Assignment: Patient in your Intensive Care Unit.

Assignment: Patient in your Intensive Care Unit.

Assignment: Patient in your Intensive Care Unit.

A 7-year-old boy is a patient in your intensive care unit. He was on a camping trip with his family when he accidentally fell on the campfire, causing severe second- and third-degree burns over 60% of his body. The clinical care team tells his parents that it will be critical to maintain their son’s airway and keep his fluid levels high.

In order to conserve fluid to maintain tissue perfusion, we take a closer look at the renal system. Norris (2019) demonstrates that the renal system consists of the kidneys, ureters, and bladder (p. 961). The kidney is made up of multiple lobes and about a million nephrons. Nephrons help to filter the blood in our body and get rid of the waste build up in our bodies (Norris, 2019, p. 961). The kidney is provided by the renal artery for blood supply which branches out to provide to the lobes (Norris, 2019, p. 962). Nephrons are not regeneratable and tend to decrease in functional status with age (Norris, 2019). Nephrons are grouped into two groups: cortical nephrons, making up 85% of nephrons and juxtamedullary nephrons, which concentrate urine (Norris, 2019). The two capillary systems that provide for the nephrons include the glomerulus and the peritubular capillary network (Norris, 2019). Through these, fluid and solutes are purified, and urine can be prepared for removal. Within the glomerular capillary membrane, there are three levels which include the capillary endothelial layer, the basement membrane, and the single-celled capsular epithelial layer (Norris, 2019, p. 964). Within the tubular components of the nephron, there are four sections which include the proximal convoluted tubule draining into the Bowman capsule, the loop of Henle, the distal convoluted tubule, and the collecting tubule collecting filtrate (Norris, 2019, p. 965).

Kidneys help to produce urine, but in order to complete this task, they must do so by glomerular filtration and tubular reabsorption and secretion (Norris, 2019, p. 965). The glomerular filtration rate is on average 125 ml/minute or 180 L/day and is measured through blood work collected through venipuncture and seen as the glomerular filtration rate (GFR) (Norris, 2019, p. 965). Multiple ions, such as sodium, potassium, chloride, calcium and phosphate ions, can be filtered and reabsorbed during the process of filtration through active transport (Norris, 2019, p. 966). The renal system is widely supported by the sympathetic system caused by angiotensin II, antidiuretic hormone (ADH), and endothelin which can cause constriction (Norris, 2019, p. 970).

In your initial post answer the following questions:

The father is confused and asks you why his son’s fluid level is important after a burn. How would you explain this to him?
A burn victim’s first several days are crucial due to the loss of skin, especially if second- and third-degree burns have occurred. The skin helps to maintain heat, homeostasis, and fluid balance within the body (Namdar et al, 2010). When this 7-year-old boy fell into the campfire and caused severe burns to his body, his dermis and epidermis was damaged and caused his totally burned surface area (TBSA) to be drastic. The intensive care unit (ICU) then will calculate his daily infusion-diuresis-ratio (IDR), in order to determine how much fluid loss and replacement will be needed for replenishment (Namdar et al, 2010). When the burn occurs, several inflammatory mediators are released, such as histamine, prostaglandins, thromboxane, and nitric oxide, which then create a more permeable membrane for the capillaries making them “leaky” so to speak (Haberal, Abali, & Karakayali, 2010). The boy will become edematous due to the loss of tissue and begin to seep fluid and heat in the next several hours and days, causing radical changes to temperature and electrolyte balances (Namdar et al, 2010). With these new changes in place for the body, dehydration begins to take place. This produces free radicals and reactive oxygen species (ROS), which are deadly and causes cellular membrane dysfunction (Haberal, Abali, & Karakayali, 2010). This can then cause interference in sodium-ATPase activity, which demonstrates edema and hypovolemia. Approximately 12 hours after the injury of a burn, intravascular hypovolemia and hemoconcentration develops and the highest levels of vasoactive mediators have been achieved. As a result, cardiac output declines to conserve for other organs suffering from the decreased plasma volume and the vasoactive mediators that are attributing to the burn (Haberal, Abali, & Karakayali, 2010). The initial steps overall are to conserve fluid to maintain tissue perfusion.

After your explanation, the father nods that he understands. He then asks how you will measure his son’s fluid levels. How would you respond?
The TBSA is calculated and the intensive care unit (ICU) then will calculate his daily infusion-diuresis-ratio (IDR), in order to determine how much fluid loss and replacement will be needed for replenishment (Namdar et al, 2010). Serum sodium concentration can then be used to determine the needs of how much fluid resuscitation will be needed for fluid maintenance to keep the boy hydrated for the next several crucial days (Namdar et al, 2010). At the time of admission, intravenous lines will be placed, preferably large bore and at least two, in order to rapidly infuse colloidal fluids into the boy, and then a urinary catheter will be placed in order to accurately measure urine output (Namdar et al, 2010). We as clinicians would want to assess blood work frequently for electrolyte imbalances to assure that if there were changes, such as hyponatremia or hyperkalemia, we would correct them appropriately and timely (Healthfully, n.d.).

As a clinician with knowledge of physiology, which aspects of this boy’s condition would you be most concerned about?
As a clinician, the main aspects to be concerned about with this patient is airway, fluid maintenance, electrolyte imbalances (such as hyponatremia and hyperkalemia), arrythmias, wound management, hygiene, antibiotics, and pain (Holland, DiGiulio, & Gonzalez del Rey, 2012). In the case of this patient, it is known what happened, and it is possible that the patient fell face first or at least inhaled the campfire, damaging or compromising the airway. There is a possibility of needing to be intubated or having an advanced airway. Fluid maintenance is needed because as 60% of the body has been burned, that is 60% of the skin that is missing and edematous, which will lose heat and fluid loss. Replacement will be needed and at a rapid infusion to avoid hypovolemia. Electrolyte imbalances will ensue due to the shock to the body of loss of tissue and heat. Some symptoms of electrolyte imbalances may include confusion, vomiting, nausea, weak pulses, muscle weakness, seizures, fatigue, and arrythmias (Healthfully, n.d.). Hyponatremia occurs to the burn victim due to the blood from the destroyed tissue and the burns on the body. Hyperkalemia happens to the burn victim due to the destruction of the burned flesh (Healthfully, n.d.). Arrythmias may occur due to the electrolyte imbalances. Hygiene, antibiotics and wound management all are in a group together as if not completed together they tend to be detrimental. Without one another, the burn wound can suffer causing further issues for the patient to not heal fast. And lastly, overall pain management will be a main factor so that the patient remains as comfortable as they can during the process of healing, debridement, and other treatments

This is a discussion post from a peer. I only need a one page reply to this answer. at a master’s level. I will attach a sample of a student’s answer.Thank you.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Assignment: Patient in your Intensive Care Unit.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Assignment: Patient in your Intensive Care Unit.

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.