TBSA Burns

John is a 17-year-old male with a 30% TBSA burns (both deep partial and full-thickness) to chest, abdomen, right side of face, neck, back, and upper arms to wrist bilaterally (hands were spared). He was given fluid resuscitation and a nasogastric feeding tube immediately. The injury occurred at work during a fall on the ice while carrying hot grease to the oil dumpster. John, a high school senior, lives 2 hours from the Level I trauma and burn center and was transported from the local hospital.

The occupational therapists at the burn center completed an evaluation of John’s burn wounds and medical status within the first 24 hours of his arrival. The goal was for John to successfully return to being an independent high school senior. John’s parents were present at his bedside on the burn unit. They were divorced but had a good relationship in caring for their son.

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Pam is a 76-year-old female, diagnosed with stage III colorectal cancer with metastases to the nearby lymph nodes in her pelvis and groin. She is a retired waitress with a history of cigarette smoking (quit at age 50) and a family history of cancer. Pam lives alone in a rural town (except for her beloved pets). She has a two story house with a full bath on the first level, two bedrooms, and one bathroom upstairs. She has a daughter and grandchildren nearby and two daughters who live out of state. She has to travel over an hour to the closest hospital for health-care visits (oncology, radiotherapy, chemotherapy). Due to the location of her cancer, she is not a candidate for surgery and opted for intensive radiation and chemotherapy. Part way through her 6 weeks of almost daily radiation, and after her first week-long chemotherapy infusion, she is extremely fatigued, dehydrated, and has a very low blood pressure. She barely has energy to walk to the bathroom, talk on the phone, and can no longer walk up the stairs to her bedroom. She has no appetite, and is also experiencing very painful blisters in her mouth and throat from the chemotherapy. The home health nurse referred her for home health OT.