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Burn Injury: A Case Study

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To calculate the extent of any burn injury, you need to know the areas that the patient is burned per body surface area. According to Code Health (2018), the adult rule of nines includes: total head 9% (front and back each equal 4.5%), the arms equal 9% each (18% total), the torso is 18% front and 18% back (total 36%), legs equal 18% each (total for both equals 36%), and the groin is a total of 1%. Code Health (2018) stated that you can almost use the patient’s size of their palm to determine the total body surface amount of the victims burn, for example, if you have about five palm sizes estimated of burns on the patient’s arm, then you have approximately 5% of a burn on the patient’s arm.
For this case, A. N. has sustained a total of 45% …show more content…

N. to have vascular dehydration (Lewis et al., 2014). The hematocrit level of 51% is expected within the first 24 hours after the burn injury happened (Lewis et al., 2014). According to Ricketts (2018), the vascular changes that occur from burn injuries include: hemoconcentration (from the elevated blood osmolarity, hemoglobin, and hematocrit); fluid remobilization after 24 hours (this occurs when the capillary leak stops, and the integrity will start to be restored in the body); and diuretic stage will then begin anywhere from 48 to 72 hours after the injury has occurred (causing hyponatremia and …show more content…

has an elevated heart rate, a low blood pressure, and a low/decreased urine output. According to Lewis et al. (2014), these findings indicate inadequate amounts of fluid resuscitation, which indicates the intravascular fluids are continuing to deplete. We need to increase the amount of fluids in this case because if we don’t, then shock will result in the development of renal failure in the patient (Lewis et al., 2014). This isn’t good, so be aware of these findings become fluid resuscitation is extremely important in a burn victim. The nurse will need to notify the physician of these findings, so that way he or she can increase the amount of lactated Ringer’s solution being infused in the patient via large-bore IV’s (16 gauge or higher) or using a central line. According to the University of Michigan (2018), if the urine output is less than 0.5 to 1 mL/kg/hr. (approximately around 30 mL/hr.), then you should increase the infusion of Lactated Ringer’s solution by at least 33% of the patient’s hourly calculated fluid requirements mentioned above. Monitor this hourly; the goal is to get A.N. up to 30

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