Fluid Resuscitation and Assessment of Smoke Inhalation in a Young Burn Patient- Night Shift Challenges on a Medical-Surgical Unit
Calculate the fluid requirement using the Parkland formula.
Parklands formula is used to determine the fluid requirements in burn patients who have been critically affected during the first 24 hours (Mehta & Tudor, 2021). The patient weighs 100 pounds. The first step is to convert this weight into kilograms, and the equivalent is 50kg. This weight in kilograms is then multiplied by the total burned surface area and amount of fluid. This will be 50x 30 x 4, which will be 6000. The 6000 is then divided into two. The first half is given during the first six hours of arrival at the hospital. The remaining half is divided into sixteen-hour, which are administered to the patient at a rate of 187.5mls per hour, while the rest of the 1500ml is given in the next eight hours
1 pound = 0.454 kg
110= 50kg
Fluid requirement = 50x 30 x 4ml
= 6000ml
Assessment for possible smoke inhalation.
Smoke inhalation can be determined by assessing the burn victim. The clinician should examine the respiratory airways and auscultate for lung sounds. Patients who have inhaled smoke will have a hoarse voice, rhonchi, wheezing, or stridor. These symptoms are present due to chemical damage to the upper respiratory airways (Gupta et al., 2018). The clinician should also examine the patient for any signs of thermal burns to the trachea or bronchi, systemic poisoning, and chemical damage. Assessment of the airways will reveal soot, and there may be signs of thermal burn in the mouth in the form of white blisters (Gupta et al., 2018). Smoke inhalation also results in systemic effects. One systemic effect of smoke inhalation is hypoxia. Hypoxia lowers oxygen capacity, poor ventilation, and reduced oxygen utilization (Gupta et al., 2018). This occurs due to the hydrogen cyanide and carbon monoxide produced. Smoke inhalation can also cause psychological symptoms such as agitation, stupor, and anxiety (Gupta et al., 2018).
Administering pain medication
For burn victims, opioid analgesics are the primary pharmacotherapy for pain management. These drugs act by blocking opioid receptors, which modulate pain perception (Mendoza et al., 2016). These drugs are cost-effective and readily accessible. The patient should be given IV morphine; morphine is a strong painkiller that will help manage the severe pains linked with burns. The dosage to be administered to this patient will be determined by the pain levels, weight, and history of opioid analgesics.
Nutritional requirements for burn victims
Nutrition is essential in burn care since it helps to promote effective wound healing. The patients should have a daily caloric intake of around 25kcal/kg (Clark et al., 2017). The meals being given to patients should have high amounts of proteins and carbohydrates. Carbohydrates will be the source of energy needed for wound healing, while proteins will help to build muscles. The meals should be given to the patient within 24-37 hours after admission to the burns unit (Clark et al., 2017). Protein will help to reduce protein digestion as a source of energy. In addition to this, the patient should be given foods rich in vitamins. These include fruits and vegetables. Appropriate nutrition will help to reduce hypoglycemia that may occur due to burns. They can also replenish nutrients lost and promote rapid wound repair. Good nutrition will also prevent metabolic issues and minimize skin complications (Clark et al., 2017).
How to prevent infection of burn wounds.
Infection prevention is critical in burn patients. The affected areas should be carefully handled, and the nurse should always practice hand hygiene. The wound dressings should also be changed more often to prevent bacterial growth (Lachiewicz et al., 2017). Any signs of infection should be noted, and appropriate action should be taken. It is also critical to apply antiseptics to the affected area, and the antiseptic of choice is silver sulfadiazine.
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
Gupta, K., Mehrotra, M., Kumar, P., Gogia, A. R., Prasad, A., & Fisher, J. A. (2018). Smoke inhalation injury: Etiopathogenesis, diagnosis, and management. Indian Journal of Critical Care Medicine, 22(3), 180-188. https://doi.org/10.4103/ijccm.ijccm_460_17
Lachiewicz, A. M., Hauck, C. G., Weber, D. J., Cairns, B. A., & Van Duin, D. (2017). Bacterial infections after burn injuries: Impact of Multidrug resistance. Clinical Infectious Diseases, 65(12), 2130-2136. https://doi.org/10.1093/cid/cix682
Mehta, M., & Tudor, G. J. (2021, July 9). Parkland formula – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK537190/
Mendoza, A., Santoyo, F. L., Agulló, A., Fenández-Cañamaque, J. L., & Vivó, C. (2016). The management of pain associated with wound care in severe burn patients in Spain. International journal of burns and trauma, 6(1), 1.
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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.
Fluid Resuscitation and Assessment of Smoke Inhalation in a Young Burn Patient- Night Shift Challenges on a Medical-Surgical Unit
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?