Jerry McDonald, a 24-year-old male client, was admitted to the hospital after an explosion at the driveway sealant plant. He caught the front of his shirt and pants on fire, and tar was spilled onto his clothing. A coworker trained in first aid had Jerry drop and roll. He used a fire extinguisher and extinguished the flames. He immediately cut away the clothing and soaked the wounds with cool tap water. He called the squad who picked up the client. It took the squad 15 minutes to take Jerry to the hospital. En route, the paramedics noted the client has full thickness burns to the front of the right arm, the anterior chest, and front of both legs. There is no evidence of singeing of facial hair, or evidence of respiratory compromise. The paramedics inserted two 16-gauge IV sites and began fluid resuscitation with lactated ringers at 2 mL/kg/% burn, with half of the fluid to be administered the first 8 hours and the other half over the next 16 hours. The client is 5 foot 8 inches in height and stated he weighed 160 lb earlier today before going to work. The burn occurred at 9 am, and when he arrived to the burn unit at the hospital it was 9:40 am. There were 10 clients taken to the hospital at the same time related to the explosion. The LPN/LVN was pulled to the burn unit to help the nurses trained in Advanced Burn Life Support. The LPN/LVN helped by inserting the Foley catheter with urometer, helped to position the client as the RN and LPN/LVN performed a quick history and head-to-toe assessment, and the LPN/LVN helped the RN to cleanse the wounds with an antiseptic solution, rinse with sterile normal saline, and using clean technique, apply a 1/16-inch layer of silver sulfadiazine (Silvadene) to the chest area and apply a burn fluff. A solution of bacitracin/polymyxin B, mupirocin, and Mycostatin is used on the arm and leg by applying rolled burn gauze over the area loosely and placing a rubber catheter at the top and again toward the middle and another at the end of the dressing so liquid solution may be applied by a 30 mL syringe every hour into each of the rubber catheters saturating the dressing. An elastic bandage is placed over the fluff, and observation windows for assessment of circulation are placed. The limb is elevated on two pillows above the level of the heart. The LPN/LVN needs to review burn management principles covered in school. (Learning Objective 5)
a. What is the total body surface area percentage burned using the rule of nines?
b. At what hourly rate should the LR be infused over the first 8 hours? The subsequent hourly rate over the following 16 hours?
c. Describe the nursing management for the client.