The burned client’s family asks at what point the client will no longer be at increased risk for infection. What is the nurse’s best response?
A. “When fluid remobilization has started.”
B. “When the burn wounds are closed.”
C. “When IV fluids are discontinued.”
D. “When body weight is normal.”
Correct Answer: B. “When the burn wounds are closed.”
Intact skin is a major barrier to infection and other disruptions in homeostasis. No matter how much time has passed since the burn injury, the client remains at great risk for infection as long as any area of skin is open.
Option A: Fluid resuscitation replaces lost fluids and electrolytes and helps prevent complications (shock, acute tubular necrosis). Once initial fluid resuscitation has been accomplished, a steady rate of fluid administration is preferred to boluses, which may increase interstitial fluid shifts and cardiopulmonary congestion.
Option C: The important point to remember is the fluid amount calculated is just a guideline. Patient’s vital signs, mental status, capillary refill, and urine output must be monitored and fluid rates adjusted accordingly. 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. Recent literature has raised concerns about complications from over-resuscitation described as “fluid creep.” Again, adequate fluid resuscitation is the goal.
Option D: Severe burn is associated with significant changes in body weight due to large resuscitation volumes, fluid shifts, a hypermetabolic state, prolonged bed rest, and caloric intake. Weight gain in the severely burned patient often follows initial fluid resuscitation, which can increase weight by up to 10–20 kg.
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