A 40-year-old male is brought to the casualty with severe burns following a industrial fire. On assessment, the nurse notes full-thickness burns covering the entire anterior torso, the entire left arm, and the anterior surface of the right leg. Using the Rule of Nines, what is the estimated Total Body Surface Area (TBSA) burned?

1. A

   27%

2. B

   36%

3. C

   45%

4. D

   54%

Appeared in: NORCET-9 Mains

Explanation

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• Rule of Nines assigns 18% to the anterior torso, 9% to each arm, and 18% to each leg (9% for anterior surface).
• Summing the involved regions: 18% (anterior torso) + 9% (left arm) + 9% (anterior right leg) = 36%.
• Accurate TBSA estimation is essential for fluid resuscitation and burn management.

Why Other Options Were Wrong

• Option A: 27% underestimates the TBSA because it does not account for all the involved regions. The anterior torso alone is 18%, and adding a full arm and half a leg exceeds 27%.
• Option C: 45% overestimates the TBSA. This would be correct if more regions, such as both legs or the posterior torso, were involved.
• Option D: 54% is much higher than the calculated TBSA for the described burns. This would require involvement of multiple large regions, such as both legs and both arms.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Rule of Nines calculation for TBSA in adult burn assessment to guide bedside assessment, documentation, and the next nursing action.
• Accurate TBSA estimation is critical for fluid resuscitation and prognosis in burn patients.
• Over- or underestimating TBSA can lead to inappropriate fluid management and complications.
• What if? If the posterior torso was also involved, the TBSA would increase by another 18%, changing the management plan.

How to Approach the Question

• Identify each burned region described in the stem.
• Recall the Rule of Nines percentages for adults: torso (18% front, 18% back), each arm (9%), each leg (18%), head (9%).
• Add the percentages for all affected regions.
• Compare your total to the options provided.
• Select the option that matches your calculation.

Concept Tested & Keywords

• Concept Tested: Rule of Nines calculation for TBSA in adult burn assessment
• Stem keywords: 40-year-old male, severe burns, full-thickness, anterior torso, left arm, anterior right leg, Rule of Nines, TBSA
• Lead-in keywords: estimated, Total Body Surface Area, TBSA
• Clinical cues: adult patient
• Clinical cues: specific body regions involved

Question ID

Qov8pe9eEv80yQK83dre0e

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 693-695