Advanced Pathophysiology

Rule of Nines for Burns in Adults Nursing NCLEX Lecture

This is Sarah with RegisteredNurseRN.com. And in this video, I'm going to be going over the rule of nines for burns in an adult patient. And this video is part of an [inaudible 00:00:09] series that I'm going to be covering over burns. And as always, don't forget to take the free quiz that will test you on how to calculate the rule of nines. So let's get started.

What is the rule of nines? The rule of nines is a calculation used to calculate the total body surface area percentage of the body that is burned. And we use this calculation for adults. Now, why would we care about knowing the percentage of the total body surface area that's burned on the body? Well, for a couple reasons. Number one, does this patient meet criteria to go to a burn unit? Also, those first 24 hours after severe burns, the patient is at risk for hypovolemic shock.

And what happens with severe burns, is that it increases the capillary permeability. So what happens is that you have your fluid, that's normally in your intervascular system, it's going to leave and go into the interstitial tissue. Well, what does that leave in the intravascular system for the heart to pump to your vital organs and tissues? Hardly anything at all. So the patient is at risk for death. And during those first 24 hours, we need to replace their fluids. And we take the total body surface percentage, and we plug that into what's called a Parkland's Burn Formula, which we're going to talk about in the next video. And this will help us determine how much fluid replacement that patient needs during the next 24 hours. And the most common solution you use to treat burns during the first 24 hours is Lactated Ringers.

Now let's talk about how to calculate the rule of nines, and then I'm going to work a practice problem of something similar you will encounter on an exam. Okay, so whenever you're doing this, you want to keep some things in mind. You want to keep in mind the anterior part of the body, which is the front, and the posterior part of the body, which is the back. Because a lot of times people forget that, "Oh, it said the head and the neck, anterior and posterior, I need to add these two numbers together." So they leave that out, and they get their calculation wrong.

Now, each area is going to be divided into the head and neck, the trunk, the arms, upper extremities, the perineum, and then the lower extremities, which are the legs. And each area is assigned a product of nine, which makes it a little bit easier to remember. So let's go over this. Okay. I like to start from head to toe. It makes it easier. We have the head and the neck, the front part of the head and neck, the anterior part is 4.5%. That's how much that's worth. The back, the posterior part is also 4.5%. And if you add those up together, say the patient had burns on the front of the head and the neck, and the back of the head and the neck, that would equal total of 9%.

So head and neck. Then we're going to move down to the trunk. The anterior part of the trunk, the front, is worth 18%. And then the back of the trunk is worth 18%. So if you had burns on both the anterior and posterior part of the trunk, that would be 36%. Then we have our upper extremities, our right arm, and our left arm. Front of the right arm is worth 4.5%. Front of the left arm is worth 4.5%. That together would equal 9%. So, on the front, over here, that would be 9%. If you had the front of both arms burned. So we'll put anterior arms.

Then we flip the patient over, if they have burns on their right back of the arm, it's 4.5%. And the back of their left arm is 4.5%. Add those together. You get nine. So 9% on that. That's the posterior, arms. But when you add them together, say your patient had burns on both the front of both arms, and the back of both arms that would equal total of 18%. So see why I said, remember that you have two of each, and don't leave one out, because it's easy to do that.

Then we moved down to the front right here. That's a perineum, that is worth 1%. And then we have our lower extremities, our legs. And again, don't forget that you have two of those, and you have the posterior and the anterior. So the right leg is worth nine, the front, and the left leg is worth nine, the front. So you add that together. You get 18%.

Then the back, the right leg is worth nine. The left leg is worth nine. So you get 18% again. That's the posterior part of the legs. And then when you add, if your patient had burns on both the front and the back of both legs, that would be 36%. Legs. And the perineum was one. So when you add 9+36+18+1+36, that gives you a 100%. So now let's look at a practice problem. Our problem says, "A 35 year old female has deep partial thickness burns on the front and back of both arms, anterior trunk, back of left leg, anterior and posterior sides of the right leg, posterior head and neck, and perineum. What is the total surface area percentage that is burned?"

So now let's calculate. Okay our patient has burns on the front and the back of both arms. So each arm in the front is each worth 4.5%, which would be a total of nine. And then we flip the patient back. Each arm again is worth 4.5%. That equals nine, 9+9= 18%. Then it says, anterior trunk. So that's the front, and the front is worth 18%. Then it says, the back of the left leg. That was worth 9%. Then it says, anterior and posterior right leg. So we're talking about the front, and the back of the right leg. So the front of the right leg is worth nine. The back of the right leg is worth nine, so that equals 18%.

Then it says, the posterior part of the head and neck. So the back of the head and neck, and that is 4.5%. And then the perineum, it's 1%. So then, all we do is add all that up. And what do we get? We get 68.5% is our total body surface area percentage that is burned on this patient. Okay, so that wraps up this review on how to calculate the rule of nines for burns. Thank you so much for watching. Don't forget to take the free quiz, and to subscribe to our channel for more videos.