NUR 606 Week 4 Discussion 1: Case-Based Discussion

March 8, 2022
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NUR 606 Week 4 Discussion 1: Case-Based Discussion

NUR 606 Week 4 Discussion 1: Case-Based Discussion

It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post. To assist you in your work for this discussion, please use the worksheet linked in each of the team threads to organize your thoughts. Then simply copy and paste the text from the document into your initial post.
Based on your assigned team, create an initial post by answering ALL questions for your assigned case (Team A, B, or C), making sure to address all components of all questions.
By Day 3, post your initial response to your assigned case study as a new discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should be limited to 500 to 750 words and comprehensively address the questions posed.
Team A
Week 4 Discussion Team A Worksheet (Word)
PJ is a three-year-old boy who pulled a pot of boiling water over his head, arms, and chest, resulting in a mixed burn to the anterior surface of his head and arms, chest, and feet. He presents with his mother in the emergency department. His mother is quite upset and says nothing like this has happened before. PJ is visibly upset and appears in pain, but is responsive and behaving appropriately for the situation.
1. What factors determine the classification of burns? What type(s) of burn is most likely for this victim?
2. Describe the process taking place in the burned area during the first hours after the injury.
3. How will the physicians in the emergency room determine the percentage of the body that may be burned? What special considerations may be involved when evaluating a child?
4. Discuss the additional effects associated with burns, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia, and the treatments involved.
5. PJ’s mother asks you how she can help him get better. Identify and explain three interventions she can implement to promote healing.
6. As he was healing, PJ developed a bacterial infection on his right arm. Explain three predisposing factors to this infection.
7. How will this burn injury affect PJ’s growth and development? What are some of the social needs in this case?
Team B
Week 4 Discussion Team B Worksheet (Word)
JL, a 50-year-old woman, fell and broke the left tibia at the ankle. She is in the emergency department, waiting for the fracture to be immobilized. The leg hurts and she notes that the ankle is red and swollen. A diagnosis of a simple fracture and sprain (damage to ligaments) is made.
1. Describe the pathophysiology of her pain and swelling as related to both the fracture and the strain. Why is the area red and swollen? Is this an acute or chronic process?
2. What can JL expect in the days to come as inflammation resolves and healing begins? What can she expect when the cast is removed? (Hint: Will she be back to normal?)
3. What is the rationale for immobilizing the fractured bone? Include in your explanation a discussion of why movement of the affected area is painful.
4. She is told to come back to the fracture clinic in 24 hours to have her cast checked. What could happen to the inflamed tissue if the edema increases in the casted area? What warning signs and symptoms will you look for?
5. She reports feeling fatigued and anorexic and has a low-grade temperature. What is the cause of these symptoms?
6. Is this injury at high risk for developing osteomyelitis? Provide rationale for your answer.
7. JL asks you if there is anything she can do to help herself get better. Identify and explain three interventions she can implement to promote healing.
Team C
Week 4 Discussion Team C Worksheet (Word)
Ms. M is 42 years old and has had rheumatoid arthritis for six years. At baseline, her fingers are stiff and show slight ulnar deviation. She has come to see you as she is currently experiencing an exacerbation, and her wrists are red and swollen. She finds it to be painful when something such as clothing touches the skin over her wrists. Her elbows and knees are also stiff and painful, especially after she has been resting. She is feeling extremely tired and depressed and has not been eating well.
1. Describe the pathophysiologic process that leads to the appearance and the pain occurring at her wrists. Is this an acute or chronic process? Could it be both?
2. Describe the pathophysiology contributing to the stiff, deformed fingers. What terms can be used to describe this?
3. Explain why some activity relieves the pain and stiffness of rheumatoid arthritis and why the pain tends to be worse with immobility. Is this true for other inflammatory or musculoskeletal conditions?
4. Describe several factors contributing to Ms. M’s systemic symptoms. Is this an acute or chronic process?
5. Explain how each of the following medications interact with the pathophysiology of rheumatoid arthritis and help return Ms. M to a more homeostatic state.
1. NSAIDs
2. Glucocorticoids
3. Disease-modifying agents
4. Biologic agents.
6. If we didn’t already know that Ms. M had rheumatoid arthritis, what other conditions would be on the differential for this patient? Think about what other conditions can present with erythematous, painful, swollen joints. Identify two such conditions and describe the most common signs and symptoms.
7. What are some possible long-term effects of chronic inflammation in conditions such as rheumatoid arthritis and other inflammatory conditions?
Replies
Review all your peers’ posts, as they will help you prepare for the quiz this week.
Select posts from two peers that addressed a case from a different team than you. For example, students from Team A reply to one post from Team B and one post from Team C. Each reply must use at least one scholarly reference other than your textbook. Thinking about your certification track and anticipated practice area:
• Describe a patient that you might encounter where you could apply the information learned in your peer’s post.
• What “signs” and “symptoms” would you expect this patient to exhibit? Identify at least four, describe the finding, and classify each as subjective or objective data.
Please refer to the Grading Rubric for details on how this activity will be graded. The described expectations meet the passing level of 80%. Students are directed to review the Discussion Grading Rubric for criteria which exceed expectations.
Posting to the Discussion Forum
1. Select the appropriate Thread.
2. Select Reply.
3. Create your post.
4. Select Post to Forum.
Please use this thread to create your reply posts, as indicated in the forum instructions.
JL, a 50-year-old woman, fell and broke the left tibia at the ankle. She is in the emergency department, waiting for the fracture to be immobilized. The leg hurts and she notes that the ankle is red and swollen. A diagnosis of a simple fracture and sprain (damage to ligaments) is made.
1. Describe the pathophysiology of her pain and swelling as related to both the fracture and the strain. Why is the area red and swollen? Is this an acute or chronic process?
2. What can JL expect in the days to come as inflammation resolves and healing begins? What can she expect when the cast is removed? (Hint: Will she be back to normal?)
3. What is the rationale for immobilizing the fractured bone? Include in your explanation a discussion of why movement of the affected area is painful.
4. She is told to come back to the fracture clinic in 24 hours to have her cast checked. What could happen to the inflamed tissue if the edema increases in the casted area? What warning signs and symptoms will you look for?
5. She reports feeling fatigued and anorexic and has a low-grade temperature. What is the cause of these symptoms?
6. Is this injury at high risk for developing osteomyelitis? Provide rationale for your answer.
7. JL asks you if there is anything she can do to help herself get better. Identify and explain three interventions she can implement to promote healing.
JL fell, fracturing her L tibia distal to her ankle resulting in redness, pain, and swelling. The patient was diagnosed with a simple fracture, “a single break in the bone in which the bone ends maintain their alignment and position” (VanMeter 2018, p.167). Her pain is caused by soft tissue damage. Damage occurs due to the breaking of the bone from the blood vessels that have broken (VanMeter 2018, p.167). “The inflammatory response develops as a reaction to the trauma in the presence of debris at the site” (VanMeter 2018, p.167-168). The inflammatory process causes her swelling. “Swelling is the result of the increased movement of fluid and white blood cells into the injured area” (Nationwide Children’s, 2021). The movement of fluid is what results in redness and swelling at the affected extremity. It is an acute process related to the fracture and the fall.
As healing begins, JL can expect to feel less pain, and the bone will be set in place and her leg cast to keep the bone in place. The swelling should also go down as the inflammatory response will stop. JL shole expect some discomfort in the bones and joints that were immobilized as the cast is removed. She will also expect some atrophy in the muscles of her affected leg, while the skin will be drier and have more hair (UCSF Health, 2021). The atrophy results from disuse of the leg. The skin changes after cast removal result from the constant covering of the skin with the cast. The hair growth results from friction from the cast. The friction stimulates the hair follicles in the skin to produce new hairs, leading to more hair growth (The Independent, 2011).
Immobilizing the fractured bone reduces the risk of increasing more debris and fragments from the bone fracture forming. Immobilization also helps with the healing of the bone as it is easier for the bone to heal “to prevent bone edges from moving and damaging other muscles, vessels or nerves and further complications” (Jacob, 2020). Immobilization can also help reduce inflammation as the bone pieces no longer agitate or move to create a more significant inflammatory response.
If the edema increases in the casted area within 24 hours of having a cast, this can result in compartment syndrome. Compartment syndrome can develop shortly after the fracture occurs, with more extensive inflammation (VanMeter 2018, p.169). In this process, “increase pressure of fluid within the non-elastic covering of the muscle compresses the nerves and blood vessels causing severe pain and ischemia or necrosis of the muscle” (VanMeter 2018, p.169).
Some common signs and symptoms of compartment syndrome are “pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements)” (USF Health, n.d.).
The feeling fatigued, anorexic, and a low-grade temperature can result from an infection, because of the bone fracture or as a second infection not related to the bone fracture.
The patient is not at high risk for osteomyelitis because the fracture was simple and not open, in which the fracture has broken through the skin. Osteomyelitis usually results from bacteria or fungi entering the blood from a fracture then spread to the bones. Staphylococcus bacteria cause most cases of osteomyelitis. A bacterium is generally found on the skin or in the nose of healthy individuals (Mayo Clinic, 2020). An opportunistic infection most likely causes osteomyelitis.
To promote healing of the bone, the patient should keep the cast on for about 6-8 weeks to ensure recovery with a simple fracture, reducing the risk of fragments inducing a more aggravated inflammatory response causing more pain and more swelling. Two, to increase foods high in vitamin D and calcium to promote healthy bone growth and maintenance. Lastly, complete and promote weight-bearing exercises to promote muscle health and circulation, better healing of limb effect, and refer patient physical therapy for a week and muscles post un casting of the leg to ensure recovery and resuming of normal function.
Resources
Jacob, P. D. (2020, July 24). What Is Splinting Used For? Broken Bones, Pain, Swelling.
MedicineNet. https://www.medicinenet.com/what_is_splinting_used_for/article.htm
Mayo Clinic. (2020, November 14). Osteomyelitis – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/osteomyelitis/symptoms-causes/syc-20375913
Nationwide Children’s. (2021). Swelling: The Body’s Reaction to Injury. Swelling: The Body’s Reaction to Injury. https://www.nationwidechildrens.org/specialties/sports-medicine/sports-medicine-articles/swelling-the-bodys-reaction-to-injury
The Independent. (2011, October 22). Hair Growth: Why is my leg hairy? https://www.independent.co.uk/life-style/health-and-families/health-az/hair-growth-why-my-leg-hairy-762704.html
UCSF Health. (2021, June 16). Care after Cast Removal. Ucsfbenioffchildrens.Org. https://www.ucsfbenioffchildrens.org/education/care-after-cast-removal
USF Health. (n.d.). Anterior Compartment Syndrome. Retrieved September 21, 2021, from https://health.usf.edu/medicine/orthopaedic/patientcare/~/media/190D4063986E4A84BB9BCDC124D0FCB2.ashx
VanMeter, K. C., & Hubert, R. J. (2018). Gould’s pathophysiology for the health professions. (6th ed.). Elsevier Saunders.
Please use this thread to create your reply posts, as indicated in the forum instructions.
Ms. M is 42 years old and has had rheumatoid arthritis for six years. At baseline, her fingers are stiff and show slight ulnar deviation. She has come to see you as she is currently experiencing an exacerbation, and her wrists are red and swollen. She finds it to be painful when something such as clothing touches the skin over her wrists. Her elbows and knees are also stiff and painful, especially after she has been resting. She is feeling extremely tired and depressed and has not been eating well.
1. Describe the pathophysiologic process that leads to the appearance and the pain occurring at her wrists. Is this an acute or chronic process? Could it be both?
2. Describe the pathophysiology contributing to the stiff, deformed fingers. What terms can be used to describe this?
3. Explain why some activity relieves the pain and stiffness of rheumatoid arthritis and why the pain tends to be worse with immobility. Is this true for other inflammatory or musculoskeletal conditions?
4. Describe several factors contributing to Ms. M’s systemic symptoms. Is this an acute or chronic process?
5. Explain how each of the following medications interact with the pathophysiology of rheumatoid arthritis and help return Ms. M to a more homeostatic state.

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1. NSAIDs
2. Glucocorticoids
3. Disease-modifying agents
4. Biologic agents.
6. If we didn’t already know that Ms. M had rheumatoid arthritis, what other conditions would be on the differential for this patient? Think about what other conditions can present with erythematous, painful, swollen joints. Identify two such conditions and describe the most common signs and symptoms.
7. What are some possible long-term effects of chronic inflammation in conditions such as rheumatoid arthritis and other inflammatory conditions?
1. Describe the pathophysiologic process that leads to the appearance and the pain occurring at her wrists. Is this an acute or chronic process? Could it be both?
The pathophysiologic process that aids in the appearance and pain occurring in her wrists is the destruction that is underway within her synovial joints. RA is known to be a systemic inflammatory autoimmune disease but finds its niche in causing the synovial membrane to become hyperplastic and more susceptible to being attacked by the immune system cells. Many rheumatologists hypothesize that the visual representation of RA “probably appears as a direct result of the sustained recruitment, inappropriate retention and impaired apoptosis” (Morović-Vergles, 2013). This is best likely defined as a chronic process that has moments of remission and flare-ups.
2. Describe the pathophysiology contributing to the stiff, deformed fingers. What terms can be used to describe this?
The pathophysiology contributing to the stiff deformed fingers is due to the destruction and damage to the cartilage. Some terminology used to describe this can be called arthralgia. Arthralgia is defined as joint pain and stiffness.
3. Explain why some activity relieves the pain and stiffness of rheumatoid arthritis and why it tends to be worse with immobility. Is this true for other inflammatory or musculoskeletal conditions?
Stiffness can be caused by the swelling around the joint, causing less mobility. Light activity can assist in improving the range of motion. According to a study, they found that “joint mobility increased as a result of a short-term intensive exercise program in RA patients with active disease” (Cooney, et. al., 2011). The continued movement helps maintain the current mobility and helps build up muscle. This is true for other inflammatory and musculoskeletal conditions due to the helpful side effects of light exercise. According to a study, “one A 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response” (Dimitrov, et. al, 2016).
4. Describe several factors contributing to the systemic symptoms noted in Ms. W.P. Is this an acute or chronic process?
Some systemic symptoms that Ms. W.P is experiencing are joint pain, fatigue, and symptoms of depression. These are most definitely related to the current exacerbation of her disease. This is a chronic process with bouts of remission and times of flare-ups. She notes “resting”, which is good, but light mobility should also be encouraged to help assist in easing some of the pain from the RA. In addition, she notes not eating well. Poor nutrition is going to hinder progress made in this disease.
5. Explain how each of the following medications interacts with the pathophysiology of rheumatoid arthritis and helps return Ms. M. to a more homeostatic state.

• NSAIDs: NSAIDs assist in decreasing the amount of prostaglandins. These enzymes cause inflammation within the body. NSAIDs block the mechanism of COX 1 and COX 2, decreasing inflammation within the body. This can result in decreased swelling, redness, fever, and symptoms of pain (Crofford, 2013).
• Glucocorticoids: Glucocorticoids act on the body by reducing the reactivity of the immune system, thus then decreasing inflammation within the body. More specifically, corticosteroids “modulate gene expression by binding to glucocorticoid receptors” (Xavier, et. al., 2016). In short, they allow for reuptake and mechanism of action of those cells that promote anti-inflammatory properties versus inflammatory properties.
• Disease-modifying agents: DMARDs work on the body by attempting to transform the disease. These medications stop your immune system cells (T and B cells) from doing their job, thus suppressing the immune system. According to John Hopkins, DMARDs in comparison to something like ibuprofen do more by having “shown to alter the disease course and improve radiographic outcome” (John Hopkins, 2020).
• Biologic agents Biologic agents work by targeting the TNF enzyme in the body. This then attempts to stop the process of the immune system that will then cause inflammation that will ravage surrounding tissue resulting in damage. (Curtis, et. al., 2013).
6. If we didn’t already know that Ms. M. had rheumatoid arthritis, what other conditions would be on the differential for this patient? Think about what other conditions can present with erythematous, painful, swollen joints. Identify 2 such conditions and describe the most common signs and symptoms.

• Tendonitis: inflamed tendons caused by overuse commonly occurs in joints (ex. wrists). S+S: pain, tenderness, reduced mobility, swelling
• Carpal tunnel syndrome: numbness, tingling in the hand caused by a pinched nerve in the wrist. S+S: pain in the wrist and hand, numbness/tingling, and weakness.
7. What are some possible long-term effects of chronic inflammation in conditions such as rheumatoid arthritis and other inflammatory conditions?
Some long-term effects of chronic inflammation is for healthy tissue to become injured or impaired over years of repeated inflammation. This then allows for a higher risk of comorbidities that often lead to a fatality like cancer, diabetes, or heart disease.

Citations
Cooney, J. K., Law, R. J., Matschke, V., Lemmey, A. B., Moore, J. P., Ahmad, Y., Jones, J. G.,
Maddison, P., & Thom, J. M. (2011). Benefits of exercise in rheumatoid arthritis. Journal of
aging research, 2011, 681640. https://doi.org/10.4061/2011/681640
Crofford, L. J. (2013, July 24). Use of nsaids in treating patients with arthritis. Arthritis Research
& Therapy. Retrieved September 21, 2021, from https://arthritis-
research.biomedcentral.com/articles/10.1186/ar4174#citeas.
Curtis, J. R., & Singh, J. A. (2011). Use of biologics in rheumatoid arthritis: current and emerging
paradigms of care. Clinical therapeutics, 33(6), 679–707.
https://doi.org/10.1016/j.clinthera.2011.05.044
Dimitrov, S., Hulteng, E., & Hong, S. (2016, December 21). Inflammation and exercise: Inhibition
of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation.
Brain, Behavior, and Immunity. Retrieved September 21, 2021, from
https://www.sciencedirect.com/science/article/abs/pii/S0889159116305645.
John Hopkins Medicine. (2020, April 14). Rheumatoid arthritis treatment options. Johns Hopkins
Arthritis Center. Retrieved September 21, 2021, from
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/.
Morović-Vergles J. (2013). Patofiziologija reumatoidnog artritisa [Pathophysiology of rheumatoid
arthritis]. Reumatizam, 50(2), 15–17.
Xavier, A. M., Anunciato, A. K. O., Rosenstock, T. R., & Glezer, I. (2016, April 19). Gene expression
control by glucocorticoid receptors during innate immune responses. Frontiers. Retrieved
September 21, 2021, from https://www.frontiersin.org/articles/10.3389/fendo.2016.00031/full.
PJ is a three-year-old boy who pulled a pot of boiling water over his head, arms, and chest, resulting in a mixed burn to the anterior surface of his head and arms, chest, and feet. He presents with his mother in the emergency department. His mother is quite upset and says nothing like this has happened before. PJ is visibly upset and appears in pain, but is responsive and behaving appropriately for the situation.
1. What factors determine the classification of burns? What type(s) of burn is most likely for this victim?
2. Describe the process taking place in the burned area during the first hours after the injury.
3. How will the physicians in the emergency room determine the percentage of the body that may be burned? What special considerations may be involved when evaluating a child?
4. Discuss the additional effects associated with burns, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia, and the treatments involved.
5. PJ’s mother asks you how she can help him get better. Identify and explain three interventions she can implement to promote healing.
6. As he was healing, PJ developed a bacterial infection on his right arm. Explain three predisposing factors to this infection.
7. How will this burn injury affect PJ’s growth and development? What are some of the social needs in this case?
1. What factors determine the classification of burns? What type(s) of burn is most likely for this victim?
Burns are classified by the depth of skin damage and the percentage of body surface care involved. (Hubert & VanMeter, 2018). First-degree burns damage the epidermis and appear red and painful. Second-degree burns involve the epidermis and dermis layers of the skin. This degree of burn appears red, swollen, blistered, and hypersensitive to touch. Third-degree burns occur when all skin layers are damaged. This appears as coagulated, charred, formation of eschar, and is quite painful. Based on the information presented in this case study, PJ likely has a second-degree burn. Blisters will form due to boiling water contacting his skin.
2. Describe the process taking place in the burned area during the first hours after the injury.
Immediately after burns, there is a shift in fluid, electrolytes, and proteins, throughout the body. The burn patient is at risk for hypovolemic shock and increased hematocrit during the first few hours after the injury. Neutrophils and monocytes, which are part of the body’s immune system, quickly travel to the site of inflammation and help in phagocytosis and cleaning of dead tissue and toxins released by the burned tissue (Tiwari, 2012).
3. How will the physicians in the emergency room determine the percentage of the body that may be burned? What special considerations may be involved when evaluating a child?
The rule of nines is used to quickly calculate the percentage of body surface area (BSA) covered by burns. Each arm is considered 9% of the total BSA (with each elbow to hand composing 4.5%), each leg is 18%, anterior and posterior parts of the trunk are each considered 18%, and the groin is 1% (Hubert & VanMeter, 2018). Children have larger heads and shorter limbs than adults, so special considerations will need to be applied for PJ.
4. Discuss the additional effects associated with burns, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia, and the treatments involved.
The inflammatory response which occurs after burns includes a loss of water and protein from the blood. This ultimately leads to a decreased blood volume and hypovolemic shock. Now that nerve endings are exposed from the damaged skin, burns are quite painful. Analgesics are required throughout the treatment and healing process. Fluid, electrolyte, and protein imbalances can occur with burns. Potassium ions move out of the cell and sodium and water molecules enter the cell. For this reason, it is crucial that these are replaced intravenously. Respiratory complications can also occur with burns. This is due to the inhalation of toxic chemicals which can harm the mucosal lining of the trachea and bronchi (Hubert & VanMeter, 2018). A concern is the inhalation of carbon monoxide, which binds to hemoglobin and inhibits the ability to oxygenate the blood. Opportunistic infections are causes of concern in burn patients because the skin, which is a normal infection-defense system for the body, is now damaged. Hypermetabolism occurs after burns because the body is consuming significant energy to heal itself. Additionally, the body uses more energy to maintain its own temperature, since heat loss is quicker in burns. Burn patients need to have an increased protein and carbohydrate diet to assist with the healing process. Finally, patients can develop anemia because erythrocytes were damaged, and bone marrow production was suppressed. Burn treatments include skin grafts, biosynthetic skin substitutes, as well as physical and occupational therapies to help prevent the scar tissue from hardening.
5. PJ’s mother asks you how she can help him get better. Identify and explain three interventions she can implement to promote healing.
PJ’s mother can help him get better by supporting his healing process. This includes setting up physical and occupational therapy appointments to help reduce the effects of scar tissue and increase the function of the affected areas (Hubert & VanMeter, 2018). Additionally, PJ’s mother can assist in rubbing antibiotic ointments over his burns to help prevent infections. Moisturizing lotions can be used once the skin is closed (MSKTC, 2021). Finally, PJ’s mother can assist the medical team in dressing changes while he is hospitalized, so she can learn how to do it in the comfort of their own home.
6. As he was healing, PJ developed a bacterial infection on his right arm. Explain three predisposing factors to this infection.
As previously mentioned, infections can quickly arise in burn patients because one of the immunological defense systems, the skin, is damaged. Multi-drug resistant organisms such as MRSA can easily enter and colonize in the body. Additionally, Norbury et. al (2016) discuss how the intravenous and intra-arterial catheters which are used in burn patients to provide access for delivery of resuscitative and pharmacologic therapy, can be a harbor for bacteria. Finally, if dressing changes are not completed by a sterile procedure, infectious agents are directly entered on to the skin. These 3 factors pre-disposed PJ to his arm infection.
7. How will this burn injury affect PJ’s growth and development? What are some of the social needs in this case?
Inevitably, scars and changes in skin pigmentation will form throughout his body. This can increase PJ’s psychological distress and decrease his self-confidence. As he grows, the skin grafts may become too stretched and he will need additional surgeries. PJ should be involved in support groups or psychotherapy to help him cope with his body’s changes. Furthermore, PJ will need to limit his outdoor activities until the skin heals. Sun rays and environmental allergens can interfere with the healing process. Socially, this may inhibit his ability to interact with his friends.
References:
Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions (6th ed.). Elsevier.
Model Systems Knowledge Translation Center. (2021). Wound Care After Burn Injury | Model Systems Knowledge Translation Center (MSKTC). Wound Care After Burn Injury. https://msktc.org/burn/factsheets/Wound-Care
Norbury, W., Herndon, D. N., Tanksley, J., Jeschke, M. G., & Finnerty, C. C. (2016). Infection in Burns. Surgical infections, 17(2), 250–255. https://doi.org/10.1089/sur.2013.134
Tiwari V. K. (2012). Burn wound: How it differs from other wounds?. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 45(2), 364–373. https://doi.org/10.4103/0970-0358.101319
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