Question

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

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

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

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

Answer 1