NORCET 8 Prelims-2025
Medical & Surgical Nursing
Easy
Which is the best formula used for a burn patient for fluid replacement therapy?
Appeared in: NORCET 8 Prelims-2025
Explanation
- The Parkland (Baxter) formula is the standard and most widely taught method for calculating fluid requirements for burn patients in the initial 24 hours.
- The formula specifies using 4 mL of Lactated Ringer's solution multiplied by the patient's weight in kilograms and the percentage of total body surface area (%TBSA) burned.
- This formula provides a large volume of crystalloid fluid to compensate for the massive fluid shift and capillary leak that occurs after a major burn, aiming to prevent hypovolemic shock.
- The administration protocol is also specific: half of the total volume is infused over the first 8 hours from the time of injury, and the second half is infused over the subsequent 16 hours.
Why Other Options Were Wrong
- Option A: The Holliday-Segar formula is used to calculate daily maintenance fluid requirements, primarily in pediatric patients under normal conditions.
- Option C: This option incorrectly labels the 2 mL/kg/%TBSA formula as the Parkland formula. The classic Parkland formula uses 4 mL/kg/%TBSA.
- Option D: This option incorrectly describes the Modified Brooke formula. The Modified Brooke formula uses 2 mL of crystalloid solution (not 3 mL) and does not typically include colloids in the initial 24-hour resuscitation period.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Fluid resuscitation formulas for burn patients to guide bedside assessment, documentation, and the next nursing action.
- Accurate fluid resuscitation is critical in managing major burns to prevent 'burn shock,' a life-threatening condition caused by hypovolemia.
- Nurses are responsible for calculating the total fluid volume, setting the correct infusion rates for the first 8 and next 16 hours, and meticulously monitoring the patient's response, primarily through urine output (target: 0.5-1 mL/kg/hr in adults).
- Titration is key; the formula is a guide, not a rule. If urine output is low, the rate is increased. If it's too high, the rate is decreased to prevent complications like pulmonary edema and abdominal compartment syndrome.
How to Approach the Question
- First, identify the core of the question, which is asking for the 'best' or most standard fluid formula for burn patients.
- Recall the common formulas used in fluid management: Parkland, Brooke, and Holliday-Segar.
- Analyze each option. Recognize that the Holliday-Segar formula is for routine maintenance fluids, not acute burn resuscitation, and eliminate it.
- Compare the remaining options, which are all variations of burn formulas. Recall the standard definition of the Parkland formula, which is 4 mL/kg/%TBSA.
- Evaluate the other formula descriptions for accuracy. The option for 'Parkland formula: 2 ml' is a misnomer for the standard definition. The 'Modified Brooke' option has incorrect parameters (3 mL of colloids instead of 2 mL of crystalloids).
- Select the option that presents the most accurate and widely recognized formula for burn resuscitation.
Concept Tested & Keywords
- Concept Tested: Fluid resuscitation formulas for burn patients.
- Stem keywords: burn patient, fluid replacement therapy, formula
- Lead-in keywords: best
Question ID
q1AJo6H7WWI_HtO9WFpdv
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 694-696, 695-697
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 748-750
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