Missy Is 3 Years Old She Enjoys Being With Mom And Grandma

Missy is 3 Years Old She Enjoys Being With Mom And Grandma In The Kit

Missy is 3 years old. She enjoys being with her mom and grandma in the kitchen. While exploring, she pulled a chair close to the stove, climbed on it, and looked inside a pot of boiling water. The steam was hot on her face, causing her to step back. When she fell off the chair, boiling water was pulled down onto her, resulting in burns on her face, hands, chest, and arms. She was rushed to the emergency department for assessment and care. Grandma applied some butter to her fingers, but her face was not treated. The medical team performed a burn assessment using the Rule of Nines and identified the burns as partial-thickness, with blistering and edema on her hands.

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The case of Missy, a young child who sustained burns from boiling water, highlights critical aspects of pediatric burn assessment and management. The initial step involves understanding the extent of her injuries, primarily achieved through the application of the Rule of Nines—a clinical tool used to estimate the total body surface area (TBSA) affected by burns. This method allows healthcare providers to quickly assess the severity and guide treatment plans effectively.

The Rule of Nines apportions the body into regions, each representing a percentage of TBSA, adjusted for children due to their different body proportions compared to adults. For children, specific adjustments are made: the head accounts for approximately 18%, each leg 14%, each arm 9%, the anterior and posterior trunk 18% each, and the perineum 1%. This assessment aids in determining fluid resuscitation needs, the likelihood of complications, and prognosis. Applying this to Missy, the burns on her face, hands, chest, and arms indicate moderate to severe injuries involving significant TBSA, necessitating prompt and specialized care.

Managing pediatric burn patients requires a comprehensive approach focusing on pain control, preventing infection, maintaining hydration, and addressing psychological impacts. A nursing diagnosis pertinent to Missy is "Acute Pain related to burn injuries as evidenced by crying and uncooperative behavior." The goal set in SMART (Specific, Measurable, Achievable, Relevant, Time-bound) terms is: "Within 30 minutes, Missy will demonstrate reduced pain behaviors and tolerate a pain assessment, with a pain score of less than 4 on a 0-10 scale."

To achieve this, three interventions are critical. Firstly, administering age-appropriate analgesics such as opioids (e.g., morphine) as per physician orders ensures effective pain relief. The typical IV dosage for children is approximately 0.05-0.1 mg/kg every 2-4 hours, titrated to achieve comfort. Secondly, employing non-pharmacological pain management strategies, including distraction techniques and comfort measures like age-appropriate toys, can help alleviate distress. Thirdly, maintaining a calm and comforting environment and using a child-friendly approach helps reduce anxiety and cooperation issues, facilitating ongoing assessment and care.

Medications likely to be ordered include analgesics, antibiotics, and anti-inflammatory agents. For pain, IV morphine at 0.05-0.1 mg/kg every 2-4 hours is standard, with close monitoring for respiratory depression. Antibiotics such as topical silver sulfadiazine are commonly used for burn wound infection prevention. Additionally, a controlled dose of acetaminophen (e.g., 15 mg/kg every 4-6 hours) may be prescribed for additional pain control and comfort. These medications support wound healing, decrease infection risk, and improve patient comfort, which is vital for children like Missy who are experiencing significant burns.

Education for the mother and grandmother is essential for ongoing care. They need to understand the severity of the burns, signs of infection, and the importance of wound hygiene, including proper dressing changes. They should be instructed on pain management strategies at home and the necessity of monitoring for complications. Emphasizing strict adherence to medication schedules and follow-up appointments ensures optimal recovery. As burns can have lasting physical and psychological impacts, family support and reassurance are vital components of care.

References

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