Integumentary Disorders Q 11

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In an industrial accident, a male client that weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his body. He’s in the burn unit receiving fluid resuscitation. Which observation shows that the fluid resuscitation is benefiting the client?

  

    A. A urine output consistently above 100 ml/hour.

    B. A weight gain of 4 lb (2 kg) in 24 hours.

    C. Body temperature readings all within normal limits.

    D. An electrocardiogram (ECG) showing no arrhythmias.

    

    

Correct Answer: A. A urine output consistently above 100 ml/hour

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In a client with burns, the goal of fluid resuscitation is to maintain a mean arterial blood pressure that provides adequate perfusion of vital structures. If the kidneys are adequately perfused, they will produce an acceptable urine output of at least 0.5 ml/kg/hour. Monitor urinary output and specific gravity. Observe urine color and Hematest as indicated. Generally, fluid replacement should be titrated to ensure average urinary output of 30–50 mL/hr (in the adult).

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Option B: The expected urine output of a 155-lb client is 35 ml/hour, and a urine output consistently above 100 ml/hour is more than adequate. Urine can appear red to black (with massive muscle destruction) because of the presence of blood and the release of myoglobin. If gross myoglobinuria is present, minimum urinary output should be 75–100 mL/hr to reduce the risk of tubular damage and renal failure.

Option C: Weight gain from fluid resuscitation isn’t a goal. In fact, a 4-lb weight gain in 24 hours suggests third spacing. Fluid replacement formulas partly depend on admission weight and subsequent changes. A 15%–20% weight gain can be anticipated in the first 72 hr during fluid replacement, with return to pre-burn weight approximately 10 days after-burn.

Option D: Body temperature readings and ECG interpretations may demonstrate secondary benefits of fluid resuscitation but aren’t primary indicators. Monitor vital signs, central venous pressure (CVP). Note capillary refill and strength of peripheral pulses. Serves as a guide to fluid replacement needs and assesses cardiovascular response.

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