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🫀 Adaptasyon Fizyolojik · Leson 10 sou 10 · 8 min

Boule: Fòmil Parkland ak Lafyèv Netwopenik

Burns: The Parkland Formula and Neutropenic Fever

🔥 Yon pasyan 70 kg ki gen boule sou 40% kò li bezwen 11.2 lit likid nan 24 èdtan, epi mwatye ladan li nan premye 8 èdtan yo depi lè boule a te fèt la, pa depi lè li te rive a. Egzamen an fè kalkil la epi li espere ou jwenn menm repons la.

🔥 A 70 kg client with 40% burns needs 11.2 liters of fluid in 24 hours, and half of it in the first 8 hours from the time of the burn, not the time of arrival. The exam does the math and expects you to match it.

💡 Ide prensipal

Parkland: 4 × kg × %TBSA, mwatye nan premye 8 èdtan yo depi boule a. Atann ipèkalemi byen bonè, epi apre ipokalemi. Siy inalasyon vle di entibe bonè. Lafyèv netwopenik 38 °C se yon ijans.

Parkland: 4 × kg × %TBSA, half in the first 8 hours from the burn. Expect hyperkalemia early, then hypokalemia. Inhalation signs mean intubate early. Neutropenic fever of 38 °C is an emergency.

🧠 Poukisa sa enpòtan

Pwofondè BOULE a: sifasyèl (wouj, douloure, san anpoul), epesè pasyèl (anpoul, mouye, trè douloure) ak epesè konplè (blan, tankou kwi oswa boule nèt, san doulè nan sant la). Estime sifas la ak RÈG NEF LA lakay granmoun: tèt 9%, chak bra 9%, chak janm 18%, pati devan kòf la 18%, pati dèyè kòf la 18%, perine 1%. FÒMIL PARKLAND: 4 mL × kg × % sifas total kò a nan lactated Ringer's pandan 24 èdtan, mwatye nan premye 8 èdtan yo DEPI LÈ BLESIRA TE FÈT LA epi rès la pandan 16 èdtan ki vin apre yo; ajiste selon yon pwodiksyon pipi omwen 0.5 mL/kg/hr (apeprè 30 mL/hr), epi plis toujou nan ka boule elektrik ak pipi fonse. Anpil sant boule kounye a kòmanse granmoun yo a 2 mL × kg × %TBSA epi yo ajiste selon pwodiksyon pipi a, men egzamen an toujou anseye Parkland. Faz IJANS la (premye 24 jiska 48 èdtan yo) pote ipovolemi, IPÈKALEMI akòz domaj nan selil yo ak iponatremi; faz EGWI a pote dyirez, ipokalemi ak risk enfeksyon. Sispèk yon blesi INALASYON lè gen boule nan figi, plim nen boule, swi nan krache a, vwa anwe oswa stridor, epi prepare w pou entibasyon bonè; bay 100% oksijèn pou monoksid kabòn. Boule sikonferansyèl yo bezwen verifikasyon eskaratomi pou sikilasyon an. Yo bay medikaman pou doulè IV, janmè IM, paske absòpsyon an pa fyab. PREKOSYON NETWOPENIK pou pasyan chimyoterapi ki gen yon kantite absoli netwofil anba apeprè 1,000 (dapre règleman etablisman an): chanm prive, ijyèn men ki fèt ak anpil swen, pa gen flè fre oswa plant, pa gen manje kri oswa ki pa byen kwit dapre règleman an, pa gen tanperati rektal oswa sipozitwa, evite foul moun ak vizitè ki malad, epi trete nenpòt tanperati 38.0 °C (100.4 °F) oswa plis kòm yon IJANS ki mande kilti ak antibyotik nan yon èdtan. TWOMBOSITOPENI: depi plakèt yo desann anba apeprè 50,000, sèvi ak prekosyon kont senyman: yon bwòs dan mou, yon razwa elektrik epi pa gen piki kote sa posib.

BURN depth: superficial (red, painful, no blisters), partial thickness (blisters, moist, very painful) and full thickness (white, leathery or charred, painless at the center). Estimate area with the RULE OF NINES in adults: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%. PARKLAND FORMULA: 4 mL × kg × % total body surface area of lactated Ringer's over 24 hours, half in the first 8 hours FROM THE TIME OF INJURY and the rest over the next 16; titrate to a urine output of at least 0.5 mL/kg/hr (about 30 mL/hr), higher with electrical burns and dark urine. Many burn centers now start adults at 2 mL × kg × %TBSA and adjust to urine output, but the exam still teaches Parkland. The EMERGENT phase (first 24 to 48 hours) brings hypovolemia, HYPERKALEMIA from cell damage and hyponatremia; the ACUTE phase brings diuresis, hypokalemia and infection risk. Suspect INHALATION injury with facial burns, singed nasal hair, soot in the sputum, hoarseness or stridor, and prepare for early intubation; give 100% oxygen for carbon monoxide. Circumferential burns need escharotomy checks for circulation. Pain medication is given IV, never IM, because absorption is unreliable. NEUTROPENIC PRECAUTIONS for chemotherapy clients with an absolute neutrophil count below about 1,000 (per facility policy): private room, meticulous hand hygiene, no fresh flowers or plants, no raw or undercooked foods per policy, no rectal temperatures or suppositories, avoid crowds and sick visitors, and treat any temperature of 38.0 °C (100.4 °F) or higher as an EMERGENCY requiring cultures and antibiotics within an hour. THROMBOCYTOPENIA: once platelets fall under about 50,000, use bleeding precautions: a soft toothbrush, an electric razor and no injections where possible.

🏥 Nan lavi reyèl

🧮 Pasyan 70 kg ki gen boule sou 40% kò li te boule a 1400 epi li rive a 1600. Fòmil Parkland: 4 × 70 × 40 = 11,200 mL. Mwatye a, 5,600 mL, dwe pase anvan 2200, uit èdtan apre boule a, sa ki kite sèlman sis èdtan pou bay li. Enfimyè a regle ponp lan sou vitès ki pi rapid la epi li siveye pwodiksyon pipi a. Pyèj egzamen an se kòmanse konte lè a depi moman rive a.

🧮 The 70 kg client with 40% burns was burned at 1400 and arrives at 1600. Parkland: 4 × 70 × 40 = 11,200 mL. Half, 5,600 mL, is due by 2200, eight hours after the burn, which leaves only six hours to give it. The nurse sets the pump for the faster rate and watches the urine output. The exam's trap is starting the clock at arrival.

📌 Sa pou retni

  • Règ nef la: tèt 9, bra 9 chak, janm 18 chak, kòf 18 devan ak 18 dèyèRule of nines: head 9, arms 9 each, legs 18 each, trunk 18 front and 18 back
  • Parkland: 4 mL × kg × %TBSA; premye mwatye a nan 8 èdtan depi blesi a; ajiste selon yon pwodiksyon pipi omwen 0.5 mL/kg/hrParkland: 4 mL × kg × %TBSA; first half in 8 hours from injury; titrate to urine output of at least 0.5 mL/kg/hr
  • Netwopeni: pa gen flè, pa gen tanperati rektal, lafyèv 38 °C bezwen antibyotik nan yon èdtanNeutropenia: no flowers, no rectal temps, fever of 38 °C needs antibiotics within an hour

📖 Tèm nan leson sa a

Fòmil Parkland (Parkland formula): Reanimasyon likid pou boule: 4 mL × kg × pousantaj sifas kò ki boule sou 24 èdtan, mwatye nan premye 8 èdtan yo depi blesi a.

Antiemetik (ondansetron, metoclopramide) (Antiemetics (ondansetron, metoclopramide)): Ondansetron bloke serotonin pou anpeche kè plen chimyoterapi ak chiriji epi li ka pwolonje entèval QT la; metoclopramide vide lestomak la men li pote yon avètisman nan bwat pou diskinezi tardif irevèsib, kidonk li limite a 12 semèn epi yo sispann li pou mouvman anòmal.

Filgrastim ak epoetin alfa (Filgrastim and epoetin alfa): Filgrastim ogmante netrofil apre chimyoterapi, lakòz doulè zo epi yo pa bay li nan 24 èdtan anvan oswa apre chimyoterapi; epoetin alfa ogmante emoglobin nan maladi ren men li ogmante tansyon ak risk boul, kidonk kenbe li lè emoglobin pase 10 a 11 g/dL.

Methotrexate: Yon blokè folat pou kansè, atrit rimatoyid ak psoriasis ki siprime mwèl la epi domaje fwa a, poumon yo ak kouch bouch la; dòz chak semèn yo pran chak jou pa erè ka letal, kidonk konfime orè a, bay sekou asid folik oswa leucovorin jan yo òdone a, epi anpeche gwosès.

✅ Teste tèt ou

Yon pasyan ki peze 80 kg gen boule sou 30% kò li. Si w sèvi ak fòmil Parkland la, konbyen likid yo ta dwe bay li nan premye 8 èdtan yo apre boule a?A client weighing 80 kg has burns over 30% of the body. Using the Parkland formula, how much fluid should be given in the first 8 hours after the burn?
  1. 9,600 mL
  2. 19,200 mL
  3. 4,800 mL
  4. 2,400 mL

Repons: C · 4,800 mL

4 × 80 × 30 = 9,600 mL pandan 24 èdtan; mwatye a, 4,800 mL, yo bay li nan premye 8 èdtan yo.

4 × 80 × 30 = 9,600 mL over 24 hours; half, 4,800 mL, is given in the first 8 hours.

Yon pasyan ki gen boule nan figi gen plim nen li boule epi vwa li anwe. Ki pwoblèm enfimyè ki pi priyoritè a?A client with facial burns has singed nasal hairs and a hoarse voice. What is the priority nursing concern?
  1. Enfeksyon boule nan figi yoInfection of the facial burns
  2. Kontwòl doulèPain control
  3. Obstriksyon vwa respiratwa ki prèt pou riveImpending airway obstruction
  4. Twòp likidFluid overload

Repons: C · Obstriksyon vwa respiratwa ki prèt pou rive

Siy sa yo anonse edèm nan vwa respiratwa a; yo ka bezwen entibasyon bonè anvan anfleman an fèmen vwa respiratwa a. Enfeksyon boule nan figi yo se yon risk reyèl, men li devlope sou plizyè jou; obstriksyon vwa respiratwa a ka touye nan kèk èdtan.

These signs predict airway edema; early intubation may be needed before swelling closes the airway. Infection of the facial burns is a real risk, but it develops over days; airway obstruction can kill within hours.

Yon pasyan k ap resevwa chimyoterapi gen yon kantite absoli netwofil 400 epi yon tanperati 38.3 °C (100.9 °F). Ki aksyon enfimyè a dwe fè an priyorite?A client receiving chemotherapy has an absolute neutrophil count of 400 and a temperature of 38.3 °C (100.9 °F). What is the nurse's priority action?
  1. Ankouraje li bwè likid epi pran repoEncourage oral fluids and rest
  2. Bay acetaminophen epi tcheke ankò nan 4 èdtanGive acetaminophen and recheck in 4 hours
  3. Fè kilti epi avèti founisè swen anObtain cultures and notify the provider
  4. Mete yon dra refwadisman sou liApply a cooling blanket

Repons: C · Fè kilti epi avèti founisè swen an

Lafyèv lakay yon pasyan netwopenik se yon ijans medikal; sepsis ka devlope rapidman, kidonk yo kòmanse kilti ak antibyotik nan yon èdtan. Bay acetaminophen epi tcheke ankò nan 4 èdtan maske lafyèv la epi li retade tretman an lakay yon pasyan ki pa ka goumen kont enfeksyon.

Fever in a neutropenic client is a medical emergency; sepsis can develop rapidly, so cultures and antibiotics are started within an hour. Giving acetaminophen and rechecking in 4 hours masks the fever and delays treatment in a client who cannot fight infection.

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