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YJPDN-01526; No of Pages 6

Journal of Pediatric Nursing xxx (2017) xxx–xxx X

Contents lists available at ScienceDirectX

Journal of Pediatric Nursing

Use of Essential Oils Following Traumatic Burn Injury: A Case Study


a a a, b,
Kathleen Jopke , Heather Sanders , Rosemary White-Traut X
Children's Hospital of Wisconsin, United States

University of Illinois at Chicago, Department of Women, Children, and Family Health Science, United States
nce extensive burns re-quire longer hospital
stays and are at increased risk for infection and
hospital acquired conditions. This compar-ative
case study is a two patient matched case control
article info abst design that follows the hospital course of two
ract children who experienced burn injuries. For one
Article history: of these patients, with the consent of the child's
parents, the grandmother treated her
Hospita granddaughter with essential oils. Essential oils
Received 4 August 2016 Revised 27 December 2016 Accepted 29 l have the potential to inhibit microbial growth,
December 2016 Available online xxxx admissi support treatment of wounds, and facilitate
ons healing. However, there have been no large
related scale studies on essential oils. Data for the two
Keywords: to burn cases were retrieved from the electronic medical
injury record at a Midwestern Pediatric Hospital.
reach Retrieved data included burn site description,
Pediatric burns Infection
40,000 treatment for burns, number of days on the
annuall ventilator, white blood cell count, length of
Hospital acquired infections Essential oils y. hospital stay, number of ICU days, infections
Patients diagnosed by positive culture and pain ratings.
who While the goals for treatment were the same for
Case study experie both children, the child who received only
standard care was diagnosed with two blood stream infections findings h is needed to expand understanding of the role
and four hospital acquired conditions while the child who are of essential oils in the treatment of burns.
received supplemental treatment with essential oils did not intrigui
develop any blood stream infections, was diagnosed with one ng,
hospital acquired condition, was in the PICU one day less, and researc © 2017 Elsevier Inc. All rights reserved.
had a four day shorter length of hospital stay. While these case
( approval was not topically and by
P required. Corporate inhalation ( Buckle,
The purpose of this
I Compliance review
case study is to present 2003; Ozata,
Introduction C indicated that
treatment, incidence of 2006).X
U approval from the
infection, length of
) parents was not
Hospital admissions related to burn hospital stay, and
required as we were
injury reach 40,000 annually ( health outcomes of two
s not indicating
children
American Burn Association NBR t patient names and Types of Burns
Advisory Committee, 2012, 2013). a both pa-tients were
Pa-tients who experience extensive y Corresponding author at: well known to two
Children's Hospital of In 2013, the
burns (greater than 30% total body . of the authors. The
Wisconsin, United States. E- American Burn
sur-face area [TBSA]) requiring X children's names
mail address: rwt@uic.edu have been altered to Association
longer hospital stays are at
reported 3400
increased risk for infection and (R. White-Traut). X protect their
fire/burn/ smoke
hospital acquired conditions ( identity. For one of
these patients, with inhalation deaths (
American Burn Association NBR P
the consent of the American Burn
u
Advisory Committee, 2012, 2013). http://dx.doi.org/10.1016/j.p child's parents, the Association NBR
r
While treatment of children with edn.2016.12.018 0882- grandmother Advisory
p
burns is complex, often family 5963/© 2017 Elsevier Inc. supplemented her
o Committee, 2012,
members supplement the care the
s All rights reserved.X granddaughter with
2013). Residential
child receives with alternative essential oils
e fires accounted for
approaches. One alternative because she
2550 of these
approach we review is the use of believed they could
o deaths, 300 deaths
essential oils which have the with similar histories inhibit infection.
f were from vehicle
potential to inhibit microbial of extensive burns The grandmother
crash fires, and 550
growth, support treatment of (40% TBSA and used lavender and a
t from other sources (
wounds, and facilitate healing and consisting of partial blend of essen-tial
h
recovery ( Allard & Katseres, and full thickness oils thought to have Wolf, Phelan, &
e
burns). One child's immune-supportive Arnoldo, 2014). Of
2016). However, there have been
no large scale studies on essential C care was augmented properties. She the 550 deaths, 400
with essential oils diffused the oils oc-curred as a result
oils ( Allard & Katseres, 2016) and a
s while the second child into the air and of contact with
little research on children or with received standard care. applied them to electricity, liquids,
e
burn patients is reported in the This case study was intact skin on the or hot objects. The
literature. The first author of this submitted for IRB soles of her feet and primary cause of
S
case study was the primary nurse approval but was forehead. Two death in burn
t
for both pa-tients presented. The determined it did not means of victims is multi-
u
observations made were only meet the definition of administering organ failure with
d
during the Pediatric Intensive Care research therefore IRB lavender oil are sepsisX
y
recom-mended -

Please cite this article as:


Jopke, K., et al., Use of
Essential Oils Following
Traumatic Burn Injury: A
Case Study, Journal of
Pediatric Nursing (2017),
http://dx.doi.org/10.1016/j
.pedn.2016.12.018X
2 K. Jopke et al. / Journal of Pediatric Nursing xxx (2017) xxx–xxx
bacteria include Patients are treated in the
Pseudomonas,X Operating Room (OR) for an
being the primary trigger. Seventy-three
initial debridement to prepare
percent of burns occur in the home ( the skin bed for grafting.
American Burn Association NBR Acinetobacter, and WhenX
Advisory Committee, 2012, 2013). Of Staphylococcus aureus.
191,848 reported burn cases, 19% were
needed, skin grafting is
children under five years of age ( Hospital Course and
conducted in the OR and
Treatment
American Burn Association NBR requires anesthesia and
Advisory Committee, 2012, 2013). Scald intubation. Several types of
Initial care management for grafts may be used
injuries are most prevalent in children
severe burn patients often depending on the patient's
under 5 years of age ( American Burn includes in-travenous (IV) TBSA.
Association NBR Advisory Committee, fluid resuscitation, Parkand
Formula Resuscitation ( Essential Oils
2012, 2013).X
Baxter, 1978; Fakhry,
Alexander, Smith, Meyer, &
In many health care settings,
Peterson, 1995) se-dation,
including post-surgery,
intubation, placement of a
Complications and Infection patients and families are
gastric tube, insertion of a
supplementing care with
urinary catheter, adequate
Between 2003 and 2012, 96.6% of analgesia, and central and essential oils ( Stea, Beraudi,
hospitalized burn patients sur-vived ( Wolfarterial line insertion ( & De Pasquale, 2014).
& Arnoldo, 2013). The majority of deaths Australian and New Zealand Aromatic plants had been
occur within the first 72 h. Complications Burn Association & used since ancient times for
resulting from burn injury include wound Education Committee, the preservative and
pain, infection, inhalation injury, medicinal properties (e.g.
2006; Enoch, Roshan, &
pneumonia, scarring, debriding and re- immune sup-port) and to
constructive procedures, pruritis, and Shah, 2009; Advanced Life impart aroma and flavor to
mental health instability (in-creased Support Group, 2004). food ( Edris, 2007). Essential
tension, anxiety, stress, and post-traumatic Patients may also receive
oils are mainly used topically
stress) ( Wolf et al., 2014). For all routine wound care and daily
and through air (diffusion).
dressing changes, bowel
patient age groups admitted to the Oils are steam distilled or
management, physical
hospital, length of hos-pital stay averages cold pressed for extraction.
therapy (PT), occupational
8–9 days ( American Burn Association All essential oils are ex-
therapy (OT), speech therapy
tracted from different parts of
NBR Advisory Committee, 2012, 2013). (ST), respiratory ther-apy the plant. For citrus, it comes
(RT), hyperbaric oxygen
Length of hospital stay can reach over 61 from the rind. Other oils
therapy, skin grafts and
days when a patient incurs burns covering come from the bark, the
titrated pain med-ications.
70%–79% TBSA ( American Burn stem, the flower, or the root.
Nutritional therapy is
There are many different
Association NBR Advisory Committee, carefully managed. Due to
types of essential oils and
2012, 2013).X the injury and the required
they are used for dif-ferent
care which often includes
therapeutic purposes, e.g.
painful procedures and
analgesia, antiseptic,
The incidence of burn related disfig-urement, patients often
antimicrobial, and
complications increases with in-creased experience increased anxiety,
TBSA burns. Within the first ten days after post-traumatic stress, and antidepressant properties. In
hospital admission for severe burns, the depressive symptoms ( Table 1, we present a
prevalence for early infection is 50% and summary of the chemical
Backstrom, Ekselius, Gerdin,
sepsis is 16% ( Wolf et al., 2014). For this compounds and therapeutic
& Willebrand, 2013; actions of lavender essential
case study, we will consider severe burns
Grigorovich, Gomez, Leach, oil ( Cavanagh & Wilkinson,
to be greater than 40% TBSA. Factors
& Fish, 2013). During
contributing to infection in-clude loss of 2002; Daferera, Ziogas, &
healing, patients also
skin barrier, arterial and venous access, Polissiou, 2000; Denner,
mechanical ventila-tion, and compromised experience pruritis ( Kuipers
2009; Koulivand, Khaleghi
immune function.X et al., 2014).X Ghadiri, & Gorji, 2013; Price
& Price, 2007; Roller,
The most prevalent complications In this particular ICU, the Ernest, & Buckle, 2009), and
following a burn injury include standard care for burns and the oil blend of wild or-ange
hypermetabolism, pneumonia, urinary wound care in-cludes daily ( Aroma Tools, 2014; Geraci,
tract infections (UTI), cellulitis, cleaning with a mild soap,
Di Stefano, Di Martino,
respiratory failure, septicemia, wound debridement, and topical
infections, renal failure, arrhyth-mia, appli-cation of antimicrobial Schillaci, & Schicchi, 2016;
central line associated bloodstream agents. Wounds are dressed Schelz, Molnar, & Hohmann,
infection (CLABSI), and sys-temic with a non-adhering dressing 2006; Wu et al., 2010), cin-
infection ( American Burn Association and wrapped (non- namon ( Aroma Tools, 2014;
circumferentially) with a dry
NBR Advisory Committee, 2012, 2013). gauze wrap dressing. Barceloux, 2009; Liakos et
Hypermetabolism is characterized by a Hypothermia is avoided by al., 2014; Starliper et al.,
profound increase in metabolic rate treating the patient in a warm 2015; Wu et al., 2010), clove
leading to slow wound healing, prolonged environment and giving ( Aroma Tools, 2014;
generalized weakness, loss of lean body warmed IV fluids ( Kim,
Halder, Mehta, Mediratta, &
mass, and increased morbidity ( Lee, Sharma, 2011; Wu et al.,
Martin, & Holland, 2012).
Norbury, & Herndon, 2012). Common
2010), eucalyptus ( Aroma Tools, 2014; from the electronic medical
record and Virtual Patient
Liakos et al., 2014; Schelz et al., 2006; Case Reports
System data set (VPS) at a
Serafino et al., 2008; Wu et al., 2010) free-standing Mid-western
and rosemary ( Aroma Tools, 2014; Pediatric Hospital, which has Case Control (Case A)
296 beds and 24 trauma ICU
Schelz et al., 2006; Wu et al., 2010) that beds. Retrieved data included
Kesha was a 2 ½ year old
were used by the grandmother. The level the child's age, sex,
female who was the victim of
of evidence for the use of each of these mechanism of injury (e.g.
a house fire and sustained
oils is also presented in Table 1 according scalding verses housefire), significant flame burns
percent of TBSA, daily
to the American Association of Critical covering greater than 40% of
highest temperature, white
Care Nurses (AACN) ( Armola et al., her TBSA. This included
blood cell count (WBC
partial and full thickness
2009).X 3
10 /μL), pain score, ICU burns to the face, trunk
days, infections di-agnosed (abdomen and chest), right
by positive culture and site. shoulder, and all four
Additional data collected extremities (including fingers
included antibiotic therapies, and toes). She also suffered
complications, supportive severe smoke inhalation and
Data Collection
therapies (e.g., PT, OT, ST), was intubated on arrival to
and length of hospital stay. the Emergency Department
The case control was identified via the The PICU staff nurses used (ED) and remained intubated
Virtual Patient System data set (VPS) and the FLACC pain scale to for 28 consecutive days.
matched to the case of interest. The case of assess levels of pain ( Unfortunately, Kesha's
interest was identified by the PICU staff mother, a sin-gle parent, died
Merkel, Voepel-Lewis,
because the grandmother supplemented in the fire. Kesha was cared
the standard care. Shayevitz, & Malviya, for in the PICU for 41 days
1997).X and hospitalized for a total of
82 days.
Data for these two cases were retrieved
Essential Oils Study, Journal of http://dx.doi.org/10.1016/j.pedn.2016.1
Following Pediatric Nursing 2.018X
Please cite this article as:
Traumatic Burn (2017),
Jopke, K., et al., Use of
Injury: A Case

K. Jopke et al. / Journal of Pediatric Nursing xxx (2017) xxx–xxx


3
Table 1

Essential oils administered.


Essential oil
Chemical compounds
Therapeutic action
Level of

evidence

Lavandula angustifolia (lavender flower, steam


Linalool, linalyl acetate, lavandulol,
Analgesia, antibacterial, antifungal, antidepressant,
n
Level E , Level X
distillation)
lavandulyl acetate, camphor
a
X
antispasmodic, balancing & sedation
b,c,d,m
X
o
M , Level C
p
X
Wild orange (Citrus sinensis) (from the orange rind,
Monoterpenes, tetraterpenes,
Antiseptic, antimicrobial, antiplasmid
d,e,k,l
X
n
Level E , Level X
cold pressed)
aldehydes, alcohols, ketones
a,l
X

p
C , Level M
o
X
Cinnamon (Cinnamomum zeylanicum) (from the
Aldehydes, phenols, alcohols,
Astringent, germicide, antibacterial, antifungal,
o
Level M , Level X
cinnamon bark, steam distillation)
sesquiterpenes, carboxylic acid X
d,f

antimicrobial
d,f,g,j,k
X
n
E , Level C
p
X
Clove oil (Eugenia caryophyllata) (from the clove
Phenols, esters, sesquiterpenes, oxides
d,h
X
antifungal, antibacterial, anti-inflammatory
o
Level M , Level X
bud, steam distillation)

4,8,11
constituents

C
p
X
Eucalyptus (Eucalyptus radiata) (from the leaf,
Oxides, monoterpenes, alcohols,
Anesthetic, antiseptic
d,e,i,j,k
X
o
Level M , Level X
steam distillation)
aldehydes
d,i
X
C p X
Rosemary (Rosmarinus officinalis) (from the flower
Oxides, monoterpenes, ketones,
Antimicrobial, antifungal, antimicrobial
d,e,k
X
o
Level M , Level X
& leaf, steam distillation)
alcohols, sesquiterpenes X
d

C X
p

Note. Adapted from “AACN levels of evidence: What's new?” by Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M.,
Bucher, L., Harrington, L., …, Medina, J., 2009, Critical Care Nurse, 29(4) pp.70–73.
Cavanagh and Wilkinson (2005), Prashar, Locke, and Evans (2004), and Woronuk, Demissie, Rheault, and Mahmoud (2011).

Cavanagh and Wilkinson (2002), Denner (2009), Price and Price (2007), Daferera et al. (2000), and Roller et al. (2009). X

Kane et al. (2004). X

Aroma Tools (2014). X

Schelz et al. (2006). X

Barceloux (2009). X

Starliper et al. (2015, #30). X

Halder et al. (2011). X

Serafino et al. (2008). X

Liakos et al. (2014). X

Wu et al. (2010). X

Geraci et al. (2016). X

Mori, Kawanami, Kawahata, and Acki (2016). X


Level E – Theory-based evidence from expert opinions or multiple case reports.

Level M – Manufacturer's recommendations only.

Level C – Qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews or randomized controlled trials with
inconsistent results.
separate central venous and left femoral
lines (CVL) that totaled arteries, which also
Initially all burns were dressed in the ED with
50 CVL days and two required more than
Silvadene™, Adaptic ™, Kerlix™, and secured with
different arterial lines aver-age dressing
Se Pro Net™. Facial burns were dressed with an
for 30 arterial days. changes because of
antibiotic ointment (Bacitracin™). Vascular access
Three of the CVL's contamination with
was established and fluid replacement was started
were located in her liquid stool.X
using the Parkland Re-suscitation Formula ( Baxter, right and left internal
1978; Fakhry et al., 1995). Upon admission to the jugular veins (IJ),
PICU, a Foley catheter and Nasogastric tube (NG) which necessitated Initial pain management
were placed. Nutritional therapy was initiated on day numerous unplanned included continuous
2, through the NG tube. Kesha was treated in the dressing changes drips of Morphine and
Operating Room (OR) on 10 separate days for because of weeping Midazolam, with
debridement, tangential excisions, dressing changes, wounds, emesis, and intermittent doses of
and skin grafts. While in the PICU, bedside dressing movement. The arterial Lorazepam. Using the
changes occurred as indicated. Kesha had five lines were in her right FLACC pain scale, by
Day 3, Kesha's pain scores were recorded at an 8 left knee and all lines grafts did not take at all.
(possible range 1–10, with 10 as the highest amount were replaced. Days 10 The WBC's elevated to
of pain) ( Merkel et al., 1997) and treated with a through 13 Kesha 3
22.1 (10 /μL) and
received a Pentobar-
continuous drip of Dexmedetomidine (see Fig. 1). bital drip for sedation followed an up and
down pattern over the
General anesthesia was used for all OR procedures. because she had been
Pain management for bedside dressing changes thrashing in bed and next fewX
included intravenous Fentanyl and Propofol doses. disrupting her grafts,
Pain scores averaged 4.8 throughout the PICU stay preventing them from
(see Fig. 1). At the end of the fourth week, a healing. On day 13,
Kesha had a positive
Methadone wean was initiated to help with
withdrawal issues. Then Kesha was slowly weaned urine culture (see Fig.
off her continuous drips and started on a patient 3) for Candida
controlled analgesia pump (PCA) of Morphine. The tropicalis, which is
following week the PCA was switched over to oral considered to be a
Roxicet and Kesha was able to communicate with catheter-associated
staff and start oral feeds.X urinary tract infection
(CAUTI) (see Fig. 4),
and fluconazole was
A temperature spike was noted on day 7 (see Fig. 2) started. On day 18 a
with a maxi-mum of 40.3 °C and white blood cell second CAUTI de-
counts (WBC's) were starting to trend upward. veloped for yeast, at
Streptococcus Viridians grew from an endotracheal this point she was
cul-ture (ETT) and Unasyn™ was started for switched to a 10 day
coverage (see Fig. 3). DuringX course of Micafungin
(see Figs. 3 & 4). A
graft check in the OR
the remainder of the PICU stay, temperatures
occurred on day 21 and
consistently stayed in the 39–41 °C range. On day 10
revealed the grafts over
she was taken to the OR for graft checks. The
her right shoulder and
findings were a successful graft take to 60% of the
axilla did not take at all.
anterior chest and abdomen, 100% to the left upper
She had several other
thigh, and 70% to the right arm. There was an area of
areas on the right chest Fig. 1. Daily high FLACC
burns to bilateral lower extremities with recurrent es-
and the right upper pain score.
char. Quantitative cultures were taken of the right and
extremity where the
Following Journal of (2017),
Traumatic Pediatric
Please cite this article as: Jopke, K., http://dx.doi.org/10.1016/j.pedn.20
Burn Injury: A Nursing
et al., Use of Essential Oils 16.12.018X
Case Study,
4 K. Jopke et al. / Journal of Pediatric Nursing xxx (2017) xxx–xxx
g
.
4
.
H
o
s
pi
ta
l
a
c
q
ui
re
d
c
o
n
di
ti
o
n
s.

F
i
Fig. 2. Highest daily temperature.
dressing changes
occurred daily un-
days. A tracheal aspirate from
less she was in the
day 26 was positive for
methicillin resis-tant OR.X
Staphylococcus aureus
(MRSA), as well as an
Maria had 2 central
arterial and central ve-nous
venous lines (CVL)
line (CVL) culture from day
in her right and left
28 which were positive for
IJ for a total of 74
yeast. This was considered as
days and 7 days
a central line associated blood
respectively, as
stream infection (CLABSI)
well as a right
(see Figs. 3 & 4). femoral arte-rial
Vancomycin and Micafungin line for 18 days. It
were started for a 10 day should be noted
course. On day 33 a CLABSI that the arterial line
for Candida parapsilosis did not have
showed up on a blood culture
from the CVL (see Figs. 3 &
4). A third course of
Micafungin was initiated. On
day 34 Kesha had a positive
culture from a nasal swab for
MRSA (see Figs. 3 & 4). On
day 40, she developed anoth-
er infection from the CVL
that was positive for
Providencia Rettgeri (see
Figs. 3 and 4). A course of
Ciprofloxacin was
administered for 10 days.
Kesha was transferred to the
general floor on day 41 and
remained hos-pitalized for an
additional 41 days.X

The hospital where Kesha

Please cite this


article as: Jopke, K.,
et al., Use of
Essential Oils
Following Traumatic
Burn Injury: A Case
Study, Journal of
Pediatric Nursing
(2017),
http://dx.doi.org/10.1
016/j.pedn.2016.12.0
K. Jopke et al. / Journal of Pediatric Nursing xxx (2017) xxx–xxx
5

on the child's foot once. feeds held. Vomitus


She diluted the blend saturated the upper
an occlusive dressing over it the entire 18 days,
with 10 mL of extremity dress-ings,
because Maria did not have any intact skin in that
fractionated coconut oil necessitating a burn and
area to hold a dressing on. Instead a 5 × 5 piece of
and 1 drop of the pure CVL dressing change.
Mepilex™ AG was placed over the area. Maria also
lavender oil. The After this incident her
had issues with CVL dressings not staying on or
grandmother rotated the temperature spiked to
maintaining occlusively because of frequent emesis,
oils. For ex-ample, in 40.5 °C (see Fig. 2).
wounds weeping and movement in bed. The arterial
the morning the
line in her groin often became saturated from her On day 10 the WBC's
grandmother would
burn wounds weep-ing, incontinence, or it would fall had increased to 33.3
diffuse 5 drops of
off from her movement in bed. 3
(10 /μL). She had two
laven-der in 100 mL of
tap water and place a positive cultures
Maria had a primary nurse (first author) and associate diluted blend of oils identified, which were
nurses on her health care team. She developed a (cinnamon, clove, Enterococcus in the
trusting bond with many of her care-givers, including eucalyptus, rosemary urine and
nurses, respiratory therapists, physicians, OT, PT and and wild orange) on the Staphylococcus from
ST. Maria also allowed the medical team to bottom of the child's the endotrachial tube
administer her burn care without resistance. Child feet. In the evening, she (ETT) aspirate (see
Life Specialists were involved with her cares done at diffused 5 drops of the
Fig. 3). The
the bedside. A Nutritionist was assigned to her care blend of oils in 100 mL
Enterococcus in the
on day 2. A psychologist started seeing her after she of tap water and used
urine was considered a
was no longer routinely on sedation medication. the rollerball of the
CAUTI and a hospital
lavender using the same
acquired infection
application and dilution
Maria had a large extended family, and someone was
method. After the (HAC) (see Fig. 4).
at the hospital for her entire length of stay. Her
second degree facial On day 11, Maria
mother and grandmother were devas-tated by the
burns healed, she returned to the OR for
injury and had a difficult time coping. Some of the
applied the diluted evaluation of the skin
nurses developed a supportive relationship with the
lavender blend, one grafts, and they were
family. Family members expressed how seeing
swipe twice per day to noted to have taken
familiar faces everyday increased their trust in
the left side of the 100%. The
Maria's caregivers, and eased their stress. Maria's
child's forehead. She temperatures remained
parents and grandpar-ents were given the option to be
thoroughly cleaned the elevated and by day 13
in the room for most bedside proce-dures. The
diffuser every morning she had another positive
grandmother chose to stay in the room for
and dried it before use. ETT culture for
everything. It was difficult for the mother to watch
This treatment con- Candida albicans, rare
her child undergo treatment. Ini-tially, the mother
tinued for 71 days, until Enterobacter, and a few
needed a sheet to cover Maria's injuries, before she
discharge.X Streptococcus
could enter her room. The nurses and therapists
worked in collaboration to educate and teach the viridansX
family members how to comfort and care for Maria.
After learning all of the detailed care, Maria was
discharged to home under the care of her mother and Maria developed severe (see Figs. 2 and 3).
grandmother. The primary goals for Maria were to opioid constipation and She was started on
minimize her pain, remain infection free, opti-mize was placed on a chronic Micafungin and
nutrition, mobility, skin integrity, and self-image. bowel regime. On day 9 Gentamicin. On days
she had an episode of 15–22 a steady increase
abdominal dis-tention, in the WBC was
Initial pain management included continuous drips of
vomiting, fever and observed along with
Dexmedetomidine, Fentanyl, and Ketamine. All OR
hypotension. Her work ele-vated temperatures,
procedures were conducted under general anesthesia.
of breathing in-creased reaching a maximum of
Pain management for bedside dressing changes
dramatically. A 41.8 °C on day 20 (see
included extra doses of Ketamine, Midazolam, and
radiograph of the
Propofol, titrating to Maria's specific need. Nurses Fig. 2). When
kidneys, ureters and
assessed Maria's pain as a 0 for the first few days, reviewing each of these
bladder (KUB) and X-
because she was heavily sedated. The next few days days individually
ray showed a right lobe
her pain scores rose to 6–7 and a Morphine PCA was significant is-sues
infiltrate, most likely as
added and she was weaned off by the 11th day. Pain occurred. On day 15 a
a result of aspiration,
scores averaged 4.4 throughout the PICU stay (see and air filled dilated tracheal aspirate came
back positive for
Fig. 1). On day 4, a low dose epineph-rine drip was bowel with Stenotrophomonas
questionable portal
started to aid in perfusion overnight. Later in the maltophilia. She was
venous gas. She was
afternoon she was extubated to an oxygen nasal also placed on a 2 week
intubated, started on
cannula. Maria was re-intubated on day 6 during an course of Bactrim™.
empiric antibiotics
OR skin grafting procedure. On day 7, Maria was On day 16, increased
extubated. The grandmother started using the abdominal distention
essential oils. The oils were placed on the soles of the (Vancomycin and and poor lung
child's feet and diffused into the air via an ultrasonic Zosyn™), a fluid bolus compliance were noted,
water diffuser. The grandmother used a rollerball to was given, a nasogastric and ventilator settings
ad-minister the oil and swiped in a downward motion tube placed, and NJ needed to be signif-
icantly adjusted. Ventilation and oxygenation compared. Additionally, opti-mal healing, Maria
remained difficult. On day 18, an emergent flexible no other factors that likely had lower
Sigmoidoscopy was performed for severe con- might influence the nutritional support due
stipation with abdominal distention leading to differences were to her chronic
respiratory compromise. The procedure showed hard considered in the case constipation.
formed stool throughout the rectum and chronic presenta-tions. For
ulceration in the distal sigmoid. Some stool was able example, it is not
to be re-moved. On day 19, Maria continued to known what infection
experience poor lung volumes and a concern for rates of other children Summary
ascites was raised. A computerized tomography (CT) with similar diagnoses
scan of the abdomen showed marked ascites. Maria were during that same
In comparing the course
was taken to Inter-ventional Radiology for a time period nor is it
of treatment and
paracentesis and peritoneal drain placement. A total known what the overall
recovery of these two
of 450 mL of fluid were removed. An improvement in infection rate of
chil-dren both received
respiratory mechanics was noted afterwards. On day patients in this PICU
standard care. Nursing
22 all lower extremity dress-ings and the arterial line were while these
goals included
were saturated with fecal contents. Dressings were children were
minimizing their pain,
changed and the arterial line and Foley were hospitalized.
prevent infection,
removed. WBC's were at a maximum of 35 (10 /μL). Additionally, hospital
3
optimizing nutrition,
staff and parents are not
On Day 24, the OR graft check found that the left facilitating mobility,
routinely cultured.
allograft site was clean and intact, however the right maintaining skin
Further, it is not known
allograft site looked poorly incorporated and more integrity, and fostering
whether, or how, the
exudative. The following day she was extubated after positive self-image.
presence of family care
her bedside dressing change. Maria was transferred Both fam-ilies visited
and visitation may have
out of the PICU to the general care unit on day 40 daily and became
influenced the children's
and was discharged to home on hospital day 78.X hospital progress. engaged in the care of
their children with the
Maria's grandmother
exception of Maria
was a constant presence
whose grandmother
while Kesha's mother
administered essential
died in the fire. Kesha's
oils. Maria's
father was pres-ent
Limitations grandmother verbalized
during her hospital stay.
that administering the
While nutritional
essential
This case study has several limitations. These support is critical to
limitations include that only two children were
Following Journal of (2017),
Traumatic Pediatric
Please cite this article as: Jopke, K., http://dx.doi.org/10.1016/j.pedn.20
Burn Injury: A Nursing
et al., Use of Essential Oils 16.12.018X
Case Study,
6 K. Jopke et al. / Journal of Pediatric Nursing xxx (2017) xxx–xxx
oils to enhance nursing practice and
for self-care. American Journal of Control, 10(1), 35–37. X
oils reduced her own stress. It also made
Nursing, 116(2), 42–49.
her feel that she was doing something Daferera, D. J., Ziogas, B. N., &
helpful for her granddaughter realizing http://dx.doi.org/10.1097/01.
that Maria often calmed down while the Polissiou, M. G. (2000). GC–MS
oils were diffused. While the goals were
NAJ.0000480495.18104.db. X
analysis of essential oils from
the same for both children, Kesha was some green aromatic plants and
diagnosed with four HACs while Maria American Burn Association NBR their fungitoxicity on Penicillium
was diagnosed with one. Although Kesha Advisory Committee (2012). digitatum. Journal of Agricultural
and Maria were similar in their degree of and Food Chemistry, 48, 2576–
burns (40% vs. 50% respectively) and National burn repository 2012
length of stay (82 vs. 78 respectively), report. (Version 8.0 ed.) American 2581.X
Burn Association, National Burn
they experienced a different hospital
course. Maria experienced more Repository, 14–87. X Denner, S. S. (2009). Lavandula
complications yet was in the PICU one angustifolia Miller: English
day less and had a four day shorter length lavender. Holistic Nursing Practice,
American Burn Association NBR
of hospital stay than Kesha. Additionally, 23(1), 57–64.
Kesha developed two blood stream Advisory Committee (2013). http://dx.doi.org/10.1097/01.HNP.0
infections while Maria did not de-velop National burn repository 2014 000343210.56710.fc. X
any. This finding is notable because report. (Version 8.0 ed., Vol. Version Edris, A. E. (2007). Pharmaceutical
Maria's arterial line was never dressed 10.0) American Burn Association, and therapeutic potentials of
occlusively and was exposed to many National Burn Repository. X essential oils and their individual
stooling episodes. Kesha had five separate volatile constituents: A review.
Armola, R. R., Bourgault, A. M., Phytotherapy Research, 21(4), 308–
central venous lines for a total of 50 days Halm, M. A., Board, R. M., Bucher,
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had a total line access of 80 days while
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Maria's total was 99 days.
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(2009). Emergency and early
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potential to inhibit microbi-al growth, Fakhry, S. M., Alexander, J., Smith,
support treatment of wounds, and facilitate and New Zealand Burn D., Meyer, A. A., & Peterson, H. D.
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Martino, E., Schillaci, D., &
spread imple-mentation of essential oils, http://dx.doi.org/10.1111/j.1365 Schicchi, R. (2016). Essential oil
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Acknowledgment Baxter, C. R. (1978). Problems and
survivors. Journal of Burn Care &
complications of burn shock
Research, 34(6), 659–665.
resuscitation. Surgical Clinics of
The authors gratefully acknowledge
North America, 58(6), 1313– http://dx.doi.org/10.1097/BCR.
Shannon Perry, PhD, RN, FAAN for
assistance with manuscript preparation and1322.X 0b013e31827e5062. X
editing. The authors also acknowledge Buckle, J. (2003). Clinical
partial funding from the Huige M. aromatherapy: Essential oils in Halder, S., Mehta, A. K., Mediratta,
Comfort Fund (CRI15312-3614) and the P. K., & Sharma, K. K. (2011).
Haertle Pain Management Fund practice. London, UD: Churchill
Essential oil of clove (Eugenia
(CRI15312-3668), the Children’s Hospital Livingstone.X caryophyllata) augments the
of Wisconsin Foundation. humoral immune response but
decreases cell mediated immunity.
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Please cite this article as:


Jopke, K., et al., Use of
Essential Oils Following
Traumatic Burn Injury: A
Case Study, Journal of
Pediatric Nursing (2017),
http://dx.doi.org/10.1016/j.
pedn.2016.12.018X

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