Burns and Burn Injury Q 27

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A client is undergoing fluid replacement after being burned 20% of her body 12 hours ago. The nursing assessment reveals a blood pressure of 90/50 mm Hg, a pulse rate of 110 beats per minute, and a urine output of 25 ml over the past hour. The nurse reports the findings to the physician and anticipates which of the following orders?

  

    A. Increasing the amount of intravenous (IV) lactated Ringer's solution administered per hour.

    B. Transfusing 1 unit of packed red blood cells.

    C. Administering diuretic to increase urine output.

    D. Changing the IV lactated Ringer's solution into dextrose in water.

    

    

Correct Answer: A. Increasing the amount of intravenous (IV) lactated Ringer’s solution administered per hour.

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The client’s urine output indicates inadequate fluid resuscitation. Hence the physician would order an increased amount of lactated Ringer’s solution administered hourly. Patients with burns of more than 20% – 25% of their body surface should be managed with aggressive IV fluid resuscitation to prevent “burn shock.” Urine output of 0.5 mL/kg or about 30 – 50 mL/hr in adults and 0.5-1.0 mL/kg/hr in children less than 30kg is a good target for adequate fluid resuscitation.

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Option B: Blood transfusion is not used for fluid resuscitation therapy unless there is an indication of a low hemoglobin level. This response, along with decreased cardiac output and increased vascular resistance, can lead to marked hypovolemia and hypoperfusion called “burn shock.” This can be managed with aggressive fluid resuscitation and close monitoring for adequate, but not excessive, IV fluids.

Option C: Diuretic works by removing circulating volume, thereby further compromising the inadequate tissue perfusion. The patient’s vital signs, mental status, capillary refill, and urine output must be monitored and fluid rates adjusted accordingly. Again, adequate fluid resuscitation is the goal.

Option D: Dextrose in water will only maintain fluid balance since it is an isotonic solution, therefore will not be helpful in this situation. Four mL lactated ringers solution × percentage total body surface area (%TBSA) burned × patient’s weight in kilograms = total amount of fluid given in the first 24 hours.

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