Samamtha OSCE

Question 1

To which class does silver sulfadiazine belong?

Answer 1

Sulphonamides

Question 2

Please outline how silver sulfadiazine works?

Answer 2

This silver ion binds with the DNA of the organism, releasing the sulphonamide which interferes with the intermediary metabolic pathway of the microbe

Question 3

What side effects of silver sulfadiazine may Samantha expierence?

Answer 3

Leukopenia. Skin reactions

Question 4

What is silver sulfadiazine?

Answer 4

It’s an antibiotic cream

Question 5

Why does Samantha need silver sulfadiazine?

Answer 5

Samantha’s scalds means she is more likely to get an infection. This is an antibiotic cream that will help to reduce the chances of an infection.

Question 6

How does the silver sulphadiazine work?

Answer 6

Silver sulfadiazine works by killing off the germs before they get into Samantha’s body, so preventing infection rather than having to treat infection.

Question 7

How often will Samantha need the silver sulphadiazine?

Answer 7

The cream will be applied once a day, probably mid morning and then covered with a dressing

Question 8

So if Samantha’s burns start to clear up shoulr we stop applying the silver sulphadiazine?

Answer 8

No the cream will need to be applied until the skin has completely healed or there is a risk of infection

Question 9

What happens if he scalds get worse, not better?

Answer 9

Samantha will be reviewed daily by the healthcare team and if there is any deterioration in the wound we have many other options to help her recover

Question 10

Are there any side effects associated with taking silver sulphadiazine that I should look out for?

Answer 10

Most children do not have any problem with the cream. Very occasionally a child may have an issue with some of their white blood cells or a reaction on their skin, but these are rare.

Question 11

Is there anything else I could do to help Samantha’s scalds heal?

Answer 11

Ensure the wound is clean and dry

Ensure the dressings are clean and dry

Encourage Samantha not to touch/scratch the area

Encourage Samantha to rest to encourage healing

Monitor for increased redness and discharge in the wound. If noted, inform medical staff immediately

If Samantha develops a higher than normal temperature inform medical staff immediately

Question 12

From the history and assessment outline four physiological concerns you have for Samantha and relate them to the Pathophysiology of thermal injury
Concern1:

Answer 12

Samantha is in significant pain due to scalds

Samantha has a extreme temperature and burns can damage the epidermis, dermis and then the subcutaneous layer and potentially could damage the muscle exposing nerve endings to the air causing nerve irritation and pain.

Question 13

From the history and assessment outline four physiological concerns you have for Samantha and relate them to the Pathophysiology of thermal injury
Concern 2:

Answer 13

Samantha has an open wound, so is at risk of infection

Skin is a protective barrier to keep microbes out of the body. Children’s skin is thinner than adults, so there is an increased risk of damage.

The scald occurs then the skin is damaged which results in a increased opportunity for microbes to enter the body

Question 14

From the history and assessment outline four physiological concerns you have for Samantha and relate them to the Pathophysiology of thermal injury
Concern 3:

Answer 14

Samantha has blisters developing in the wound

The epidermal and dermal layers of skin start to produce serum, plasma and blood which may fill the gaps which cause blisters

Question 15

From the history and assessment outline four physiological concerns you have for Samantha and relate them to the Pathophysiology of thermal injury
Concern 4:

Answer 15

Tachypnoea, tachycardia and hypertension

Could be a response to pain, fear or there could be a systemic problem

Question 16

Name one concern relating to Samantha’s mental well-being

Answer 16

Samantha is very anxious and stressed and needs support

Question 17

Explain the process you would follow in preparation for prioritising care and writing a plan of care

Answer 17

Well it’s the nursing process:

I’d review Samantha’s history

Then review the assessment and clinical observations and decide which are out with acceptable limits

Decide the ADLs with which Samantha needs support

Consider priority of importance of Samantha’s needs

Write the care plan, ensuring each element is SMART

Ensure evaluation date is set

Question 18

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 1: Samantha is in a significant amount of pain due to scalds

Answer 18

Assess pain and administer analgesia as prescribed and evaluate the effect

Question 19

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 2: Samantha has an open wound, so is at risk of infection

Answer 19

Clean, dry and dress the would and apply antibiotic cream as prescribed to minimise risk of infection

Question 20

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 3: Samantha has blisters developing in the wound

Answer 20

Leave blisters intact unless advised by medical staff to do so. Clean, dry and dress the area, applying antibiotic cream as prescribed

Question 21

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 4: Tachypnoea, tachycardia, hypertension

Answer 21

Administer analgesia as prescribed then re-check vital signs once pain settled. If still elevated, escalate.

Question 22

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 5: Samantha is very anxious and stressed and needs support

Answer 22

Build a therapeutic relationship with Samantha and mum to reduce anxiety

Question 23

Of those 5 priorities of care, which three are the most urgent?

Answer 23

Samantha is in significant pain due to scalds

Samantha has an open wound, so is at risk of an infection

Samantha is very anxious and stressed so needs support