Discussions 1

The mechanics of breathing are greatly compromised in each of the cases in the following manners: infant respiratory distress syndrome leads air sacs to collapse when air is expired and increases the energy needed to breathe; emphysema leads to air sacs becoming damaged and enlarged, which makes it difficult to breathe; and pulmonary fibrosis leads to air sacs becoming scarred, which makes it difficult to breathe.

The physiology that plays a vital role in the development of these diseases consists of the following: infant respiratory distress syndrome stems from a lack of surfactant in the lungs; premature birth is often one reason for this lack.[footnoteRef:2] The physiology of the development of emphysema can include the presence of chronic bronchitis which can lead to it; smoking, or exposure to harmful chemicals and irritants over time. For pulmonary fibrosis, the physiology includes exposure to silica dust, asbestos, coal dust, and long term exposure to toxins. [2: Jasani, Bonny, Nandkishor Kabra, and Ruchi Nanavati. "Surfactant replacement therapy beyond respiratory distress syndrome in neonates." Indian pediatrics 53, no. 3 (2016): 229-234.]

The factors that are most important for them to know as they treat patients are to understand the patient’s quality of life and to include the patient in the care process. Quality of care is meaningless if it does not include a conversation about quality of life when it...

This conversation can help each form the other.
2

I would tell the father that fluid management is what helps to improve the burn patient’s chances of survival. Burned skin sets of a chain reaction in the body: a necrotic zone develops and toxins can spread creating a shock to the system; unless the body is stabilized with fluids, the patient’s status can quickly become critical.[footnoteRef:3] [3: Haberal, M., Abali, A. E. S., & Karakayali, H. (2010). Fluid management in major burn injuries. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 43(Suppl), S29.]

Fluids are monitored by looking at blood pressure, heart rate and urine output, electrolytes, potassium and sodium levels, and to make sure the right balance is achieved.

As a clinician, the aspects of the boy’s condition that I would be most concerned about would be his breathing and his fluid levels. If these can be stabilized, the boy has a fighting chance.

3

The boy should be made aware of the possibility of infection that could occur from being cut by a rusty nail. He made need a tetanus shot, as Clostridium tetani thrive in oxygen deprived settings, like a rusty nail.[footnoteRef:4] It is important to let the boy know that he needs to check his records to see when the last time he had a tetanus shot was. If he hasn’t had one, it would be a…