Case study - Burn (pediatric): Nursing

Nurse Lawrence works in a pediatric rehabilitation facility and is caring for Abigail, a 2-year-old who was admitted to the facility from a burn unit after being treated for an accidental scalding injury that resulted in partial- and full-thickness burns. In collaboration with the registered nurse, RN Miley, Nurse Lawrence goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Abigail’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Lawrence recognizes important cues, including Abigail’s vital signs, which are temperature 98.6 F or 37 C, heart rate 88 beats per minute, respirations 18 breaths per minute, blood pressure 96/52 mmHg, and oxygen saturation 100 percent on room air. Next, Nurse Lawrence uses the Face, Legs, Activity, Cry, and Consolability, or FLACC scale, and determines Abigail’s pain rating is 5 out of 10 according to her behavioral cues.

Next, Nurse Lawrence analyzes these cues. He reviews the electronic health record, or EHR, with RN Miley, and they note an order for sterile dressing changes, and that Abigail is prescribed a topical antimicrobial to be applied to her burns. They also see that she’s been prescribed medication for pain management and that she received her last dose four hours ago.

Nurse Lawrence recalls that a scald is a type of thermal burn caused by hot liquids or steam, and he knows that toddlers, like Abigail, are at high risk for these types of burns as they start to become more mobile and explore their environment.

He recalls that partial-thickness burns involve the epidermis and part of the dermis layers of the skin, and that full-thickness burns involve both the epidermis and the entire dermis.

This destroys the network of immune cells that reside in the epidermis and the physical barrier the skin provides against microorganisms. He further understands that the risk of infection is increased because the wound exudate is easily colonized by bacteria and the vascular supply to the burned tissue is impaired. Nurse Lawrence realizes that Abigail needs management of her burn injuries to promote skin integrity and prevent infection.

Now, using the information they've gathered, Nurse Lawrence and RN Miley choose a priority hypothesis of impaired skin integrity.