DOSDOS, BIANCA MIKAELA F.

BSN-3

Case Study

Mr. Abraham Aguila is a 32 year old male who presents to the

Emergency Department after sustaining severe 2nd and 3rd degree

burns in a house fire.  The below diagram estimates his wounds.

He weighs 85 kg and is 5’11”. Mr. Aguila’s vitals are: BP 90/48,

HR 108, Temp 97.2, pain 10/10. You note circumferential burns

around the Right Upper Arm and soot around the mouth with singed

nose hairs, plus some facial swelling.

Areas affected include; half of the head/neck, top half of front

torso, top half of back, full top half of right arm, full top

half of left leg, and half of front abdomen.

1. Using the Rule of Nines, estimate the Total Body Surface

Area Burned (TBSA %).

 Half of the head/neck – 4.5%

 Top half of front torso – 9%
 Top half of back – 9%
 Full top half of right arm – 4.5%
 Full top half of left leg – 9%
 Half of front abdomen – 4.5%
 Half of lower back – 4.5%
The estimated TBSA burned is 45%

2. Calculate the total fluid volume required for resuscitation

in the first 24 hours using the Parkland Burn Formula.

4 x 45% x 85 kg = 15,300 mL in 24 hours

 Give ½ in the first 8 hours = Start fluids at 956 mL/hr

3. What is the TOP nursing priority for Mr. Aguila?

 Fluid resuscitation to prevent hypovolemic shock

 Mr. Travis’s vitals are: BP 90/48, HR 108, Temp 97.2,
Pain 10/10.
4. What are your main concerns for complication(s)?

 Airway due to possible/likely inhalation burns and

airway swelling
 Compartment syndrome due to circumferential burns
around right arm
 Decrease in cardiac output
 Decreased perfusion and oxygen delivery
 Acute respiratory failure and acute respiratory
distress syndrome
 heart failure and pulmonary edema
 sepsis

5. Physiologically, explain the alterations in Mr. Aguila’s

vital signs.

- Blood pressure: 90/48 is due to the vasoconstrictive

compensatory response to plasma volume loss and the heart
rate of 108 is due to the increased workload of the heart
and oxygen demand
- Due to burn there is an immediate decrease in cardiac
output that precedes the loss of plasma volume.
Hypovolemia occurs due to ensuing plasma loss which
decrease perfusion and o2 delivery. As fluid continue to
decrease due to capillary leakage the vascular volume
decrease, cardiac output continue to decrease, and BP
drops which can lead to burn shock. Systemic inflammation
causes release of free oxygen radicals that increase
capillary permeability which also increase plasma loss
and subsequent peripheral edema. The sympathetic nervous
system then release catecholamine that increase
vasoconstriction and increase the pulse rate. The
decrease of temperature is due to the integumentary loss
which results in inability to regulate body temperature
 - He is likely hypovolemic due to the loss of fluids from
the burns, hence the low BP and high HR
- He is hypothermic because of his inability to regulate
temperature due to skin loss
6. What are your priorities for daily care of Mr. Aguila?
 Change dressing daily (wound care)
 Infection prevention and meticulous wound care – sterile
dressing changes
 Pain control – PCA if able
 Manage ventilator and respiratory needs until able to be
extubated
 Maintain temperature and hemodynamics
 Inspect wounds for discoloration/ hemorrhage which would
indicate developing infection
 Give prescribed medications
 Nutritional supplementation
 Prevention of scars
 Physical, occupational and vocational rehabilitation
 Psychosocial counseling
 Monitoring and maintaining normal vital signs
 Adequate fluid intake and output
 Maintain a clean and healthy environment to prevent
infection
 Minimized and relieve pain and discomfort
 Maintaining adequate nutrition
 Promote skin integrity
 Promote physical mobility
 Support patient and family process
 Monitor and manage possible complications
 Teach self-care or hygiene