You Are Working The Night Shift On A Medical Surgical Unit

You Are Working The Night Shift On a Medical Surgical Unit You Assign

You are working the night shift on a medical-surgical unit. Your assignment includes a 19-year-old woman admitted early this morning with burns over 30% of her body surface area, including partial-thickness burns on her legs and back. 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, and explain the time intervals and amounts for each. The client was sleeping when the fire started and managed to escape through thick smoke; you are concerned about possible smoke inhalation. What assessment findings would support this concern? The client reports severe pain. What is the drug of choice for pain relief, and how should it be administered? What nutritional requirements are necessary for the client’s burns to heal? What measures are taken to prevent infection in this client?

Paper For Above instruction

The management of burn injuries, particularly in young adults, requires prompt and precise intervention to optimize outcomes. The appropriate calculation of fluid resuscitation, assessment of potential complications, pain management, nutritional support, and infection prevention are critical components of effective burn care. This paper discusses the application of the Parkland Formula for fluid therapy, signs of smoke inhalation, pain management strategies, nutritional needs for burn healing, and infection prevention measures tailored to a 19-year-old woman with significant burns affecting her body surface area.

Fluid Resuscitation Using the Parkland Formula

The Parkland Formula is a widely accepted method for calculating initial fluid requirements in burn patients. It prescribes 4 mL of lactated Ringer's solution per kilogram of body weight per percentage of total body surface area (%TBSA) burned during the first 24 hours post-injury. For this patient, weighing 110 pounds (approximately 50 kilograms), and with 30% TBSA burns, the calculation is as follows:

• Fluid requirement = 4 mL x 50 kg x 30 = 6,000 mL in the first 24 hours.

Half of this volume (3,000 mL) should be administered in the first 8 hours from the time of injury (which is 0200), and the remaining half (3,000 mL) over the subsequent 16 hours. Since the patient was admitted at 0400, the fluid calculation is adjusted accordingly, but the clinician should administer approximately half of the total fluid in the first 8 hours following the injury time, considering the delay (from 0200 to 0400). It is essential to calculate the remaining fluids based on the exact time of injury and time since admission to ensure proper resuscitation.

Signs of Smoke Inhalation

Patients exposed to smoke and fire are at risk for inhalation injuries, which can lead to respiratory compromise. Clinical assessment findings supporting smoke inhalation include soot or carbonaceous particles around the mouth and nose, singed nasal hairs, facial burns, hoarseness, cough, wheezing, productive cough with carbonaceous sputum, and difficulty breathing. Changes in oxygen saturation levels and abnormal arterial blood gases indicating hypoxia or carbon monoxide poisoning (e.g., elevated carboxyhemoglobin levels) are also indicative. Early recognition and intervention are vital to prevent progression to respiratory failure.

Pain Management Strategies

Severe burn injuries are extremely painful, and effective pain control is a priority. The drug of choice for pain relief in burn patients is typically an opioid analgesic, such as morphine. Morphine provides effective pain relief and can be titrated to achieve adequate analgesia. It is administered intravenously for rapid onset, especially in severe pain settings, with careful monitoring for respiratory depression, hypotension, and nausea. Alternative adjuncts may include non-opioid analgesics or anxiolytics, but opioids remain the cornerstone in managing acute severe pain.

Nutrition for Burn Healing

Nutritional support is fundamental in burn management to promote wound healing, immune function, and recovery. Burn patients require increased caloric intake, often 1.5 to 2 times their resting energy expenditure. Protein requirements are elevated to support tissue repair, generally recommended at 1.5–2 grams per kilogram of body weight daily. Carbohydrates and fats are essential for energy, while micronutrients such as vitamin C, zinc, and iron play roles in collagen synthesis and immune support. Early initiation of enteral nutrition via a feeding tube is preferred to meet metabolic demands and prevent malnutrition.

Infection Prevention Measures

Burn wounds are highly susceptible to infection; thus, rigorous infection control measures are instituted. These include maintaining sterile dressing changes, applying topical antimicrobial agents (e.g., silver sulfadiazine), and monitoring for signs of wound infection such as increased redness, swelling, pus, or foul odor. Hand hygiene, strict aseptic technique, and environmental cleanliness are essential. Additionally, immunizations (such as tetanus toxoid) are updated, and systemic antibiotics are reserved for documented infections to prevent resistance. Supporting the immune system through adequate nutrition and minimal invasive procedures also reduces infection risk.

Conclusion

Effective management of burn injuries involves integrating precise fluid resuscitation, vigilant assessment for inhalation injuries, effective pain control, comprehensive nutritional support, and strict infection prevention. Adhering to evidence-based protocols such as the Parkland Formula and employing multidisciplinary care significantly improves outcomes for young adults with severe burns. Early recognition and treatment of complications are essential to reduce morbidity and mortality in this vulnerable population.

References

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