A patient comes in the emergency department with burn injury on one arm and whole back. According to rule of 9 calculate the burn area in TBSA?

1. A

   27%

2. B

   36%

3. C

   18%

4. D

   9%

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

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• The 'Rule of Nines' is a standardized method used to quickly estimate the Total Body Surface Area (TBSA) affected by a burn in adults.
• According to this rule, the entire surface of one arm accounts for 9% of the TBSA.
• The entire back, also known as the posterior trunk, is assigned 18% of the TBSA.
• The total burn area is the sum of the affected parts: 9% (for one arm) + 18% (for the whole back) equals 27%.

Why Other Options Were Wrong

• Option B: This value is incorrect for the described injury. 36% would represent a burn covering the entire trunk (anterior and posterior), which is 18% + 18%, or both legs, which is 18% + 18%.
• Option C: This value only accounts for part of the injury. 18% represents the TBSA for the whole back alone or one entire leg, but it does not include the additional burn on the arm.
• Option D: This value is too low. 9% represents the TBSA for only one arm or the head and neck, but it fails to account for the extensive burn on the patient's back.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for an adult burn patient in acute care settings.
• Accurate TBSA calculation is a critical first step in managing major burns, as it directly guides the volume of intravenous fluid resuscitation needed to prevent life-threatening burn shock.
• A burn of 27% TBSA in an adult is considered a major burn that requires aggressive fluid management, meticulous wound care, and often transfer to a specialized burn center for comprehensive care.
• What if? If the patient were a child (under 14 years old), the 'Rule of Nines' would be inaccurate. The Lund-Browder chart would be the preferred method, as it accounts for the different body proportions of children, especially their larger head-to-body size ratio.

How to Approach the Question

• First, identify the key information provided in the question: the patient is an adult, and the burn locations are 'one arm' and 'whole back'.
• Recall the standard percentages assigned to different body parts in the adult 'Rule of Nines'.
• Assign the correct percentage to 'one arm', which is 9%.
• Assign the correct percentage to the 'whole back', which corresponds to the posterior trunk and is 18%.
• Sum the percentages for all affected areas: 9% + 18% = 27%.
• Compare the calculated total with the given options and select the one that matches.

Concept Tested & Keywords

• Concept Tested: Calculation of Total Body Surface Area (TBSA) using the Rule of Nines for an adult burn patient.
• Stem keywords: burn injury, one arm, whole back, rule of 9, TBSA
• Lead-in keywords: calculate
• Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

Question ID

QLhA6BxzUa7MJkP3LTBm9F

Copy ID

Reference Book

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

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 747-749