Situation: You are working the day shift on the medical-surgical unit in a small district hospital. Your assignment includes an 18-year-old female college student, admitted the previous night. She was caught in a house fire and sustained burns over 30% of her body surface area, with partial-thickness burns on her legs and back.
1. The client is undergoing burn fluid resuscitation using the standard Baxter (Parkland) formula. She was burned at 0200 and admitted at 0400. She weighs 110 pounds. Calculate her fluid requirements, specify the fluids used in the Baxter formula, specify how much will be given, and indicate what time intervals will be used.
Baxter Formula: Lactated ringer's 4 ml/kg/%burn/24 hours - given in the first 8 hours post-injury.
110 lbs = 51kgs.
So: 4 x 30 x 50 = 6000cc needed to be given for the 1st 24 hours. 3000 cc or 3 litres for the first 6 hours (she was admitted 2 hours after injury). The remaining 3 litres will be given at the next 16 hours.
2. 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? • Cough ➢ When the mucous membranes of the respiratory tract get irritated, they secrete more mucus. ➢ Bronchospasm and increased mucus production lead to reflex coughing. ➢ The mucus may be either clear or black depending on the degree of burned particles deposited in the lungs and trachea.
• Shortness of breath ➢ This may be caused by direct injury to the respiratory tract, leading to decreased oxygen delivery to the blood, the decreased ability of blood to carry oxygen because of chemicals in smoke, or the inability of the body's cells to use oxygen. ➢ The patient may have rapid breathing as they attempt to compensate for these injuries.
• Hoarseness or noisy breathing ➢ This may