KABWE GROUP
SCENARIO
MULENGA PRECIOUS
N’GAMBI VICTORIA
NYIRENDA KWALI
SCENARIO QUESTION
Ms. Joana Mwaka female aged 36 years old is brought to casualty after
a house fire.
On admission she presents with:
• Burns to face, neck and anterior chest.
• Singed nasal hairs, hoarse voice, soot in mouth.
• Bp 100/60mHg. HR 120b/m, RR 30b/m, Oygen saturation 92%.
QUESTIONS
1.Use the TEWS to triage Ms. Mwaka.
2.Outline the classification of burns.
3.Calculate the TBSA for Ms. Mwaka
4.What are the priorities in this burn patient?
5.Calculate fluid requirements for Ms. Mwaka.
6.What nursing care are you going to provide in the first 24hours?
1.Use the TEWS to triage Ms.
Mwaka.
• Respiratory Rate (RR) ≥30 = 3
• Heart Rate (HR) ≥120 = 2
• Systolic BP (SBP) 81–100 = 2
• Temperature (°C) 35.1–38.4 = 0
• AVPU (Consciousness) Alert = 0
• Mobility With help = 1
• Trauma presence 1
Triage Early Warning Score= 9 based on the assesed vitals.
• Red category( emergency). Immediate attention is needed.
2.Outline the classification of burns.
Burns are typically classified by depth:
• Superficial (First-degree) burns: Affect only the epidermis, causing
redness and pain (e.g., sunburn).
• Partial-thickness (Second-degree) burns: Epidermis and portions of the
dermis are involved Accessory structures (eg, sweat glands, hair follicles)
are often involved.
• Full-thickness (Third-degree) burns: Destroy all layers of the skin,
appearing leathery, white, brown, or black, with no pain due to nerve
damage.
3.Calculate the TBSA for Ms. Mwaka
Assuming the burns to the face, neck, and anterior chest are full or
deep partial thickness, the Total Body Surface Area (TBSA) can be
estimated using the Rule of Nines:
• Face and neck: 4.5%
• Anterior chest: 18%
• Total Body Surface Area (TBSA) burned is approximately 22.5%.
Burn extent
• Another method to use the Rule of Nines to
estimate the extent of burn injury.
4.What are the priorities in this burn
patient?
The priorities for Ms. Mwaka, based on her presentation, are:
• Airway management: Due to singed nasal hairs, hoarse voice, and soot,
anticipate and manage potential airway obstruction (e.g., intubation or
tracheostomy).
• Breathing and Ventilation: Assess and support respiratory function, considering
inhalation injury.
• Circulation: Establish IV access and initiate fluid resuscitation to prevent burn
shock.
• Pain management: Administer analgesia as needed.
• Burn wound care: Cover burns with clean dressings.
• Hypothermia prevention: Maintain body temperature.
5.Calculate fluid requirements for Ms. Mwaka.
Fluid requirements are calculated using the Parkland formula:
• Total fluid in 24 hours = 4 mL x Body Weight (kg) x %TBSA.
• For TBSA of 22.5% and assuming an average weight of 60 kg.
• Fluid required in first 24 hours = 4 mL x 22.5 x 60 = 5400 mL.
• Administer half the total fluid in the first 8 hours (2700 mL) and the
remaining half over the next 16 hours (2700 mL).
6.What nursing care are you going
to provide in the first 24hours?
Nursing care in the first 24 hours includes:
• Continuous Airway Monitoring: Assess for signs of airway obstruction
(e.g stridor, hoarseness, difficulty in breathing, face or neck swelling)
and administer 100% humidified oxygen via non- rebreather mask at
15L/min
• Monitoring of vital signs and respiratory status: monitor HR, RR, BP,
SP02, and level of consciousness at every 15-30min then hourly if
stable. These help track the progression of shock, respiratory failure
or hypoxia
CONT….
• Fluid resuscitation: initiate IV fluids immediately, start with ringers'
lactate (preferred in burn patient). Begin administering 2700mL over
the 8 hours and administer the remaining 2700mL over the following
16 hours to restore circulating volume and tissue perfusion.
• Urine output monitoring: essential to guide fluid therapy, ensure
adequate renal perfusion and detect early complications. Target is
(0.5-1mL/kg/hr).<30/hr may indicate inadequate fluide replacement
and kidney injury.
CONT….
• Pain management: administer IV analgesics such as morphine 0.1mg/
kg or pethidine 100mg IV or IM tds, and assess pain regularly to
determine patients' response to analgesics.
• Wound care: cleaning of burns and covering with sterile, non-stick
dressings to prevent infections and fluid loss.
• Infection prevention: burnt patients are highly susceptible to infections
due to loss of skin barrier. Strict aseptic technique is mandatory during
dressing changes and administer silver sulfadiazine cream to prevent
wound colonization and infection which are major risks in burn injuries.
Administer IV antibiotics for Prophylaxis. (E.g ceftriaxone 1-2g)
CONT...
• Temperature Regulation: warm environment of 28 degrees Celsius to
prevent hypothermia. Cover patient with clean, dry blankets using a bed
cradle.
• Nutritional Support: Initiate early enteral feeding if tolerated. The diet
should be well balanced rich in proteins for tissue repair, in calories for
energy replacement and vitamins to promote the immunity of the
patient
• Psychological Support: Address anxiety and provide emotional support to
both patient and their family through out the initial critical period.
• Monitoring for complications: Watch for signs of compartment
syndrome, infection, or renal failure.
THANK YOU...
ANY CONTRIBUTIONS?
