u-World NCLEX NOTES Revision File 2023 Update

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Adult Health 1.) Parkland Formula: is an IV fluid resuscitation protocol used to calculate the fluid replacement needed in the 1st 24 hours after a burn injury. ½ of the calculated fluid volume is administered during the 1st 8 hours after injury, when the greatest amount of intravascular volume loss occurs • 4mL X weight (kg) X TBSA burned = total infusion volume • 24-hr infusion volume / 2 = 8 hour infusion volume Example question: The nurse is calculating IV fluid resuscitation for a client weighing 85 kg with visible partial-thickness burns covering 40% of the body. How many liters of IV fluid resuscitation are needed during the first 8 hours? • Calculate total volume needed for infusion for 24 hours o 4mL X 85 kg X 40% TBSA = 13, 600 mL • Calculate volume needed for infusion during first 8 hours o 13, 600 mL/2 = 6800 mL • Convert mL to L o (6800 mL / 1) ( L / 1000 mL ) = 6.8 L 2.) Dehiscence Emergency Interventions: • Stay with the patient and instruct them not to strain • Notify HCP IMMEDIATELY • Place client in Low Fowler’s position with knees slightly flexed to relieve abd. Pressure • Cover the viscera with sterile dressings saturated in NS solution to prevent bacterial invasion and keep area from drying out • Assess VS to monitor for shock (hypotension, tachypnea, tachycardia) • Document wound and organ assessments (color) and interventions taken. If the blood supply is interrupted, the protruding organs can become ischemic (dusky) and necrotic (black) • Keep NPO in preparation for emergency surgery 3.) Parkland Formula Calculating TBSA using RULE of NINES: Example question: The nurse admits an adult client with partial-thickness burns to the anterior surface of the right leg and the anterior and posterior torso. The client weighs 198 lb. The TBSA burned is calculated using the rule of nines. How many mL of IV fluid will the client require in the first 24 hrs? • Calculate the TBSA burned using the rule of nines (anterior torso) + (posterior torso) + (anterior leg) = TBSA burned o 18% + 18% + 9% = 45%

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