In this instructional video, Christina Rafano of the Nursing School Show explains how to manage fluid resuscitation for burn patients using the Parkland formula. She begins by outlining the four immediate nursing priorities for an acute burn: securing the airway, providing prescribed oxygen, obtaining baseline vital signs, and initiating IV fluid resuscitation. The video then delves into the pathophysiology of burns, describing how tissue damage triggers capillary leak, leading to massive fluid shifts from the vasculature into interstitial spaces and risking hypovolemic shock. To estimate the extent of the burn, Rafano reviews the Rule of Nines, which assigns a percentage of total body surface area (TBSA) to each body region. Using the TBSA percentage, the Parkland formula (4 mL × patient weight kg × %TBSA) calculates the total crystalloid volume (lactated Ringer’s) required over the first 24 hours. She emphasizes that only half of this volume should be given in the first eight hours, with the remaining half administered over the next sixteen hours to avoid fluid overload. Continuous monitoring of urine output is highlighted as the primary indicator of adequate perfusion and resuscitation, with a target of at least 30 mL per hour. The video concludes with promotional information about study checklists, resource boxes, and a Nursing SOS membership to support nursing students.
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Are you confused about how to use the Parkland formula for burns in nursing school? Or maybe you're not sure where to even start with it? Don't worry, friend. I have you covered. In this video, we are going to dive into what the Parkland formula is and how to use it when treating burns. Hello. Hello, my friend. My name is Christina Rafano and I am the creator of the nursing school show where we walk you through step, step by step, how to pass nursing school. Now, hit that subscribe button and click the notification bell and let's dive in. Now, when it comes to burns, there are four priority nursing interventions that you need to do immediately for an acute burn patient. First, you will make sure that their airway is clear. Then you will give oxygen as prescribed. You will take a set of vital signs to establish their baseline, and then you will start IV fluid resuscitation. We walk through these interventions and more about burn burns here in this video. So be sure to check that out after watching this one. Now, the main intervention we're going to focus on in this video is fluid resuscitation. Now, fluid resuscitation is a huge deal when working with a patient with burns. In patients with burns, there is so much fluid shifting out of the blood vessels. So think back to what happens when there is a burn, right? There is damage to the underlying tissues, which then causes them to release chemicals that cause basal constriction. And it causes the cells to kind of separate called capillary leak or increased capillary permeability. So the blood vessels become leaky, that capillary leak, and they leak fluid into the surrounding tissues, then causing swelling. Now, the biggest thing to watch for is hypovolemic shock. There is a tremendous amount of fluid loss that occurs when fluid moves from those blood vessels into the surrounding tissues. And this leads to swelling and that intracellular dehydration, dehydration inside the cells. Now, with all that leaking fluid out of the blood vessels and then into the surrounding tissues, it then decreases the amount of overall fluid inside the blood vessels, which then can cause dehydration really quickly. Now, we want to make sure that they don't lose too much fluid volume and go into hypovolemic shock. So managing this fluid volume is very high up on your priority list of interventions to do so. In managing FL resuscitation on burn patients, you will use the rule of nines to help you determine how much fluid is needed to then replace what will be lost in those first few hours following a burn now, the rule of nines will give you a percentage of the total body surface area or the TBSA that was injured in the burn. The main formula you will see used for fluid resuscitation after a burn is the Parkland formula. Now, with this formula, you will give 4 ML of lactated ringer, multiplied by the patient's weight in kilograms and then multiplied by the percentage of total body surface area that was burned. Now, you will get this as a percentage from assessing the patient with the rule of nines. Now, again, we want to prevent the patient from becoming dehydrated as much as possible because their body is reacting to that burn and will be losing quite a bit of fluid from this. So making sure that we can predict this and then stay ahead of it is so super, super important in burn patients. So the Parkland formula gives us a good idea of how much fluid they will lose and then need to be replaced. The Parkland formula will give you a total fluid volume to infuse into the patient to help replace what is lost and prevent hypovolemic shock. All right, so now that we have that total volume that you'll give your patient, it is important to not give it all at once. We don't give it all at once, so instead we space it over 24 hours. We don't want to overlo the body with fluid and cause more problems. So giving it over a 24 hour period will help it be best absorbed by the body. So those first few hours after a burn are when the most fluid shifting can occur. So you'll give half of it during the first eight hours and then the remaining half over the next 16 hours. Now, this will help combat that interstitial fluid shift and then correct that hypovolemia without overwhelming the body. Now, because we are giving fluid to make make up to an estimated and predicted loss, we will want to keep a very close eye on urine output to monitor for adequate hydration and kidney function. We need to make sure that the fluid that we're giving the patient isn't just leaking into the surrounding tissues, but that it's actually staying in the blood vessel where we want to put it, where it should be, since that is the goal. In order to make sure that the fluid is going where it needs to go and staying there, we will monitor their urine output. This will also help us assess how their kidneys are functioning as well as fluid resuscitation and the treatment continue. Urine output should increase as that circulatory volume increases, the more blood gets to the kidneys, all of these fluid shifts and decreased blood volume can lead to renal failure since the kidneys won't be getting enough blood. So you'll need to carefully track their intake and their output especially especially as they get fluid resuscitation treatment because you will want to make sure that their kidneys are being perfused properly. If the kidneys are making urine, that means that they are being perfused and that the body is circulating blood better. So urine output is a key indicator for cardiac output. The patient should be diurese adequately and a stable urine output should be maintained greater than 30 milliliters per hour. 30 milliliters per hour is the magic number for the kidneys. You always want your patient's urine output to be at least 30 milliliters per hour because that will tell you that the kidneys are being perfused and that they're getting enough blood. Now my friend, there's three ways that I can help you more through nursing school. Number one, be sure to download the Nursing School Study Checklist that I have for you that walks you through how to study in nursing school and critically think better in Nursing school step by step. And be sure to check out our Nursing School boxes that we have available for you. They are packed with resources to help you succeed in nursing school, learn things faster and better. And of course, if you want me to hold your hand through your nursing school journey, do not miss out on joining the Nursing SOS Membership community. It is filled with step by step nursing lectures to help you understand everything faster so that you will be more prepared for your exams and then of course more confident too. The links to all of those things are down below in the description and if you like this video, make sure to hit hit that like button. Leave a comment below of course, to let me know that you loved it, share it with a friend and hit that subscribe button and click the notification bell so you never miss a video. And click on one of these videos right over here so you can keep rocking nursing school. And as always my friend, go become the nurse that God created only you to be. And I'll catch you next time on the Nursing School show. Take care. Bye bye.
