Just follow the rubric

Based on the nursing assessment, the client has a total burn percentage of 22.5% (4.5% face, 9% arm, 9% anterior chest). Superficial burns are not calculated as part of fluid resuscitation. Therefore, 4 mL x 67.2 kg x 22.5% equals a total fluid volume of 6,048 mL needed for the client based on the Parkland formula. The first half of the fluid should be administered over 8 hours, while the next half should be administered over 16 hours. The total amount given in the first eight hours is 3024 mL. For the second half, the nurse should set the pump for 189 mL/hr.

LAB RESULTS
Date	Lab	Normal	Result
2/8 0830	RBC	4.2-5.9 cells/L	4.2
	WBC	4,000-10,000 mm3	7,500
	Hgb	12-17 g/dL	12.2
	Hct	36-51%	39
	Platelets	150,000-350,000 mm3	198,000
	Na	136-145 mEq/L	141
	K+	3.5-5.0 mEq/L	3.1
	Cl	98-106 mEq/L	102
	CO2	22-26 mEq/L	26
	Ca	9-10.5 mg/dL	9.1
	Glucose	70-100 mg/dL	89
	Albumen	3.5-5.0 g/dL	3.6
	BUN	8-20 mg/dL	18
	Creatinine	0.7-1.3 mg/dL	0.8
2/14 0830	RBC	4.2-5.9 cells/L	4.1
	WBC	4,000-10,000 mm3	15,200
	Hgb	12-17 g/dL	12.2
	Hct	36-51%	39
	Platelets	150,000-350,000 mm3	195,000
NURSING ASSESSMENT & NOTES
2/7 2230	Neuro/Cognitive: Alert, oriented to person, place only. Cardiovascular: S1 & S2 sounds present. Tachycardic at rate of 114. Respiratory: Breathing labored. +accessory muscle use. +rhonchi and wheezing in all lobes. Productive cough with carbonaceous sputum. +singed nares. Integumentary: Partial-thickness burns to face, anterior chest, and right arm. Superficial burns to the abdomen. Psychosocial: Client crying and anxious. Pain: 10/10 pain to face, chest, and right arm. Lines/Drains: 18 gauge left-hand peripheral IV, 18 gauge left antecubital peripheral IV—lines patent and intact.
2/8 0700	Nursing Note: Report received from N. Honeycutt, RN. Client sedated and vented. Family at the bedside.
2/8 0900	Neuro/Cognitive: Nonverbal. Responds to painful stimuli by withdrawal. Pupils 2 mm, nonreactive. Cardiovascular: S1 & S2 sounds present. Normal sinus rhythm rate: 88. Respiratory: Continuous mandatory ventilation 7.0 endotracheal tube, tidal volume: 500, rate: 12, PEEP: 5, FiO2: 80%. Integumentary: Gauze dressing intact on chest and right arm. Partial-thickness burn to face left open to air. Pain: Nonverbal pain scale: 8/10. Lines/Drains: Triple lumen central venous catheter to L subclavian. Excellent blood return. Fentanyl via distal lumen, Propofol via medial lumen. Last site locked. 18-gauge L hand peripheral IV. 18-gauge L antecubital peripheral IV.
2/8 0900	Nursing Note: L subclavian CVC noted to be bloody. Site care and new dressing applied. Confirmed with pharmacy that propofol and potassium chloride are compatible.
2/14 0830	Neuro/Cognitive: Alert, oriented x 4. Speech 0000clear. Cardiovascular: S1 and S2 sounds present. Sinus tachycardia. Respiratory: Breathing regular, even. Equal chest rise and fall. Lung sounds crackles in bilateral bases. Integumentary: Gauze dressings intact on chest and right arm. Occlusive dressing to left thigh graft site with moderate amount of purulent drainage. Redness around graft site. Lines/Drains: Triple lumen central venous catheter to L subclavian. Excellent blood return.

VITAL SIGN TREND
Date	Temp	HR	RR	BP	SpO2	O2
2/14 0810	101.4 °F (38.6 °C)	108	20	108/76	93%	RA

2/7 2235

Prescriptions:

Prepare for rapid sequence intubation
Calculate %TBSA affected and administer lactated ringers 4 mL/kg/%TBSA – administer first half over 8 hours, second half over 16 hours
Labs: CBC, CMP, ABG, lactic acid
Succinylcholine 0.6 mg/kg IVP STAT
Etomidate 0.3 mg/kg IVP STAT
Fentanyl 1000 mcg/hr IV continuous infusion
Propofol 5-50 mcg/kg/min IV continuous infusion – titrate every 5-10 minutes in increments of 5-10 mcg/kg/min

2/8 0930

Prescriptions:

Insert nasogastric tube – set to low intermittent suction
Strict intake and output
May complete lab draws from central line
Serum potassium level after KCL infusion
Potassium chloride 20 mEq/100 mL D5W – administer over 1 hour x 3 consecutive doses
4 mg morphine IV push q2h PRN for breakthrough pain

2/14 0900

Prescriptions:

Ceftriaxone 2 g IVPB q24h
Vancomycin 1 g/250 mL 0.9% NS IVPB q8h – infuse over 90 minutes
Acetaminophen 1 g by mouth q4h PRN for pain
Lorazepam 1 mg IV push q4h PRN for anxiety
Famotidine 20 mg/50 mL 0.9% NS twice daily – infuse over 15 minutes
Silver nitrate 0.5% aqueous solution three times daily – apply to gauze dressing and wound
Labs: CBC, CMP, lactic acid, blood cultures x 2 sites, urinalysis with culture and sensitivity

2/7 2230

Medical History: Generalized anxiety disorder, post-traumatic stress disorder, depression, childhood abuse

Medications:

Lorazepam 1 mg by mouth three times daily PRN
Paroxetine 30 mg by mouth daily

Name: Jacky Joseph

Age: 22 years

Provider: H. Tartau MD

Allergies: hydromorphone, cephalosporins

Admit Wt: 148 lbs (67.1 kg)

BMI: 24.6