Question

I. Read chapters 22, 23, 24 from your Text Book and Power Point Presentation

II. NCLEX Review questions chapters 22, 23, 24 from Evolve Resources

III. Case Study : Initial Management of a Patient with Burns

Patient Profile

M.J. is a 23-year-old white woman transferred via ambulance to the hospital after a fire in her apartment. She was asleep when the fire started and managed to make her way out of the apartment through the smoke. She sustained second- and third-degree burns over the right side of her face and neck, right side of the anterior trunk, 2/3 of lower right thigh, and right arm. In the emergency department, she received a tetanus shot, morphine for pain, and 2 L of IV fluids.

Subjective Data

Single, lives alone

Attends local college part-time while working full-time as a waitress

Denies tobacco, alcohol, and drug use

Objective Data

Physical Examination

Blood pressure 190/80, pulse 88, temperature 99° F, respirations 28

Height 5’4”, weight 180 lbs

Voice is hoarse; singed nose hair

Productive cough with moderate amounts of gray sputum

Pupils equal, round, reactive to light and accommodation; right eye swollen

Heart rate and rhythm regular; no murmur

Lungs with wheezes throughout

Bowel sounds diminished in all four quadrants

Restless, complaining of pain at a level 10 on ten-scale

Urinary catheter draining burgundy colored urine

Nasogastric tube is draining yellow-green drainage

Discussion Questions

1. What is the difference between a second-degree (partial thickness) and third-degree (full-thickness) burn?

2. What is the extent of M.J.’s burn injury and how is it determined ?

3. Calculate M.J.’s fluid requirements for the first 24 hours using the Parkland formula?

Answer 1

1.Burn are the most common household injury that is charecterized by severe skin damage and that causes the affected cells to die.    Second degree burns or partial thickness burns the lower layer of skin that is epidermis and the dermis.That may causes the pain,redness,swelling and blistering. Third degree burns is also called as the full thickness burns,that go through the dermis and affect deeper tissues.

Difference between Second and Third degree burns

Second degree skin burn :

-second degree burns are more serious because the damage extends beyond the top layer of skin -Red and sore blisters are appear on the skin -Common treatment is required such as the antibiotic treatment.(short term therapy is needed)

Third degree burns ;

-That is more severe and causes most damage extending through all the layers of skin -Skin may exibit waxy and white colour,dark colour,there is no any blisters present in this case -Long term treatment is needed and also surgery,physical therapy,rehabilitation is necessary for the patient.

2.The extent of burn injury is defined as the percentage of total body surface damaged by burns and may be determined by the Rule of Nines. The total body surface area (TBSA) affected by burns is 18% (explanation : The head (9%),right arm(9%).

3.One of the formula that uses the TBSA that has been affected by burns is the parkland formula.In this formula calculates the amount of fluids that this person has to recive in the first 24 hrs after sustaining burns. the formula is , Parkland formula =2-4mLof RL solution x weight in kilogramxTBSA =Total fluid requrements for the first 24 hrs after burn

TBSA is calcualated critical for the management and treatment of burned person by Rule of Nine calculation.based on rule of nine calculation,each part of the body makes up certain percentage of the total body surface area,it is called as rule of nines because each part is either 9%.The entire head and front of the head is 4.5%,each arm makes up 9%,each legs 18%,

Parkland Formula =2000mLX81.6466x18%

Fluid needed in 24 hour period is 2939.2776 mL

Fluid given in first 8 hours is 1469.6388 mL