The Parkland Formula for Fluid Resuscitation
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.
Instructions
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?
Sample Solution
This is for informational purposes only. For medical advice or diagnosis, consult a professional.
Parkland Formula Calculation
Patient Information:
- Weight: 110 pounds = 50 kg (approximately)
- TBSA Burned: 30%
- Time of Admission: 0400
Parkland Formula:
Total Fluid Requirement = 4 mL/kg x %TBSA x Weight (kg)
= 4 mL/kg x 30% x 50 kg
= 6000 mL
Fluid Administration:
- First 8 hours (0400 - 1200):
- 50% of total fluid: 3000 mL
- Hourly rate: 375 mL/hour
- Next 16 hours (1200 - 0400):
- 50% of total fluid: 3000 mL
- Hourly rate: 187.5 mL/hour
Assessment Findings for Smoke Inhalation
- Respiratory:
- Cough (productive or non-productive)
- Wheezing
- Stridor
- Dyspnea
- Tachypnea
- Use of accessory muscles
- Decreased breath sounds
- Abnormal breath sounds (crackles, wheezes)
- Sooty sputum
- Hoarseness
- Singed nasal hairs
- Facial burns
- Cardiovascular:
- Tachycardia
- Hypotension
- Arrhythmias
- Neurological:
- Altered mental status
- Confusion
- Headache
- Anxiety
- Restlessness
- Lethargy
Full Answer Section
Pain Management
- Drug of Choice: Intravenous opioids (e.g., morphine, fentanyl) are the preferred method for pain relief in burn patients.
- Administration: Titrate the dose to achieve adequate pain control while monitoring for respiratory depression. Non-pharmacological interventions, such as relaxation techniques and distraction, may also be helpful.
Nutritional Requirements
- Hypermetabolic State: Burn patients experience a significant increase in metabolic rate, leading to increased caloric needs.
- Protein Intake: Adequate protein intake is essential for wound healing and tissue repair.
- Early Enteral Feeding: Early initiation of enteral feeding is recommended to prevent complications such as gastrointestinal atrophy and bacterial translocation.
Infection Prevention
- Aseptic Technique: Strict adherence to aseptic technique during wound care and dressing changes.
- Frequent Wound Cleansing: Gentle cleansing of wounds with mild soap and water or specialized wound cleansers.
- Antimicrobial Therapy: Topical antimicrobial agents may be applied to the wounds to prevent infection.
- Hand Hygiene: Frequent handwashing by healthcare providers and visitors.
- Isolation Precautions: If indicated, isolation precautions may be implemented to prevent the spread of infection.