ANSWER
Case Study: Taking Care of a Burn Patient 1. Fluid Needs Applying the Parkland Equation
The Parkland formula determines how much fluid is needed overall for the first twenty-four hours following a burn:
4-times \text{body weight (kg)} \times \text{% Total Body Surface Area (TBSA) burned} is the formula.
Compute:
Weight: 50 kg (110 pounds)
30% of TBSA burnt, or 4 × 50 × 30 = 6000
mL, or six liters
5 x 50 x 30 = 6000 mL (6 liters)
Distribution of Fluids:
Half of the entire volume (3000 mL) throughout the first 8 hours.
Half of the remaining 16 hours (3000 mL).
The first 8-hour window begins at the time of the burn because it happened at 0200 and the patient was admitted around 0400. The fluid administration plan is as follows if the burn happened at 0200:
3000 mL (375 mL/hour) from 0200 to 1000 (8 hours).
3000 mL (187.5 mL/hour) from 1000 to 2400 (16 hours).
2. Results of the Smoke Inhalation Assessment
Since possible smoke inhalation can cause respiratory issues, it needs to be treated right away. The following evaluation results support this worry:
burns on the face or burned hairs on the nose.
Sputum or oropharyngeal soot.
Stridor or hoarseness, which denotes inflammation or blockage of the airways.
respiratory discomfort or coughing.
decreased oxygen saturation due to hypoxemia.
Symptoms of carbon monoxide poisoning: crimson skin, disorientation, or a change in mental state.
3. Pain Control
For severe pain management in burn victims, intravenous opioids like morphine or fentanyl are the preferred medication.
Justification: Because burn patients may have decreased tissue perfusion, absorption from intramuscular or subcutaneous routes may be compromised, making IV administration the recommended method.
Dosage: To successfully manage pain and prevent oversedation, administer in modest, titrated dosages.
Monitoring: Check for symptoms of drowsiness, respiration rate, and pain levels on a regular basis.
4. Dietary Needs for the Healing of Burns
Because burn injuries cause a hypermetabolic state, people with burns have much higher metabolic and caloric needs. Among the nutritional needs are:
Calories: depending on the amount of the burn, 35–40 kcal/kg/day or more.
Protein: 1.5–2 g/kg/day to promote muscle breakdown and wound healing.
Minerals and Vitamins:
vitamin C for the production of collagen.
Zinc to promote healing of wounds.
For epithelialization, vitamin A.
Hydration: Getting enough fluids to keep tissues hydrated and promote tissue perfusion.
If oral intake is not enough to meet calorie needs, enteral feeding should be started as soon as possible.
5. Infection Control Strategies
Because of the loss of skin integrity, burn patients are particularly vulnerable to infections. Among the preventative actions are:
Tight Aseptic Method:
When changing dressings and caring for wounds, use sterile gloves, gowns, and tools.
Taking Care of Wounds:
Debride necrotic tissue on a regular basis.
Use topical antimicrobials, such as mafenide acetate or silver sulfadiazine.
Separation Precautions:
To reduce your exposure to infectious agents, use barrier nurses or separate rooms.
Stewardship of Antibiotics:
To lower the possibility of antibiotic resistance, stay away from prophylactic systemic antibiotics unless an illness has been diagnosed.
Keeping an eye on infections:
Keep an eye out for symptoms of a wound infection, such as fever, purulent discharge, or increased erythema.
Keep an eye on test results, such as the white blood cell count and culture outcomes.
Diet:
Eat enough food to support the immune system, especially protein and minerals like zinc and selenium.
Initial Mobilization:
To lower the risk of pneumonia and other consequences, promote physical activity.
For the best possible patient recovery, this all-encompassing strategy guarantees that fluid resuscitation, pain management, nutritional requirements, and infection control are successfully addressed.
QUESTION
You are working the night shift on a medical-surgical unit. You assignment includes a 19 year old woman admitted early this morning. She has sustained burns over 30% of her body surface area, with partial-thickness burns on her legs and back.
Instructions
- The staff are following the Parkland Formula for fluid resuscitation. The client arrived at 0200 and was admitted at 0400. She weighs 110 pounds. Calculate her fluid requirement, using the Parkland formula. Explain the time intervals and amounts for each.
- The client was sleeping when the fire started and managed to make her way out of the house through thick smoke. You are concerned about possible smoke inhalation. What assessment findings would corroborate this concern?
- The client is in severe pain. What is the drug of choice for pain relief and how should it be given?
- What nutritional requirements are necessary for the client’s burns to heal?
- What measures are taken with the client to prevent infection?