1
NUR 409 – Clinical Simulation Case Studies
Case Study 136
You are working in the emergency department (ED) of a community hospital when the
ambulance arrives with A.N., an 18-year-old woman who was caught in a house fire. She was
sleeping when the fire started and managed to make her way out of the house through thick
smoke. The emergency medical system crew initiated humidified oxygen at 15 L/min per
nonrebreather mask and started a 16-gauge IV with lactated Ringer's solution. On arrival to
the ED, her vital signs are 100/66, 125, 34, SaO2 93%. An additional 16-gauge IV is
inserted. She appears anxious and in pain.
1. As you perform your initial assessment, you note superficial partial-thickness burns on
A.N.'s right anterior leg, left anterior and posterior leg, and anterior torso. Shade the
affected areas, then using the “rule of nines,” calculate the extent of A.N.'s burn injury.
Right anterior leg = 9%
Left anterior leg = 9%
Left posterior leg = 9%
Anterior torso = 18%
Total = 45% TBSA
2. Because you are concerned about possible smoke inhalation, what signs will you monitor
A.N. for?
• Monitor for signs of developing brassy cough, difficulty swallowing, excessive
drooling and expiratory sounds.
3. Interpret A.N.'s laboratory results.
• Hgb elevated from fluid loss
• Hct elevated from fluid loss.
NUR 409 – Clinical Simulation Case Studies
Case Study 136
You are working in the emergency department (ED) of a community hospital when the
ambulance arrives with A.N., an 18-year-old woman who was caught in a house fire. She was
sleeping when the fire started and managed to make her way out of the house through thick
smoke. The emergency medical system crew initiated humidified oxygen at 15 L/min per
nonrebreather mask and started a 16-gauge IV with lactated Ringer's solution. On arrival to
the ED, her vital signs are 100/66, 125, 34, SaO2 93%. An additional 16-gauge IV is
inserted. She appears anxious and in pain.
1. As you perform your initial assessment, you note superficial partial-thickness burns on
A.N.'s right anterior leg, left anterior and posterior leg, and anterior torso. Shade the
affected areas, then using the “rule of nines,” calculate the extent of A.N.'s burn injury.
Right anterior leg = 9%
Left anterior leg = 9%
Left posterior leg = 9%
Anterior torso = 18%
Total = 45% TBSA
2. Because you are concerned about possible smoke inhalation, what signs will you monitor
A.N. for?
• Monitor for signs of developing brassy cough, difficulty swallowing, excessive
drooling and expiratory sounds.
3. Interpret A.N.'s laboratory results.
• Hgb elevated from fluid loss
• Hct elevated from fluid loss.
