A patient has burns over the front of the chest and abdomen. The percentage of burns is calculated to be:

Appeared in: GMCH - 2016

Explanation

The 'Rule of Nines' is a standard tool used to estimate the total body surface area (TBSA) affected by burns in adults.
According to this rule, the entire anterior trunk (the front of the body from the neck to the pelvis) accounts for 18% of the TBSA.
The anterior trunk is further divided into the chest (9%) and the abdomen (9%).
The question states burns are on the 'front of the chest and abdomen,' so the total TBSA is the sum of these two areas: 9% + 9% = 18%.

Option A: A value of 9% would represent a burn on only the front of the chest OR only the front of the abdomen, but not both as specified in the question.
Option C: A value of 24% does not align with the standard divisions of the Rule of Nines for the trunk area. It might represent a combination of other body parts (e.g., an arm and a leg).
Option D: A value of 36% represents the TBSA for the entire trunk, including both the anterior (front) and posterior (back) surfaces.

Clinical Relevance

Nursing practice connection: Use the key finding related to Calculation of Total Body Surface Area (TBSA) for burns using the Rule of Nines to guide bedside assessment, documentation, and the next nursing action.
Accurate TBSA calculation is a critical first step in burn management, as it directly influences the volume of intravenous fluids needed for resuscitation, often calculated using the Parkland formula (4 mL x body weight in kg x %TBSA).
Underestimation of TBSA can lead to inadequate fluid replacement and hypovolemic shock, while overestimation can cause fluid overload and complications like pulmonary edema.
What if the patient was a child under 15? The 'Rule of Nines' would be inaccurate due to different body proportions. The Lund-Browder chart, which adjusts TBSA percentages for age, would be the more appropriate tool for assessment.

How to Approach the Question

First, identify the key terms in the question: 'burns,' 'front of the chest and abdomen,' and 'percentage.'
Recognize that calculating burn percentage in an adult typically involves the 'Rule of Nines.'
Recall the TBSA percentages assigned to different body parts by this rule.
Specifically, remember that the anterior trunk is 18%, which is composed of the anterior chest (9%) and the anterior abdomen (9%).
Sum the percentages for the affected areas mentioned in the question (chest + abdomen).
Compare your calculated total (18%) with the given options and select the matching one.

Concept Tested & Keywords

Concept Tested: Calculation of Total Body Surface Area (TBSA) for burns using the Rule of Nines.
Stem keywords: burns, front of the chest, abdomen, percentage of burns
Lead-in keywords: calculated to be
Negative lead-in flag: false

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E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 178-180

Practise the full GMCH - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.