CBRN Pediatric & Geriatric Burn Care — Questions and Answers
Question 1: Why is the Lund-Browder chart preferred over the rule of nines for estimating TBSA in a young child?
- It ignores head size
- It adjusts for the larger proportion of surface area in the head and smaller proportion in the legs (Correct answer)
- It is easier to memorize
- It applies only to adults
Correct answer: It adjusts for the larger proportion of surface area in the head and smaller proportion in the legs
Children's heads make up a larger percentage of body surface and their legs a smaller one than in adults. The Lund-Browder chart adjusts for age, so it estimates TBSA more accurately.
Question 2: A 15-kg child with a major burn is receiving resuscitation fluid. What should the nurse expect in addition to the formula fluid?
- No other fluids, to avoid overload
- Maintenance fluid containing dextrose, because of limited glycogen stores (Correct answer)
- Only colloid infusions
- Free water by mouth only
Correct answer: Maintenance fluid containing dextrose, because of limited glycogen stores
Small children (generally under about 30 kg) have limited glycogen reserves and are prone to hypoglycemia. Maintenance fluid with dextrose is given along with resuscitation fluid, and glucose is monitored.
Question 3: A toddler has sharply demarcated, symmetrical burns of both feet and buttocks with sparing of the flexed hip creases. The caregiver's story is inconsistent. What is the nurse's best action?
- Accept the explanation and discharge
- Document objectively and make a mandatory report to child protective services (Correct answer)
- Confront the caregiver in front of the child
- Wait for a second occurrence before reporting
Correct answer: Document objectively and make a mandatory report to child protective services
Symmetric, sharply demarcated immersion patterns with inconsistent histories are red flags for abuse. Nurses are mandated reporters, require only reasonable suspicion, and should document objectively without accusing.
Question 4: Why are older adults at higher risk of a poor outcome after a burn of the same size as a younger adult's?
- Thicker skin makes burns deeper
- Thinner skin, comorbidities, reduced physiologic reserve, and slower healing (Correct answer)
- Better immune function
- Higher metabolic rate
Correct answer: Thinner skin, comorbidities, reduced physiologic reserve, and slower healing
Aging skin is thinner, so burns are deeper. Cardiac, renal, and pulmonary disease and diminished reserve increase mortality, complications, and the risk of fluid overload during resuscitation.
Question 5: Why are infants and young children at high risk of hypothermia during burn care?
- Lower body surface area to mass ratio
- Higher body surface area to mass ratio and less insulating fat (Correct answer)
- Excess brown fat
- Increased shivering capacity
Correct answer: Higher body surface area to mass ratio and less insulating fat
Children have proportionally more surface area relative to mass, so they lose heat faster, and burn wounds increase evaporative loss. Warm rooms, warmed fluids, and limited exposure during dressing changes help prevent hypothermia.
Question 6: A pregnant patient with a major burn arrives in the emergency department. What is the primary principle of care?
- Fetal assessment takes priority over maternal stabilization
- Maternal resuscitation and stabilization come first, since fetal outcome depends on maternal status (Correct answer)
- Withhold fluids to protect the fetus
- Delay transfer to a burn center
Correct answer: Maternal resuscitation and stabilization come first, since fetal outcome depends on maternal status
The best fetal care is effective maternal resuscitation, including airway, oxygenation, fluid, and positioning (left uterine displacement in later pregnancy). Fetal monitoring and obstetric consultation are added once the mother is stabilized.
