Burn Total Body Surface Area Calculations and Bow Tie Item Format Study Guide

Rule of Nines Burn Total Body Surface Area (TBSA) Calculation

• Anatomical Percentage Allocations:

  • Head: Total $9\%$ TBSA
    • Anterior head (front): $4.5\%$
    • Posterior head (back): $4.5\%$
  • Upper Extremities (Arms): Total $9\%$ TBSA per arm
    • Anterior arm (front): $4.5\%$
    • Posterior arm (back): $4.5\%$
    • Anterior and posterior of a single arm: $9\%$
    • Anterior and posterior of both arms combined: $18\%$
  • Lower Extremities (Legs): Total $18\%$ TBSA per leg
    • Anterior leg (front): $9\%$
    • Posterior leg (back): $9\%$
    • Anterior and posterior of a single leg: $18\%$
    • Anterior and posterior of both legs combined: $36\%$
  • Trunk / Torso: Total $36\%$ TBSA
    • Anterior trunk (front): $18\%$
    • Posterior trunk (back): $18\%$
  • Perineum: $1\%$ TBSA

• Assessment Rules and Calculation Guidelines:

  • Numerical Entry: Enter only the calculated numeric value into the answer box.
  • Percentage Symbol: Do not include the percent sign ($\%$) inside the answer box.
  • Rounding Rule: Do not round up or down. Preserve exact decimal values (for example, a total calculation of $34.5$ must be entered as 34.5).
  • Question Formats: Burn percentage assessments may appear as fill-in-the-blank (numeric input), drop-down items, or Select All That Apply (SATA).

Examination Scope and Item Types

• Subject Matter Scope:

  • Cancer
  • Skin Disorders and Burns
  • Sensory Disorders

• Question Formats:

  • Fill-in-the-blank numerical calculations
  • Select All That Apply (SATA)
  • Standard Drag and Drop
  • Bow Tie Questions (ATI / Next Generation NCLEX format)

Next Generation NCLEX (NGN) Bow Tie Item Format

• Overview and Conceptual Layout:

  • The Bow Tie item is an interactive drag-and-drop format assessing clinical judgment.
  • The question interface contains a client record exhibit on the left side and a bow-tie-shaped central diagram.

• Client Record Exhibits (Left Panel):

  • Nurses' Notes
  • Doctor's / Provider's Orders
  • Laboratory Results
  • Vital Signs

• Bow Tie Diagram Structure:

  • Center Section: Client Condition (Select 1 primary condition).
  • Left Wing: Actions to Take (Select 2 distinct nursing actions/interventions).
  • Right Wing: Parameters to Monitor (Select 2 distinct physiological parameters or lab/vital sign indicators).

• Clinical Decision-Making Process for Bow Tie Questions:

  1. Review client exhibits (vital signs, lab results, orders, and nursing notes).
  2. Identify the target disease process based on core examination topics (Cancer, Skin, Sensory).
  3. Drag the target condition into the central node.
  4. Select two appropriate nursing interventions corresponding directly to the identified condition and drag them to the left wing.
  5. Select two condition-specific monitoring parameters and drag them to the right wing.

Exemplar Bow Tie Clinical Scenario

• Clinical Assessment & Diagnostic Selection:

  • Scenario Options: Pneumonia, Chronic Obstructive Pulmonary Disease (COPD), Pulmonary Embolism, Malignant Lung Neoplasm.
  • Selected Condition: Malignant Lung Neoplasm.

• Action Selection:

  • Options Evaluated: Initiate oxygen, schedule follow-up chest X-ray, provide education on deep breathing, arrange for biopsy of pulmonary mass, administer albuterol via nebulizer mask.
  • Action 1: Arrange for biopsy of the pulmonary mass (confirmatory diagnostic evaluation).
  • Action 2: Administer albuterol via nebulizer mask (airway management and dyspnea mitigation).

• Parameter Monitoring Selection:

  • Options Evaluated: Weight, blood pressure, oxygen saturation levels, respiratory rate.
  • Parameter 1: Oxygen saturation levels.
  • Parameter 2: Respiratory rate.