Burns and Burn Injury Q 67 - Gyan Darpan : Learning Portal
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Thursday 31 March 2022

Burns and Burn Injury Q 67

The nurse is administering fluids intravenously as ordered to a client who acquired a full-thickness burn injury on the abdomen. To determine the sufficiency of fluid resuscitation, the nurse would monitor which of the following would provide the most reliable parameter for determining adequacy?
    A. Level of consciousness
    B. Peripheral pulses
    C. Urine output
    D. Vital signs

Correct Answer: C. Urine output

Of all the options, urine output is the most reliable indicator for determining the adequacy of fluid resuscitation. 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.

Option A: Heart rate, mental status, and capillary refill may be affected by the underlying disease process and are less reliable markers. The actual endpoint of fluid therapy in shock is to optimize tissue perfusion. However, this parameter is not measured directly. Surrogate endpoints include clinical indicators of end-organ perfusion and measurements of preload.
Option B: Because of compensatory vasoconstriction, mean arterial pressure (MAP) is only a rough guideline; organ hypoperfusion may be present despite apparently normal values. Because urine output does not provide a minute-to-minute indication, measures of preload may be helpful in guiding fluid resuscitation for critically ill patients.
Option D: Patient’s vital signs, mental status, capillary refill, and urine output must be monitored and fluid rates adjusted accordingly. Recent literature has raised concerns about complications from over-resuscitation described as “fluid creep.” Again, adequate fluid resuscitation is the goal.

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