Discuss how you might feel in this situation if you wereJulie’s father.
