Fluids and ElectrolytesFluids and ElectrolytesNCM102NCM102

by: ispongklongby: ispongklong

BurnsBurns

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TypesTypesChemicalChemicalElectricElectricThermalThermal InhalationInhalation

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Fluid considerationsFluid considerations Fluid shift and edema formation occur within Fluid shift and edema formation occur within

24-48 hours after burn injury. Fluid 24-48 hours after burn injury. Fluid mobilization occurs within approximately 18-mobilization occurs within approximately 18-36 hours after burn injury.36 hours after burn injury.

Serum K levels ↑ and Hct levels ↑ because Serum K levels ↑ and Hct levels ↑ because of hemoconcentrationof hemoconcentration

The ↑ capillary permeability and the The ↑ capillary permeability and the histamine released from the injured cells histamine released from the injured cells precipitate a ↓ in fluid volume precipitate a ↓ in fluid volume

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NURSING PRIORITY:NURSING PRIORITY:The client with burn injury is often awake, mentally The client with burn injury is often awake, mentally

alert, and cooperative at first. The level of alert, and cooperative at first. The level of consciousness may change as respiratory consciousness may change as respiratory status change or as the fluid shift occurs, status change or as the fluid shift occurs, precipitating hypovolemia. If the client is precipitating hypovolemia. If the client is unconscious or confused, assess him or her unconscious or confused, assess him or her for the possibility of a head injury.for the possibility of a head injury.

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Assess forAssess for Patent airwayPatent airway Presence of adequate breath soundsPresence of adequate breath sounds Symptoms of hypoxiaSymptoms of hypoxia Pulmonary damagePulmonary damage

Burns around the face, neck, mouth or in the oral Burns around the face, neck, mouth or in the oral mucosal areamucosal area

Circulatory statusCirculatory status Tachycardia and hypotension occur earlyTachycardia and hypotension occur early Elevate UOElevate UO

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Assess forAssess for GI function – check last time client ateGI function – check last time client ate Fluid statusFluid status

UO (30 ml/hr)UO (30 ml/hr) Hypotension (< 90/60)Hypotension (< 90/60) Confusion / disorientationConfusion / disorientation

Circulatory status of the extremitiesCirculatory status of the extremities

Determine the Determine the severity of burnsseverity of burns

Rule of nines (adult)Rule of nines (adult) Pediatric burn Pediatric burn

calculationcalculation

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DEPTH OF BURNS Superficial or first-degree burn: Area is reddened

and blanches with pressures; no edema present; area is generally painful to touch

Partial thickness or second-degree burn: Dermis and epidermis are affected; formation of large, thick-walled blisters; underlying skin is erythematous

Full-thickness or third-degree burn: all of the skin is destroyed; may have damage to the subcutaneous tissue and muscle; usually has a dry appearance, may be white or charred; will require skin grafting to cover area

Fourth-degree burn: full-thickness burn in which underlying structures (fascia, tendons, and bones) are severely damaged, usually blackened

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Severity according to ageSeverity according to age Infants have an immature immune system Infants have an immature immune system

and poor body defenseand poor body defense Elderly clients heal more slowly and are Elderly clients heal more slowly and are

more likely to have wound infection more likely to have wound infection problems and pulmonary complicationsproblems and pulmonary complications

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TreatmentTreatment Respiratory status takes priority over the Respiratory status takes priority over the

treatment of the burn injurytreatment of the burn injury If burn area is small If burn area is small cold compress or cold compress or

immerse in cool water (immerse in cool water (not icenot ice) to ↓ heat) to ↓ heat No ointment on the burn areaNo ointment on the burn area Analgesics IV, IM, SQ. oral forms may not Analgesics IV, IM, SQ. oral forms may not

be absorbed effectivelybe absorbed effectively

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Nursing interventionNursing intervention Maintain patent airway; prevent hypoxiaMaintain patent airway; prevent hypoxia Evaluate fluid status; determine circulatory Evaluate fluid status; determine circulatory

statusstatus Prevent of decrease infectionPrevent of decrease infection Maintain nutritionMaintain nutrition Prevent contractures and scarringPrevent contractures and scarring Promote acceptance and adaptation to Promote acceptance and adaptation to

alterations in body imagealterations in body image

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Formula name Electrolyte- Containing solution

Colloid-Containing Solution

Dextrose in Water

Evans NSS 1 ml/kg/%burn NSS 1 ml/kg/%burn 2000 ml

Brooke LR 1.5 ml/kg/%burn 0.5 ml/kg/%burn 2000 ml

Modified Brooke LR 2 ml/kg/%burn None None

Parkland LR 4 ml/kg/%burn None None

Hypertonic Saline

Fluid containing 250 mEq of Na/L to maintain hourly urine output of 70 ml in adults

None None

First 24 hours

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Formula name Electrolyte- Containing solution

Colloid-Containing Solution

Dextrose in Water

Evans ½ of first 24-hr requirement

½ of first 24-hr requirement

2000 ml

Brooke ½ - ¾ of first 24-hr requirement

½ - ¾ of first 24-hr requirement

2000 ml

Modified Brooke None 0.3-0.5 ml/kg/%burn Titrate to maintain urine output

Parkland None 0.3-0.5 ml/kg/%burn Titrate to maintain urine output

Hypertonic Saline

Same solution to maintain hourly urine output of 30 ml in adults

None None

Second 24 hours