compliance and significant shunting. The physician should be notified immediately of
deteriorating respiratory status.
Medical management of the patient with acute respiratory failure requires intubation
and mechanical ventilation (if not already in use). If ARDS has developed, higher
oxygen levels, positive end-expiratory pressure, and pressure support are used with
mechanical ventilation to promote gas exchange across the alveolar–capillary
membrane (see Chapter 25).
Visceral Damage
The nurse must be alert to signs of necrosis of visceral organs due to electrical injury.
Tissues affected are usually located between the entrance and exit wounds of the
electrical burn. All patients with electrical burns should undergo cardiac monitoring,
with dysrhythmias being reported to the physician. Careful attention must also be paid
to signs or reports of pain related to deep muscle ischemia. To minimize the severity of
complications, visceral ischemia must be detected as early as possible. In the operating
room, the physician may perform fasciotomies to relieve the swelling and ischemia in
the muscles and fascia and to promote oxygenation of the injured tissues. Because of
the deep incisions involved with fasciotomies, the patient must be monitored carefully
for signs of excessive blood loss and hypovolemia.
Evaluation
Expected Patient Outcomes
Expected patient outcomes may include the following:
Achieves optimal fluid balance
o Maintains intake and output and body weight that correlate with
expected pattern
o Exhibits vital signs and hemodynamic values within designated limits
o Demonstrates increased urine output in response to diuretic and
vasoactive medications
o Has heart rate less than 110 beats/min in normal sinus rhythm
Has no localized or systemic infection
o Has wound culture results showing minimal bacteria
o Has normal urine and sputum culture results
Demonstrates anabolic nutritional status
o Gains weight daily after initial loss secondary to fluid diuresis and no
oral intake of food or fluid
o Shows no signs of protein, vitamin, or mineral deficiencies
o Meets required nutritional needs entirely by oral intake
o Participates in selecting diet containing prescribed nutrients
o Exhibits normal serum protein levels
Demonstrates improved skin integrity
o Exhibits generally intact skin that remains free of infection, pressure,
and injury
o Demonstrates remaining open wound areas that are pink, re-
epithelializing, and free of infection
o Demonstrates donor graft sites that are clean and healing
o Has healed wounds that are soft and smooth
o Demonstrates skin that is lubricated and elastic
Has minimal pain
o Requests analgesic agents before specific wound care procedures or
physical therapy activities