The burned client is ordered to receive intravenous cimetidine, an H2 histamine blocking agent, during the emergent phase. When the client’s family asks why this drug is being given, what is the nurse’s best response?
A. “To increase urine output and prevent kidney damage.”
B. “To stimulate intestinal movement and prevent abdominal bloating.”
C. “To decrease hydrochloric acid production in the stomach and prevent ulcers.”
D. “To inhibit loss of fluid from the circulatory system and prevent hypovolemic shock.”
Correct Answer: C. “To decrease hydrochloric acid production in the stomach and prevent ulcers.”
Ulcerative gastrointestinal disease may develop within 24 hours after a severe burn as a result of increased hydrochloric acid production and decreased mucosal barrier. Cimetidine inhibits the production and release of hydrochloric acid.
Option A: Adequate fluid therapy is crucial in maintaining renal function. Monitoring by urine output or Swan-Ganz catheterization and thermodilution cardiac output determination is useful in the circulatory management of severely burned patients. Albumin infusion increases plasma volume by 37% and normalizes elevated basal levels of aldosterone and plasma renin activity.
Option B: Other management for severe burns includes nasogastric tube placement as most patients will develop ileus. Foley catheters should be placed to monitor urine output. Cardiac and pulse oximetry monitoring are indicated. Pain control is best managed with IV medication.
Option D: Patients with burns of more than 20% – 25% of their body surface should be managed with aggressive IV fluid resuscitation to prevent “burn shock.” A variety of formulas exist, like Brooke, Galveston, Rule of Ten, etc.4, but the most common formula is the Parkland Formula. This formula estimates the amount of fluid given in the first 24 hours, starting from the time of the burn.
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