UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Competency Appraisal 2

TEACHING-LEARNING ACTIVITY (TLA)

LEVEL: _IV__ SECTION: ___________

COURSE/SUBJECT: Competency Appraisal 2
PROFESSOR:
TOPIC: Care of Client with Fluid , Electrolyte , Acid Base Imbalances and Burns
DATE: February 2019

ACTIVITY: Case Scenario Analysis of Client with Burns

FOCUS OF STUDY:

- Care of Client with Fluid and Electrolyte Imbalances

- Care of Client with acid-base imbalances
- Care of Client with Burns
- Care of Client with Shock
- Care of Client undergoing fluid Resuscitation

Learning outcomes:

After studying the case scenario, the student should be able to:

1. Identify learning issues

2. Utilize the Nursing Process in the plan of care for this client

3. Compare the manifestations of different classification of burns, the manifestations

in the different phases of burns.

4. Prioritize nursing care for the patient during the emergent/resuscitative phase.

5. Use lab data and clinical manifestations to determine the effectiveness of fluid
resuscitation.

6. Prioritize nursing care for the patient during the acute phase of burn in jury.

7. Assess and manage complications that may happen during the different phases of
major burn injury.

8. Integrate bioethical concepts in the care of the client

9. Integrate psychosocial aspects of care

DESCRIPTION OF THE ACTIVITY AND RELATED INSTRUCTIONS:

MEDIAL SURGICAL NURSING Case Scenario 1

Mr. MJ , 56 years old is brought to the Emergency Room after gas tank explosion
accident. He is alert and oriented and experiencing severe pain associated with burn
injuries. He appears very anxious. The eyebrows, eyelashes and hair are singed. There
is soot in the nares and mouth. There is thick, white leathery eschar on the chest, neck ,
whole part of his back and circumferential burns on his right arm. The skin of the face is
pink , moist and blistered.

A. As the ER nurse, what priorities should be set for the client’s care? What
immediate interventions, nursing and medical should be undertaken?

B. What priority nusing diagnoses do you establish with this client? What expected
outcomes do you establish in the nursing care plan?
 C. How would you classify MJ’s burns? What is your estimate of his TBSB?

D. What systemic effects do you expect after this major burn injury?

Initial assessment revealed heart rate is 142 bpm, RR- 36 breaths/min and labored.
BP- 98/60, Temp-36.8 C. Lung sounds indicate inspiratory and expiratory wheezing and a
persistent cough reveals sooty sputum production. He states that his pain 10/10. Bowel
sounds are absent. Weight - 176 pounds.

The physician inserted a large bore central line into Mr MJ’s sublavian vein and started
a rapd infusion of lactated Ringer’s solution. Mr MJ is receiving 40% humidified O2 via face
mask. Initial ABG are as follows: ph – 7.49, pCO2 – 32 mmHg, HCo3 – 22 meq/L . PO2-
60 mmHG. A Foley catheter is inserted and initially drains a moderate amount of dark,
concentrated urine. A nasogastric tube is inserted and MJ was placed on NPO till further
order.

E. Explain the rationale of the assessment findings and the rationale of the
procedures done to MJ

F. What drugs would you give and by what route would you administer them to control
MJ’s pain?

MJ was started on fluid resuscitation using the Parkland formula as a guide. The lab
studies sent were CBC, ABG, urinalysis, BUN, Na, K det., total protein and revealed the
following findngs: H.gb -20g/dl; Hct – 52%; glucose – 168 mg/dl; BUN – 27mg/dl. Urinalysis
– 20-30 pus cells/hpf

G. Using the Parkland formula, calculate the amount of fluid this patient would require
for the first 24 hours. What information is needed for this formula? What type of fluid
is administered?

H. How would you interpret the lab values of MJ? What should be your next step?

I. What other clinical indicators would you use to assess the adequacy of fluid
resuscitation?

J. What is the most likely cause of his abnormal glucose level?

Day 2 lab test revealed Lab values – Na -126 meq/L, K – 6.0 meq /L,. ABG revealed –
pH -7.30, pCO2- 35 mmHG, HCO3 -18 meq/L. , Decreasing urine output. The decision to
initiate dialysis was reached after thoughtful discussion with the family members. Double
lumen cuffed hemodialysis IJ catheter was used in acute hemodialysis

K. What is the rationale of these lab and ABG findings? What would be your next
step?

L. Discuss the different phases that happens in major burns, assessment

findings and management.

M. What complications can happen in these different phases of burns?

N. Discuss Shock as a result of burn injury. What are the different kinds of
shock that can happen in major burns, causes and management?

O. Discuss the rationale of placing the patient in acute hemodialysis and the
nursing care for the procedure

INSTRUCTIONS:

1. All Class secretaries will provide the facilitator the CLASS LIST for grading
purposes.
2. The facilitator will provide the class with Case Scenario a week before the
discussion with corresponding focus of study and guidelines.
 3. Each RLE group will submit their written output before the case presentation in
class. This will be graded and counted as part of their presentation grade
4. Each student must be ready for learning issues and discussion during the class.
This will be graded and counted as part of their participation grade.
5. There will be a pre test and post test about the focus of study.

CA-2 MN/2019