A client is admitted with a burn injury to both of his upper extremities. What is the total body surface area (TBSA) affected for this patient, according to rule of nine?

1. A

   9%

2. B

   18%

3. C

   36%

4. D

   27%

Appeared in: OSSSC Nursing Officer-2021

Explanation

• The Rule of Nines is a standardized tool for the rapid estimation of burn size in adults.
• It divides the body into sections, each representing 9% or a multiple of 9% of the Total Body Surface Area (TBSA).
• According to this rule, each complete upper extremity (arm) accounts for 9% of the TBSA.
• Since the client has burns on both upper extremities, the total affected area is calculated as 9% (for the first arm) + 9% (for the second arm), which equals 18%.

Why Other Options Were Wrong

• Option A: This percentage represents the TBSA for a burn covering only one full arm or the entire head and neck.
• Option C: This value corresponds to the TBSA for burns covering both lower extremities (18% each) or the entire trunk (18% anterior + 18% posterior).
• Option D: This percentage does not correspond to a standard combination of body parts under the Rule of Nines for this scenario.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for adult burn injuries to guide bedside assessment, documentation, and the next nursing action.
• Accurate TBSA estimation is a critical first step in managing moderate to severe burns, as it directly influences the volume of intravenous fluids administered to prevent life-threatening burn shock.
• The TBSA percentage is a key factor in the American Burn Association's criteria for referral to a specialized burn center, ensuring patients with severe injuries receive appropriate care.
• What if? If the patient were an infant, the Rule of Nines would be inaccurate due to different body proportions (e.g., a larger head). The Lund-Browder chart, which is age-specific, would be the correct tool to use for a more accurate TBSA estimation.

How to Approach the Question

• First, identify the key information in the question: the patient is an adult, the injury is a burn, the location is 'both upper extremities,' and the method is the 'Rule of Nines.'
• Recall the percentage allocations for the adult Rule of Nines. Remember that each major body area is a multiple of 9.
• Specifically, recall that one full arm is assigned 9% of the TBSA.
• Calculate the total for the specified area: since both arms are affected, the calculation is 9% (left arm) + 9% (right arm).
• Sum the values: 9 + 9 = 18.
• Select the option that matches your calculated result of 18%.

Concept Tested & Keywords

• Concept Tested: Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for adult burn injuries.
• Stem keywords: burn injury, upper extremities, total body surface area, TBSA, rule of nine
• Lead-in keywords: What is
• Negative lead-in flag: false

Question ID

QP_JLFQjoWZviUITDNwZBo

Copy ID

Reference Book

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