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?
1) Degree of burn is catagorises according to the damage done to the skin into first, second and third degree burns.
Second degree- When the first two layers of the skin that is epidermis and dermis are damaged by burns then it is known as second degree burn. Usually characterised by blisteres and thickening of the skin. They are painful.
Third degree-When thr burn injury extend to the subcutaneous tissue under the epidermis it is termed as third degree burn. Usually characterised by thickening with a white leathery appearance. These are not painful as nerves are damaged leading to loss of pain.
Extend of burn injury can be determined by rule of 9 method.
Can also use palm method in which patient plam size is consider as 1℅ of burn.
| Area of burn | according to rule of nine | For M. Js burn injury |
| Head and face (front) | 4.5℅ | 2 |
| Head and face ( back) | 4.5℅ | 2.5 |
| Arms (front) | 9℅ | 9 |
| Arms (back) | 9℅ | 9 |
| Chest (front) | 9℅ | 4.5 |
| Chest (Back) | 9℅ | |
| Stomach (front) | 9℅ | 4.5 |
| Legs front | 18℅ | 6 for one leg 2/3rd part |
| Legs back | 18℅ | |
| Genitalia | 1℅ | |
| Stomach ( back) | 9℅ | |
| Total | 100℅ | 33.5℅ |
Parkland formula
Ringer lactate
4ml × total body burn surface area × body weight in kg
4ml × 33.5 × 81in kg
= 10,854 ml
Half fluid that is 5472 in first 8 hrs and remaining 5472 in next 16 hrs
I. Read chapters 22, 23, 24 from your Text Book and Power Point Presentation II. NCLEX...
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