Burn Victim Assessment
Severe fluid loss is one of the major problems experienced by patients with severe burn injuries. Therefore, managing burn injuries requires effective fluid rejuvenation (Haberal, Abali & Karakayali, 2010). The parkland Formula is one of the most effective approaches used to calculate and determine major burn patients’ most effective fluid resuscitation objective. The patient in the presented scenario is a 19-year-old female who presents to the medical-surgical unit with burns over 30% of the body surface. To effectively manage the patient, her fluid requirements will be determined using the Parkland formula, assess possible smoke inhalation by the patient, and the available pain-relieving medications. In addition to these steps, assessing the patient’s nutritional requirements and infection prevention measures will be very important.
Parkland Formula
The volume of Ringers Lactate = 4ml X % burn surface area X body weight
= 4ml x 50kg x 30%
= 6000 cc
3000 cc will be given within eight hours of the burn incident. This will be given up to 10 a.m. The next 3000 cc will be given within the next 16 hours. This will be from 10 am to 2 am.
Compromised Airway
Symptoms of smoke inhalation include signs of respiratory distress and copious sputum, which may have evidence of soot, edema, dry cough, charring, and hoarseness of voice (Tanizaki, 2015). In addition to this, the patient presents with labored breathing and stridor (Tanizaki, 2015). The nurse should examine the airway and lung sounds. Positive findings for smoke inhalation include soot deposition in the nares and blistering in the mouth (Tanizaki, 2015). The patient will have hoarseness and rhonchi. The patient may also have symptoms of hypoxia, such as anxiety, stupor, and agitation (Tanizaki, 2015). The presence of these symptoms will confirm smoke inhalation.
Medication Administration
The patient will be given IV morphine to help manage her severe pain. This medication should be given as soon as possible. Intravenous analgesics are preferred for burn patients, and morphine is the drug of choice to manage acute pain (Griggs et al., 2017). The patient will be given 5mg of morphine every five minutes. The side effects associated with morphine include constipation, nausea, vertigo, rash, and headaches (National Health Service, 2018). It can also cause serious side effects such as difficulty breathing, muscle stiffness, and seizures (National Health Service, 2018). The nurse should watch out for these side effects since the patient may have been exposed to smoke inhalation.
Nutritional Requirements
Patients with severe burn injuries have a hypermetabolic response due to profound metabolic and catabolic derangements (Clark et al., 2017). Failure to meet the excessive protein and energy requirements after a severe burn can lead to multiple organ failure, increased risk of infection, and even mortality (Clark et al., 2017). The patient should have an enteral feeding of high-protein, high-carbohydrate diets. During burns, the skeletal muscles become the major energy source, leading to rapid muscle wasting (Clark et al., 2017). This is why weight loss is not recommended. The total caloric intake should be around 6000 kcal/day to promote wound healing. The feeding should consist of carbohydrates, proteins, vitamins, and fats.
Infection Prevention
Infections are the common cause of morbidity and mortality in burn patients. Strict infection protocols must thus be implemented. This will include physically isolating the patient in a private room and minimizing visitation from individuals (Palmieri, 2019). In addition to this, nurses and other healthcare professionals who come into contact with the patient should wear gloves and gowns (Palmieri, 2019). Topical antibiotic therapy is also important in reducing infections.
References
Clark, A., Imran, J., Madni, T., & Wolf, S. E. (2017). Nutrition and metabolism in burn patients. Burns & Trauma, 5. https://doi.org/10.1186/s41038-017-0076-x
Griggs, C., Goverman, J., Bittner, E. A., & Levi, B. (2017). Sedation and pain management in burn patients. Clinics in Plastic Surgery, 44(3), 535-540. https://doi.org/10.1016/j.cps.2017.02.026
Haberal, M., Abali, A., & Karakayali, H. (2010). Fluid management in major burn injuries. Indian Journal Of Plastic Surgery, 43(3), 29. doi: 10.4103/0970-0358.70715
National Health Service. (2018, December 3). Morphine: Strong painkiller to treat severe pain. nhs.uk. https://www.nhs.uk/medicines/morphine/
Palmieri, T. L. (2019). Infection prevention: Unique aspects of burn units. Surgical Infections, 20(2), 111-114. https://doi.org/10.1089/sur.2018.301
Tanizaki, S. (2015). Assessing inhalation injury in the emergency room. Open Access Emergency Medicine, 31. https://doi.org/10.2147/oaem.s74580
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Question 
Scenario
You are working the night shift on a medical-surgical unit. Your 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.
Burn Victim Assessment
Instructions
In a two-page APA formatted paper, discuss the following:
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?
RUBRIC
Parkland Formula
16% of total grade
Mastery: Advanced or exceeds achievement
Correctly calculated the Parkland Formula as well as explaining why the interval is important for the rescue of a burn victim. The intervals and amounts are correct.
Compromised Airway
16% of total grade
Mastery: Advanced or exceeds achievement
Demonstrated thorough understanding of signs and symptoms & nursing assessment of a compromised airway secondary to thermal smoke.
Medication Administration
16% of total grade
Mastery: Advanced or exceeds achievement
Describe the correct recommendation for medication administration as well as include details about the timing of delivery and included risks.
Nutritional Requirements
16% of total grade
Mastery: Advanced or exceeds achievement
Demonstrates an understanding of the need for increased caloric consumption and why losing weight is not recommended
Prevention of Infection
16% of total grade
Mastery: Advanced or exceeds achievement
Demonstrates an understanding of nursing interventions and 3 types of dressing to prevent infection.