Rule of Nines for Burns in Adults Nursing NCLEX Lecture w/ Examples

The rule of nines for burns in adults is used to calculate the total body surface area of a patient that has suffered from a burn.

The TBSA (total body surface area) percentage helps the medical team determine how severe the burns are (does the patient need to be admitted to a burn unit) and how much fluid replacement will be needed during the first 24 hours.

The percentage of body surface area burned is used in the Parkland Burn Formula to determine the total amount of fluid replacement that will be needed to help prevent hypovolemic shock.

Patients who have 15-25% or more of a BSA that is burned will definitely need fluid replacement.

WHY? After a severe burn (partial-thickness or more) the capillary permeability increases, which leads to the fluid shifting from the intravascular space to the interstitial space. This depletes fluid volume in the intravascular space, leaving the heart with barely anything to pump to the vital organs and tissues. This can lead to death.

Therefore, Lactated Ringers (an isotonic solution) are prescribed to help increase the intravascular compartment.

Rule of Nines Calculations:

Adult:
Head and Neck: 9% (4.5% anterior and posterior)
Right Arm: 9% (4.5% anterior and posterior)
Left Arm: 9% (4.5% anterior and posterior)
Trunk: 36% (18% anterior and posterior)
Perineum: 1%
Right Leg: 18% (9% anterior and posterior)
Left Leg: 18% (9% anterior and posterior)
TOTAL: 100%

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