Academic level – Undergrad 1-2
Type of paper – Analysis
Topic Title – Parkland formula
You are working the night shift on a medical-surgical unit.
You 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.
In a two-page APA formatted paper, discuss the following:
The staff are following the Parkland Formula for fluid resuscitation. The client arrived at 02: 00 and was admitted at 04:00. 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 finding 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?
A 19-year-old female was admitted to the medical-surgical ward after receiving burns covering 30% of her body surface, with partial-thickness burns on her legs and back. Following the Parkland formula, her fluid replacement must be calculated using her weight of 110 pounds, equivalent to 50 kilograms. The formula stipulates 4 ml of lactated Ringer’s solution per kg body weight per percent burn area in a 24-hour period (Schaefer & Szymanski, 2022)). This patient has 30% total body surface area (TBSA) burns, so her calculation is as follows:
4 ml/kg x 50 kg x 30% TBSA = 6,000 ml/24 hours.
However, estimating fluid resuscitation for burn wounds is merely an approximation, and the real fluid necessities could vary, influenced by the patient’s vital signs, urine output, accompanying injuries, or preexisting medical conditions. Fluid resuscitation is administered at specified intervals, with the initial fifty percent provided within the initial 8-hour period (Schaefer & Szymanski, 2022). Hence, this patient needs 3,000 milliliters during the initial 8-hour period after admission, which began at 4 AM. The subsequent half will be administered over the following 16 hours, with the remaining 3,000 milliliters scheduled between 12 PM and 8 AM the next day. The fluid administration is adjusted to sustain an appropriate urine output ranging from 30 to 50 milliliters per hour.
The patient was in a state of slumber when the fire originated, and she had to navigate her path through dense smoke to exit. Consequently, there are notable concerns about potential smoke inhalation and respiratory damage, given the details of her exposure. Assessment findings that would corroborate this include hoarseness, wheezing, singed nasal hairs, swollen and inflamed nasal mucosa, presence of carbonaceous sputum, respiratory distress, hypoxemia, and altered mental status (Desai et al., 2020). Continuous observation of the patient’s respiratory condition is vital due to the potential for substantial airway and lung harm resulting from smoke inhalation.
To alleviate pain, this patient’s preferred medication for managing intense burns is intravenous morphine sulfate. It can be given continuously or intermittently, adjusted according to the patient’s pain intensity and level of sedation (Griggs et al., 2017). Nurses must closely monitor such adverse effects as respiratory depression. Infection control measures include strict hand hygiene, the use of sterile techniques for dressing changes and invasive procedures, and isolation if infection develops. This patient is at high risk for disease due to the extent and depth of injury, necessitating that topical antimicrobials may be applied to the wounds (Greenhalgh, 2019). Nurses must observe signs of infection, including fever, increased wound pain, erythema, and purulent drainage.
High caloric intake is necessary to meet the hypermetabolic response to the burn injury. According to Heyland et al. (2020), clinical practical guidelines recommend a diet high in protein (1.5–2 grams of protein/kg/day), complex carbohydrates, and fats is recommended, providing at least 25–35 kcal/kg/day. Daily laboratory work is necessary to monitor electrolyte, protein, and hemoglobin levels while supplementing additional vitamins and minerals. Enteral feeding by nasogastric tube may be required if oral intake is inadequate.
Proper burn wound care and debridement are essential to prevent complications like infection and scarring, with a referral to a burn specialist recommended for major burns. Ongoing physical and occupational therapy will prevent contractures and rebuild strength and mobility. Due to her significant injuries, this patient will require extensive recovery and rehabilitation services. A multidisciplinary approach involving professionals like nurses, physicians, dietitians, and therapists is crucial for optimal healing and outcomes.
Desai, S. R., Zeng, D., & Chong, S. J. (2020). Airway management in inhalation injury: A case series. Singapore Medical Journal, 61(1), 46–53. https://doi.org/10.11622/smedj.2019048
Greenhalgh, D. G. (2019). Management of burns. New England Journal of Medicine, 380(24), 2349–2359. https://doi.org/10.1056/nejmra1807442
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
Heyland, D., Ortiz, L. A., Garner, W. L., Mandell, S. P., Colpaert, K., Stoppe, C., & Day, A. G. (2020). 15 nutrition therapy in the burn care setting: What is best achievable practice? Journal of Burn Care & Research, 41(Supplement_1). https://doi.org/10.1093/jbcr/iraa024.019
Schaefer, T. J., & Szymanski, K. D. (2022). Burn evaluation and management. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK430741/