Case Study


Provide a brief summary of the case.

Anatomy and Physiology 1 Lab Name ________________________________

Case Study Assignment. You are a medical student working your way through college and are assigned to a hospital given background information on a patient. You were provided the chief complaint and brief history of the patient outlined below. You are asked by the nurse in charge to read the following case, investigate the topic (severe burns and function of the integumentary system) and complete a written report in MLA format including references addressing each of the questions identified below. Use this link for guidance on MLA writing format:

Total length of your report should be about two to three pages. The purpose of this assignment is to put things you are learning in the course (lecture and lab) into context using real life situations. This assignment’s focus is to investigate real issues of the integumentary system and epithelial tissues.

Chief Complaint: A 60-year-old female was admitted for severe second- and third-degree burns following her rescue from a burning house.

History: Lily Tigre, a 60-year-old female, was received in the emergency room and was reported to have been rescued from her burning house by the neighbor. The neighbor’s family dog was able to wake up the neighbor and they saw flames coming from the windows and heard a person screaming. Investigations at the scene suggest the patient was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, the patient had been rescued but emergency crews reported she had suffered severe burns and excessive smoke inhalation.

In the emergency room, Lily was unconscious. She had second-degree burns over 9% of her body and third-degree burns over 18% of her body — both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 60 / 37; heart rate = 212 beats / min.; and respiratory rate = 40 breaths / min. She was quickly deteriorating from circulatory failure. Two IVs were inserted, and fluids were administered through each. Her vital signs stabilized, and she was transported to the intensive care unit (ICU).

Lily regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.

Lily began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers. She lost 17 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories (“Kcals”) per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse.

Questions for you to address in your report. Your supervisor asks you to prepare a 2 to 3 page report to accomplish two things: 1) evaluate your knowledge about the integumentary system and how the body deals with severe stress as well as the specifics about the case; and 2) your supervisor needs to be apprised of the case in an official capacity. You are to address each of the items below in report form (MLA format means complete sentences and paragraphs with references). Assume you are writing your report to your supervisor relaying information about a patient (Lily). You are given clues in the above Case on pertinent information. It is likely you will need to use outside resources like your textbook as well as internet for your investigation. For example, your textbook would be a great resource for addressing the second item below, but you might need to research a little more to item 3. Your grade will be based on how well (professional) the report is written, how well each of the items below are addressed, and the accuracy of your report.

1. Provide a brief summary of the case.

2. In your summary, describe each of the three major layers that make up healthy skin.

3. In your report, explain what first-degree burns, second-degree burns, and third-degree burns are and how this relates to the patient.

4. Investigate and explain the process of debridement and how it relates to this patient.

5. Investigate why this patient was relatively pain-free when she woke up.

6. Explain why this patient’s blood pressure was so low and her heart rate was so high upon arrival at the emergency room (ie. What is causing this)

7. Explain why it was important to immediately administer intravenous fluids to this girl.

8. Investigate “broad-spectrum” antibiotics, and why they were administered and why antibiotics needed to be switched. Is healthy skin normally colonized by bacteria?

9. Address skin-grafting and why it was necessary in this patient? (Why not just let the skin heal on its own?)

10. In your report to your supervisor, describe the series of events that occur in skin which is healing with the help of a skin-graft.

11. Investigate decubitus ulcers and why bedridden patients are at risk for developing them. Explain in the report where on the body such ulcers most commonly occur.

12. Explain why the patient lost so much weight despite being on a very high-calorie diet.

13. Provide a conclusion of what long-term problems the patient may face as a result of extensive scar tissue formation over her trunk and her right elbow.

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