Sample Case Study
Sample Case Study
Sample Case Study
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
TABLE OF CONTENTS
I. OBJECTIVES
II. INTRODUCTION
III. EPIDEMIOLOGY
V. PATHOPHYSIOLOGY
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
I. Objectives
General Objective:
The general objective of this case study is to provide information and data
regarding cases both locally and internationally as well as causes and prevention of flame burn-
related injuries.
Specific Objectives:
II. Introduction
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Burn injury is a persistent global public health concern, and is a significant cause of
morbidity and mortality worldwide. It is a distinct form of trauma considered to be one of the
most severe injuries that can happen to an individual, and is an extremely stressful experience for
both the burn victim and his/her family. In spite of the extraordinary advances in the
management of burns, the profound impact of burn injuries to a patient's physical, social,
psychological and emotional well-being cannot be overemphasized. Burns physically disfigure,
inflict pain, and limit function and activities of daily living among patients. One of the worst
tragedies a person can suffer and endure. The social and economic consequences on the victim
and his/her family may be devastating and life changing.
The Global Burden of Disease 2004 Update of the World Health Organization reports
186 million fire related deaths (female-male ratio 7:1) and 6.6 million disability-adjusted life
years lost due to fires in low and middle-income countries in South East Asia alone. Ninety-five
percent of all fatal fire-related burns occurred in low and middle-income countries. South East
Asia also accounts for just over one-half (53%) of the total number of fire-related burn deaths
worldwide and for more than 50% of total number of disability-adjusted life years lost to fire-
related burns. Strategies in disaster prevention, health and hospital policies put burn-related
injuries at the bottom priority for most developing countries. There is paucity of epidemiologic
data available in the local setting to allow lawmakers and health policy practitioners to come up
with reasonable recommendations regarding burn care and management.
III. Epidemiology
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
In the Philippines, there are only five hospitals with burn units, Philippine General
Hospital, Jose Reyes Memorial Medical Center, East Avenue Medical Center, Quirino Memorial
Medical Center and Southern Philippines Medical Center in Davao City. It means that there are
approximately 40-45 beds for more than 100 million Filipino patients.
The Alfredo T. Ramirez (ATR) Burn Center of the Philippine General Hospital (PGH),
established in 1967, is currently at the forefront of burn care in the country. A primary referral
burn center in the country, it has been a pioneer in the comprehensive and multidisciplinary care
for patients suffering from burn injuries. As a center of excellence in burn treatment, the Center
caters to both adult and pediatric cases, with around 300 admissions, 2,000 outpatient consults,
and 300 operations a year. From an original two-bed facility, it has evolved and expanded into a
12-bed center serving the country.
In the UP-PGH ATR Burn Center, burn patients are admitted base on the American Burn
Association Classification (Figure 1). Which includes the following: all acute burn patients
classified with moderate and major injuries, those less than 2 years of age regardless of percent
total body surface area (% TBSA), those with injuries to the hands, face, feet, and perineum, all
patients with electrical and chemical burns, and those with smoke inhalational injury, other
associated medical illnesses, or with multiple trauma. Comprehensive and multidisciplinary care
is provided to patients by highly trained staff and personnel.
The UP-PGH ATR Burn Center adheres to the guidelines recommended by the Philippine
Society of Burn Injuries and International Society of Burn Injuries. Initial assessment and
stabilization are conducted based on the ABC's of burn injury (airway, breathing, circulation / C-
spine / compartment syndrome, disability / deficits, exposure). Immediate and comprehensive
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
evaluation of burn patients using systematic primary and secondary survey is key to appropriate
management. Appropriate fluid resuscitation, wound care, and surgical management, if needed,
are instituted in a timely and organized manner. The Parkland Formula is use to resuscitate
acutely burned patients; and early tangential excision and skin grafting is being practiced in the
institution as part of the definitive management for the burn injuries.
Published studies regarding the profile of burn injuries in the Philippines are inadequate
and this study aimed to document the current trend and profile among admissions in the UP-PGH
ATR Burn Unit from August 2013 to July 2015. Specifically, this study aimed to describe the
profile of patients admitted to the UP-PGH ATR Burn Center from August 2013 to July 2015, in
terms of age, gender, percent total body surface area (% TBSA), severity, anatomic involvement,
etiology of burn, place of injury, length of time prior to consult, number of operations, length of
stay, morbidity and mortality. This investigation also aimed to correlate clinical epidemiologic
data with outcomes of burn injury. The general objectives of this study were: 1) to describe the
epidemiologic profile of burn patients admitted at the UP-PGH ATR Burn Center for the last 2
years, 2) to determine the relationship of identified clinical variables with mortality.
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
A burn is tissue damage caused by heat, chemicals, electricity, sunlight, or nuclear radiation. The
most common burns are those caused by hot liquid or steam, building fires, and flammable liquid
and gases. Burns are defined by how deep they are and how
large an area they cover. A large burn injury is likely to
include burned areas of different depths. Deep burns heal
more slowly, are more difficult to treat, and are more prone
to complications such as infections and scarring. Very deep
burns are the most life threatening of all and may require
amputation.
Severe burns cause serious, body-wide problems. At the root of most of these problems is
the body’s explosive inflammatory response.
A normal inflammatory response protects the body from invaders, such as bacteria,
viruses, fungi, cancerous cells, toxins, and foreign materials. It activates in response to infection,
injury, or other threat. It is design to destroy the cause of the problem, contain the damage, and
clean up the mess left by dead cells and other debris. However, when faced with large or deep
burns, it can overreact, often making the injury more severe and harming the heart, lungs, blood
vessels, kidneys, and other organ systems.
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
During this inflammatory response, there is fluid loss that can cause a sharp and
potentially deadly drop in blood pressure known as shock. Fluid can also become trap inside the
body, leading to swelling known as edema. If tissues and organs do not receive enough oxygen
because of shock, edema, or something else, they suffer damage and can fail. The lungs, heart,
brain, and kidneys are particularly susceptible.
Infection is also a major concern. Burns damage the skin’s protective barrier, meaning
bacteria and other foreign invaders can sneak in. Burns also weaken the immune system, so the
body is less able to fight off threats. Infections can take hold not only in the injured area, but also
in organs such as the lungs (pneumonia) and bloodstream (sepsis), where they are potentially
lethal.
V. Pathophysiology
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
high risk of septic shock. Four main principles are of utmost importance in the current
management of patients with severe thermal injury, namely early wound closure, prevention of
septic complications, adequate nutrition and control of the external environment.
Personal Profile
Patient’s Name: Cayago, Erikson Y. Date of Birth: October
23, 1975
Gender: Male Age: 47 years old
Date Admitted: October 27, 2022 / Flame Burn Injury Religion: Catholic
Source of Data Collected: Patient himself
Patient manifests immediate response to stimuli with gradual feeling of pain, shows
effortless breathing and absence of fever as well as good blood circulation as evidenced by
Respiratory rate of 16cpm, Pulse rate of 98bpm, Temperature of 36.6 and Blood pressure of
130/70.
2nd Assessment:
o Admitted last 27th day of October due to Flame Burn Injury caused by flammable
lacquer thinner that affects left forearm and both right and left foot.
o Patient verbalizes no known history of any allergies related to foods, drinks and
any medications.
o There is no history of any self-administered medication taken at home as well as
no history of any related injuries in both maternal and paternal side.
o Patient frequently ate vegetable and fish at hospital and at home.
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Pain Assessment:
o Patient verbalizes that the feeling of pain occurs when parts of the body affected
by burn move.
o Pain increases during time of removal and changing of bandage.
o The feeling of pain started from the upper affected area (arm) that radiates down
to the lower extremities (both right and left foot).
o Patient describes the feeling of pain using pain scale of 1 to 10. Whereas, patient
felt 8 as the most severe (when the body moves and removal, changing of
bandages occur) and pain scale of 5 as tolerable (when no stimuli that increases
the pain exists).
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Laboratory Tests
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
MECHANISM OF ACTION
It has analgesic and antipyretic actions in the central nervous system. It inhibits
prostaglandin synthetase in the hypothalamus, prevents synthesis of spinal prostaglandin, and
inhibits inducible nitric oxide synthesis in macrophages. In therapeutic doses, inhibition of
prostaglandin synthesis is not significant in peripheral tissues, so paracetamol has minimal anti-
inflammatory action.
Intravenous paracetamol infusion provides onset of pain relief within five to ten
minutes after the start of administration. The peak analgesic effects is obtained in one hour and
the duration of this effect usually four to six hours. Fever is reduced within 30 minutes after the
start of administration. Duration lasts at least six hours.
INDICATIONS
o For relief of mild to moderate pain, where the enteral route of administration is not
clinically appropriate.
CONTRAINDICATIONS
o Hypersensitivity to paracetamol.
o Patients with severe hepatocellular insufficiency, hepatic failure or decompensated
active liver disease.
SIDE EFFECTS
o Blood/Black, Tarry Stool
o Bloody/Cloudy Urine
o Skin Rash/Hives or itching
o Sore Throat
o Unusual bleeding/bruising
o Unusual tiredness/fatigue
o Pain in the lower back/side
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
o Yellow eyes/skin
MECHANISM OF ACTION
It is a second generation cephalosporins are more effective in treating Gram-negative
bacilli compared to first generation cephalosporins, which have a greater coverage for Gram-
positive cocci.
Like penicillin antibiotics, contain a β-lactam ring structure. Works as bactericidal
antibiotic by binding to penicillin-binding proteins (PBPs), It inhibit the last step of the bacterial
wall synthesis. Once the β-lactam ring binds to PBPs, cross-linking between peptidoglycan units
is inhibited.
INDICATIONS
It is used to treat certain infections caused by bacteria, such as bronchitis, gonorrhea
and infections of the skin, ears, sinuses, throat, tonsils and urinary tract. Cefuroxime is in a
class of medications called cephalosporin antibiotics. It works by stopping the growth of
bacteria.
Antibiotics such as cefuroxime will not work for colds, flu, or other viral infections.
Using antibiotics when they are not needed increases your risk of getting an infection later that
resists antibiotic treatment.
SIDE EFFECTS
Most Common Serious side effects:
o Diarrhea - Severe Stomach Pain
o Nausea - Diarrhea
o Vomiting - Yellowing of the skin or eyes.
o Unusual taste in your mouth - Seizure
- Severe tingling
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
MECHANISM OF ACTION
Silver sulfadiazine disrupts bacteria by damaging the cell membrane and the cell wall
rather than by inhibiting folic acid synthesis. Silver sulfadiazine has a wide spectrum of
bactericidal activity against both gram-positive and gram-negative organisms.
INDICATIONS
Silvadene Cream (silver sulfadiazine) is a topical antimicrobial drug indicated as an
adjunct for the prevention and treatment of wound sepsis in patients with second and third –
degree burns.
SIDE EFFECTS
o Red spots on the skin
o Red/Swollen Skin
o Skin Rash
o Blistering/Loosening of the skin
o General body swelling
o Blue-green to black skin discoloration
o Increased sensitivity to sunlight
o Sores, ulcers or white spots in the mouth/lips
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Dependent
- Scheduled
medication
enhances
healing process
and avoid other
diseases
existence.
-
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Dependent
- Timely and
scheduled
medication
enhances
healing process.
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Dependent Dependent
- Continuous -Administration
administration of of Medication
medication as ordered by the
ordered by the physician
physician. boosts the
healing process.
XI Recommendations/Discharge
Medications
Have all the necessary medicines and take it on scheduled time as prescribed by the
physician. Gather all the significant information regarding the medication to be taken at home
and take medication as essentials so that healing processes will be ensured and further
complication may prevent.
Taken at the hospital
o Silver Sulfadiazine on Affected Area.
o Paracetamol 500mg q 6 hours / as necessary.
o Cefuroxime 750mg q 8 hours
Exercises
o Range of Motion enhancement exercises at home.
o Deep Breathing Exercises
o Ambulation with support and as tolerated.
Treatment
o Continuous application of topical ointment
o Rehabilitation Therapy
Health Teaching
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
Outpatient/Observation
o Have scheduled regular follow check up with the physician.
o Assists the patient in Activities of daily living.
o Advise the family to note for any changes that the patient manifests.
o Always place the client in comfortable environment and place.
Diet
o Green Leafy Vegetables
o Fruits
o Meat rich in vitamins and nutrients.
o Avoidance of fatty and oily foods as well as fast and junk foods.
Spiritual
o Ensure that the patient always have someone to talk to, promote activities that will
enhance spiritual and over-all well-being.
REFERENCES
https://pcs.org.ph/wp-content/uploads/2022/03/PCS-v72-no2-1-profile_patients1.pdf
https://www.bhs.org.au/bhsapps/govdoc/gdhtml/gddrg0020-26855-60608.pdf
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OUR LADY OF FATIMA UNIVERSITY
Valenzuela Campus
120 McArthur Highway, Marulas, Valenzuela City
College of Nursing
https://www.reliasmedia.com/articles/84953-the-burned-patient-assessment-diagnosis-and-
management-in-the-ed#:~:text=Diagnostic%20Studies&text=Basic%20laboratory%20studies
%20should%20be,a%20pregnancy%20test%2C%20when%20appropriate.
https://www.mayoclinic.org/drugs-supplements/silver-sulfadiazine-topical-route/side-effects/
drg-20068819?p=1
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