Page 318 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 303

Apply dry, sterile dressings to larger burns to prevent infection and hypothermia.
Prepare to perform escharotomy (longitudinal surgical incisions) to relieve
pressure from burn swelling) if respiratory or circulatory compromise.

Nursing Interventions (Late)
Assess degree of range of motion instituting ROM to prevent further defor-
mities.
Monitor for signs of sepsis and infection due to loss of protective skin
layers.
Administer topical or intravenous antibiotics to prevent and treat infection.
Provide emotional support, as long-term therapy may be necessary and
deformity can lead to issues with self-esteem.
Prepare for dermal replacement if new cells are not growing and the patient has
third- or fourth-degree burns.

NURSING ALERT

Carbonaceous (sooty) sputum, hoarseness, or facial burns and stridor are ominous Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
signs. Prepare for early intubation due to airways swelling.

Abdominal Injuries
What Went Wrong?
Abdominal injuries are caused when a patient is launched forward over an
object in high-speed accidents. Injuries may be blunt or penetrating and involve
the stomach, liver, spleen, small and large bowel, bladder, and kidneys. Abdom-
inal injuries can create life-threatening airway issues if abdominal contents
enter the thoracic cavity compressing lungs and mediastinum. Massive hernia-
tion can compress lungs and decrease venous return and therefore CO. Blunt
injury to the liver and spleen can lead to hemorrhagic shock. Penetrating inju-
ries to abdominal viscera of the bowel can lead to peritonitis. Blunt trauma to
the bladder and kidneys can lead to infection and renal failure.

Prognosis
These injuries may be difficult to diagnose and are usually found on secondary
survey. Many of these injuries require hemodynamic stabilization or immediate
surgical repair if signs and symptoms of shock continue during FVR.