Which clinical manifestation indicates that the burned client is moving into the fluid remobilization phase of recovery?
A. Increased urine output, decreased urine specific gravity
B. Increased peripheral edema, decreased blood pressure
C. Decreased peripheral pulses, slow capillary refill
D. Decreased serum sodium level, increased hematocrit
Correct Answer: A. Increased urine output, decreased urine specific gravity
The “fluid remobilization” phase improves renal blood flow, increasing diuresis and restoring fluid and electrolyte levels. The increased water content of the urine reduces its specific gravity. Injured capillaries heal approximately 24 to 36 hours after a burn, so intravascular fluid loss typically ceases at this time, and fluid begins to shift back into the intravascular compartment. This stage is called the fluid remobilization period.
Option B: Edema develops when the rate at which fluid is filtered out of the capillaries exceeds the flow in the lymph vessels. Edema formation often follows a biphasic pattern. An immediate and rapid increase in the water content of burned tissue is seen in the first hour after burn injury.
Option C: Inadequate fluid resuscitation is the most common cause of diminished distal pulses in the newly burned patient. Another potential cause of diminished pulses is peripheral edema, which develops in many severe burn patients due to the large fluid volumes needed for resuscitation.
Option D: Hyponatraemia is frequent, and the restoration of sodium losses in the burn tissue is, therefore, essential hyperkalemia is also characteristic of this period because of the massive tissue necrosis. Following a severe burn injury, significant hematologic changes occur that are reflected in complete blood count (CBC) measurements. Over the first week after injury, HGB and HCT decreased. This decrease was due to loss of red blood cells. WBC counts were initially elevated but decreased over the first 4 days. PLT also decreased over the first 4 days.
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