Lab tests were ordered including a CBC, chemistry panel, urinalysis, and carboxyhemoglobin.

Click here for Lab Results

Click here for Carboxyhemoglobin results

 

Urinalysis results showed some protein and red cells in the urine indicating some kidney damage (see Workbook, Systemic Effects of Burns). We will discuss urinalysis in more depth in a subsequent case study.

 

A chest x-ray was also ordered to assess damage to the respiratory tract due to toxins from smoke inhalation. Inhaled toxins in smoke can damage the normal lining of the respiratory tract leading to swelling, collapse of the airway, and respiratory distress.

 

20. What type of energy do x-rays use to create ionizing radiation in order to see pictures of the inside of the body?

 

21.  What structures in the chest cavity absorb radiation and appear light on an x-ray?

 

22.  Structures that are filled with air appear to be what color on a chest x-ray?

 

Results from the x-ray were negative for respiratory damage. The problems with Anna's airway are most likely due to the edema in her neck and face obstructing the airway.

 

Anna's wounds were gently cleaned and wrapped with a silver, antimicrobial dressing. Because one of the major functions of the skin is protection, one of the most common complications from a burn injury is infection with possible sepsis. These dressings will help protect Anna from infection until she is stable enough for surgery. IV antibiotics are also given to guard against infection.

 

Anna is taken to the burn ICU. Her RN inserts an NG (nasogastric) tube for feedings. Enteral feedings will begin as soon as Anna is hemodynamically stable.

 

 

Burns cause a hypermetabolic state; the core body temperature is reset and the body is metabolizing (breaking down energy stores) at almost twice the normal rate. With Anna's burns being estimated at about 40% of her total surface area, she could lose 25% of her weight in just 3 weeks without nutritional support. This rapid loss of nutrients leads to suppression of the immune system and may even lead to death. Burn patients may require as much as 5,000 calories per day. A dietician will be monitoring Anna carefully, assessing her resting metabolic rate and making sure she receives the right combination of carbohydrates, fats, and proteins to adequately heal.

 

For more information on nutrition guidelines, click here.

 

23.  If an adult has a burn covering 25% of their body surface area, how much does their metabolic rate increase?

 

24.  How much weight might an adult patient lose with a surface burn of 40%, without adequate nutritional support?

 

25.  If possible, when should enteral feedings begin and what type of enteral diet is recommended?