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?
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Burn Victim Assessment
Full Answer Section
Assessing for Smoke Inhalation
Assessment findings suggestive of smoke inhalation include:
- Respiratory symptoms: Cough, hoarseness, wheezing, stridor, tachypnea, and dyspnea.
- Carboxyhemoglobinemia: Elevated carboxyhemoglobin levels in the blood, leading to hypoxia.
- Singed nasal hairs or facial burns.
- Soot in the sputum or nasal passages.
- Altered mental status.
Pain Management
Drug of Choice:
- Intravenous opioids: Morphine or fentanyl are commonly used for severe pain.
- Route of Administration: Intravenous administration is the most rapid and effective route for pain relief in this case.
Nutritional Requirements
To support wound healing, the client will require a high-calorie, high-protein diet. This may be provided through:
- Enteral nutrition: If the gastrointestinal tract is functioning, a nasogastric or orogastric tube may be used to deliver a specialized formula.
- Parenteral nutrition: If enteral feeding is not feasible, intravenous nutrition may be necessary.
Infection Prevention
To prevent infection, the following measures should be taken:
- Wound Care:
- Gentle cleansing with mild soap and water.
- Debridement of necrotic tissue.
- Application of topical antimicrobial agents.
- Use of sterile dressings.
- Systemic Antibiotics: Broad-spectrum antibiotics may be administered to prevent systemic infection.
- Strict Aseptic Technique: Adhering to strict aseptic technique during wound care and invasive procedures.
- Early Grafting: Early wound grafting can reduce the risk of infection and promote healing.
- Monitoring for Signs of Infection: Closely monitoring for signs of infection, such as fever, increased pain, purulent drainage, and redness.
Remember that this is a general overview, and the specific management of a burn injury will vary depending on the severity of the burn, the patient's overall health, and other individual factors.
Sample Answer
Calculating Fluid Resuscitation using the Parkland Formula
Parkland Formula: Fluid Resuscitation = 4 mL x % TBSA x Weight (kg)
Given:
- Weight = 110 pounds = 50 kg (approximately)
- Time of admission = 0400
Assuming a 50% TBSA burn:
- Fluid Resuscitation = 4 mL x 50% x 50 kg = 1000 mL
Half of the total fluid volume should be administered within the first 8 hours post-burn.
- First 8 hours: 500 mL
- Remaining 16 hours: 500 mL
12% Discount
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