The burned client relates the following history of previous health problems. Which one should alert the nurse to the need for alteration of the fluid resuscitation plan?
A. Seasonal asthma
B. Hepatitis B 10 years ago
C. Myocardial infarction 1 year ago
D. Kidney stones within the last 6 month
Correct Answer: C. Myocardial infarction 1 year ago
It is likely the client has a diminished cardiac output as a result of the old MI and would be at greater risk for the development of congestive heart failure and pulmonary edema during fluid resuscitation. The initial response to severe burn injury or early shock state is characterized by a decrease in cardiac output and metabolic rate. The reduction in cardiac output is partially due to hypovolemia and reduced venous return.
Option A: Systemic effects may occur especially after inhalation injury. Systemic effects of inhalation injury occur both indirectly from hypoxia or hypercapnia resulting from loss of pulmonary function and systemic effects of pro-inflammatory cytokines, as well as direct effects from metabolic poisons such as carbon monoxide and cyanide.
Option B: A history of hepatitis B does not affect the fluid resuscitation plan. Fluid creep in patients recovering from acute burns still exists, despite the use of a more treatment conservative approach. Most severe burn patients develop fluid overload and body weight increase after acute fluid resuscitation. How to quickly return patients to their pre-injury body weight is an important issue
Option D: Acute renal failure is one of the major complications of burns and it is accompanied by a high mortality rate. Most renal failures occur either immediately after the injury or at a later period when sepsis develops.
No comments:
Post a Comment