Anatomy And Physiology 1 Lab Name Cas

Anatomy And Physiology 1 Labname Cas

Anatomy and Physiology 1 Lab Name ________________________________ Case Study Assignment. You are a medical student working your way through college and are assigned to a hospital given background information on a patient. You were provided the chief complaint and brief history of the patient outlined below. You are asked by the nurse in charge to read the following case, investigate the topic (severe burns and function of the integumentary system) and complete a written report in MLA format including references addressing each of the questions identified below. Use this link for guidance on MLA writing format: Total length of your report should be about two to three pages.

The purpose of this assignment is to put things you are learning in the course (lecture and lab) into context using real life situations. This assignment’s focus is to investigate real issues of the integumentary system and epithelial tissues. Chief Complaint: A 60-year-old female was admitted for severe second- and third-degree burns following her rescue from a burning house. History: Lily Tigre, a 60-year-old female, was received in the emergency room and was reported to have been rescued from her burning house by the neighbor. The neighbor’s family dog was able to wake up the neighbor and they saw flames coming from the windows and heard a person screaming.

Investigations at the scene suggest the patient was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, the patient had been rescued but emergency crews reported she had suffered severe burns and excessive smoke inhalation. In the emergency room, Lily was unconscious. She had second-degree burns over 9% of her body and third-degree burns over 18% of her body -- both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 60 / 37; heart rate = 212 beats / min.; and respiratory rate = 40 breaths / min.

She was quickly deteriorating from circulatory failure. Two IVs were inserted, and fluids were administered through each. Her vital signs stabilized, and she was transported to the intensive care unit (ICU). Lily regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas.

Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic. Lily began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers. She lost 17 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories ("Kcals") per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer.

By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse. Questions for you to address in your report. Your supervisor asks you to prepare a 2 to 3 page report to accomplish two things: 1) evaluate your knowledge about the integumentary system and how the body deals with severe stress as well as the specifics about the case; and 2) your supervisor needs to be apprised of the case in an official capacity. You are to address each of the items below in report form (MLA format means complete sentences and paragraphs with references).

Your report must include the following items:

1. Provide a brief summary of the case.

2. In your summary, describe each of the three major layers that make up healthy skin.

3. Explain what first-degree burns, second-degree burns, and third-degree burns are and how this relates to the patient.

4. Investigate and explain the process of debridement and how it relates to this patient.

5. Investigate why this patient was relatively pain-free when she woke up.

6. Explain why this patient’s blood pressure was so low and her heart rate was so high upon arrival at the emergency room (i.e., what is causing this).

7. Explain why it was important to immediately administer intravenous fluids to this girl.

8. Investigate "broad-spectrum" antibiotics, and why they were administered and why antibiotics needed to be switched. Is healthy skin normally colonized by bacteria?

9. Address skin-grafting and why it was necessary in this patient (why not just let the skin heal on its own?).

10. Describe the series of events that occur in skin which is healing with the help of a skin-graft.

11. Investigate decubitus ulcers and why bedridden patients are at risk for developing them. Explain where on the body such ulcers most commonly occur.

12. Explain why the patient lost so much weight despite being on a very high-calorie diet.

13. Provide a conclusion of what long-term problems the patient may face as a result of extensive scar tissue formation over her trunk and her right elbow.

Use credible sources and references, formatted according to MLA guidelines.

Paper For Above instruction

The case of Lily Tigre exemplifies the complex response of the human body to severe burn trauma and highlights the critical role of the integumentary system in protection, thermoregulation, and healing. Lily, a 60-year-old woman, sustained extensive second- and third-degree burns covering significant portions of her thoracic, abdominal regions, and right elbow after being trapped in a fire caused by a fireplace spark. Her injuries led to systemic instability, requiring urgent medical intervention, including debridement, antibiotic therapy, skin grafting, and supportive care. This report aims to analyze the physiological and pathological aspects of her condition, emphasizing skin anatomy, burn types, healing processes, and long-term implications.

The skin, the body's largest organ, is structurally composed of three principal layers: the epidermis, dermis, and hypodermis (subcutaneous layer). The epidermis is the outermost layer, primarily composed of keratinized stratified squamous epithelium, serving as a barrier against environmental insults and pathogens. Beneath it lies the dermis, a thicker layer rich in collagen and elastin fibers, containing blood vessels, nerve endings, hair follicles, and sweat glands that provide nutrition, sensation, and thermoregulation. The hypodermis, consisting of adipose tissue and loose connective tissue, insulates the body and absorbs shock, anchoring the skin to underlying tissues. The integrity of these layers is vital for homeostasis and effective wound healing.

Burns are classified into first-, second-, and third-degree categories based on the depth and severity of tissue damage. First-degree burns involve only the epidermis, causing redness, pain, and mild swelling, and typically heal without scarring. Second-degree burns extend into the dermis, causing blistering, severe pain, and potential for scarring. Third-degree burns penetrate the entire skin, destroying both the epidermis and dermis, often damaging underlying tissues, resulting in firm, leathery, and insensate areas. In Lily's case, she sustained second-degree burns over 9% of her body and third-degree burns covering 18%, necessitating extensive medical management including grafting to facilitate skin regeneration.

Debridement is a surgical procedure utilized to remove necrotic, dead, or infected tissue from burn wounds to promote healing and prevent infection. For Lily, debridement involved the removal of burned tissue that was devitalized and possibly infected, preparing the wound bed for skin grafts. This process reduces bacterial load, improves tissue viability, and creates a suitable environment for graft adherence. It is crucial in burn treatment to facilitate healing and minimize scarring and functional impairment.

Interestingly, Lily was relatively pain-free upon waking, which can be attributed to the destruction of nerve endings in the third-degree burn areas. Since third-degree burns destroy nerve tissue, the patient’s skin loses sensation in those regions, explaining her minimal pain despite the extensive tissue damage. Conversely, areas of second-degree burns, which involve the dermis, typically remain innervated and painful, but her overall perception was muted due to nerve destruction and the effects of her injury and medication.

Lily’s hypotension (blood pressure of 60/37 mmHg) and tachycardia (heart rate of 212 bpm) were caused primarily by hypovolemia due to significant fluid loss from burn injuries and increased insensible fluid loss through damaged skin. Burn wounds can cause capillary leak syndrome, resulting in plasma loss into tissues, leading to decreased circulating blood volume, impairing cardiac output, and causing circulatory shock. The body compensates by increasing heart rate to maintain perfusion, but prolonged hypovolemia risks multi-organ failure if uncorrected.

Administering intravenous fluids was crucial in Lily's case to replace lost plasma volume, restore blood pressure, and maintain tissue perfusion. Fluid resuscitation protocols, such as the Parkland formula, guide the management of burn shock by calculating the volume of fluids needed within the first 24 hours to prevent hypovolemic shock and support vital organ function.

Broad-spectrum antibiotics are agents effective against a wide range of bacterial pathogens, vital in preventing and controlling infections in burn wounds, which are highly susceptible due to loss of skin barrier function. Lily was initially treated with broad-spectrum antibiotics but needed to switch due to systemic staphylococcal infection. Healthy skin normally harbors commensal bacteria, which are generally harmless, but burns compromise the skin's integrity, increasing susceptibility to pathogenic bacterial colonization and infection.

Skin grafting became necessary for Lily because third-degree burns destroy the dermal layer, preventing natural regeneration. Since the burned tissue cannot heal on its own effectively, grafting provides a new source of epidermal and dermal tissue, promoting wound closure, reducing scarring, and restoring function. Conventional healing of extensive full-thickness burns would result in significant scarring and contractures, impairing movement, particularly around joints such as the elbow.

The healing process involving skin grafts encompasses several steps: preparation of the wound bed through debridement, transplantation of cultured epidermal sheets or autografts, followed by revascularization and integration into the underlying tissue. Initially, the graft relies on diffusion of nutrients until revascularization occurs. Neovascularization then ensures a blood supply, allowing the graft to survive and mature into functional skin comparable to native tissue.

Decubitus ulcers, or pressure sores, develop in bedridden patients like Lily, due to sustained pressure on areas where the bone is close to the skin, impairing blood flow and causing ischemia. Common sites include the sacrum, heels, hips, and elbows. Patients at risk must be repositioned regularly to relieve pressure, which is why Lily’s care included changing her position every two hours. These ulcers can become infected, complicating recovery.

Despite the high-calorie intake, Lily experienced weight loss primarily due to the hypermetabolic state induced by burns, systemic inflammation, and wound healing processes. Burn injuries increase metabolic rate substantially as the body expends energy to repair tissues, combat infection, and manage stress responses, leading to rapid catabolism of muscle and fat stores despite increased caloric consumption.

In conclusion, Lily Tigre’s extensive burns necessitated advanced medical interventions including fluid resuscitation, debridement, antibiotic therapy, and skin grafting. Long-term issues may include scar contractures, limited mobility, psychological impacts such as post-traumatic stress disorder, and ongoing risk for infections. Her case underscores the importance of understanding the physiology of skin and the multi-faceted approach required for effective burn management and recovery.

References

• Bolognia, Jean L., Julie V. Schaffer, and Lorenzo Cerroni. Dermatology. Elsevier, 2018.
• Cummings, CW, et al. Otolaryngology: Head and Neck Surgery. 6th ed., Elsevier, 2014.
• Gurtner, Geoffrey C., et al. "Wound Healing and Scar Formation." Nature, vol. 453, no. 7193, 2008, pp. 314–321. https://doi.org/10.1038/nature07039
• Hugh, Owen. "Burn Injuries." American Family Physician, vol. 90, no. 10, 2014, pp. 755-763.
• Martyn, G. and C. McGuiness. “Pathophysiology of Burns.” British Journal of Nursing, vol. 23, no. 17, 2014, pp. S24–S27.
• Neuner, Alexandra, et al. "Burns and Skin in the Realm of Science and Medicine." Scientific Reports, vol. 12, 2022, pp. 1-14.
• Reichner, William M. "Fluid Resuscitation in Burns." Critical Care Medicine, vol. 44, no. 1, 2016, pp. 10-15.
• Ryan, Michael, and Steven R. Weller. "Wound Healing and Skin Grafting." Clinics in Plastic Surgery, vol. 35, no. 4, 2008, pp. 413–423.
• Serra, M. et al. "The Role of Skin Microbiota in Skin Barrier Function." Journal of Investigative Dermatology, vol. 139, no. 10, 2019, pp. 2140–2148.
• Singer, Alexander J., and Peter J. Ward. "Burn Shock: Pathophysiology and Resuscitation." Critical Care Clinics, vol. 28, no. 2, 2012, pp. 221–243.