# a nurse working on a medical-surgical unit

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.

Instructions

1. In a two-page APA formatted paper, discuss the following:
2. 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.
3. 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?
4. The client is in severe pain. What is the drug of choice for pain relief and how should it be given?
5. What nutritional requirements are necessary for the client’s burns to heal?
6. What measures are taken with the client to prevent infection?

As a nurse working on the night shift on a medical-surgical unit, it is important to be knowledgeable about the management of burn injuries. In this scenario, a 19-year-old woman has been admitted with burns covering 30% of her body surface area, with partial-thickness burns on her legs and back. This essay will discuss the following aspects of her care: fluid resuscitation, assessment for smoke inhalation, pain management, nutritional requirements, and infection prevention measures.

The first aspect to consider is fluid resuscitation. The staff is following the Parkland Formula for calculating fluid requirements in burn patients. The client arrived at 0200 and was admitted at 0400, and she weighs 110 pounds. The Parkland Formula recommends that the client receive 4 mL of lactated Ringer’s solution per kilogram of body weight per percent burn. Therefore, her fluid requirement is calculated as follows:

4 mL x 110 lbs (50 kg) x 30% = 6600 mL in the first 24 hours

Half of this amount is given in the first 8 hours, and the remaining half is given over the next 16 hours. Therefore, the client should receive 3300 mL of lactated Ringer’s solution over the first 8 hours and then 3300 mL over the next 16 hours. It is important to monitor the client’s fluid status closely, as both under- and over-resuscitation can have negative consequences.

The second aspect to consider is assessment for smoke inhalation. The client was sleeping when the fire started, and thick smoke was present. Therefore, it is important to assess the client’s airway and breathing. One assessment finding that would corroborate concerns about possible smoke inhalation is the presence of carbonaceous sputum or soot in the client’s mouth, nose, or throat. Additionally, the client may have hoarseness, stridor, or wheezing, and may be coughing or experiencing difficulty breathing. It is important to notify the healthcare provider immediately if any of these findings are present.

The third aspect to consider is pain management. Burn injuries are extremely painful, and it is important to provide adequate pain relief. The drug of choice for pain relief in burn patients is typically opioids, such as morphine or fentanyl. These drugs can be given intravenously or via patient-controlled analgesia (PCA). PCA allows the client to self-administer small doses of pain medication as needed, which can improve pain control and client satisfaction.

The fourth aspect to consider is nutritional requirements. Burn injuries increase the client’s metabolic rate, leading to increased energy and protein requirements. The client may require enteral or parenteral nutrition support to meet these requirements. Additionally, the client may require vitamin and mineral supplements to support wound healing.

The fifth aspect to consider is infection prevention measures. Burn injuries increase the client’s risk of infection, as the skin provides a barrier to pathogens. Therefore, it is important to maintain strict infection control measures, such as hand hygiene, use of personal protective equipment, and proper wound care. The client may require prophylactic antibiotics to prevent infection, and wound cultures should be obtained if signs of infection are present.

In conclusion, the management of burn injuries requires a comprehensive approach that addresses fluid resuscitation, assessment for smoke inhalation, pain management, nutritional requirements, and infection prevention measures. As a nurse working on the night shift on a medical-surgical unit, it is important to be knowledgeable about these aspects of care in order to provide safe and effective care to clients with burn injuries.

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