fluid balance & burns

the largest amount of water in an infant is in the ___

ECF

daily fluid requirements

<10 kg- 100 mL/kg, 10-20 kg- 1000 mL + 50 mL/kg each kg >10, >20 kg- 1500 mL + 20 mL/kg for each kg >20

dehydration (volume depletion) is most commonly due to…

diarrhea

late signs of shock

oliguria, elevated BUN, low BP/hypotension

oral rehydration solution (ORS) amount

50 mL/kg, additional 10 mL/kg with diarrhea

parenteral fluid bolus rate (isotonic fluids!- LR/NS)

20 mL/kg/5-20 min and repeat PRN

water intoxication causes…

decreased Na, CNS sx, irritability, V/D, HA, somnolence, seizures

__% total body surface area (TBSA) burned can be life threatening

10

superficial (first-degree) burns

minimal tissue damage, no blistering, heals in 5-10 d, no scarring, minimal tissue damage, ex: mild sunburn

partial-thickness (second-degree) burns

edema, severe capillary damage, wet, shiny weeping surface, burns, heals in 14-21 d, scarring likely, sensitive to touch, air currents, painful, moist, red, visible amount of scarring, epidermis and part of the dermis

full-thickness (third-degree) burns

involve entire epidermis and dermis, extend in sq tissue, nerve endings, sweat glands, hair follicles destroyed, deep red-tan, white, black brown, lack sensation, autografting required for healing

fourth-degree burns

full thickness, involving muscle, fascia, and bone

severity of injury & where management happens

minor- outpatient, moderate- hospital specialty, major- burn center

major burns pathophysiology

causes systemic response, capillary permeability, anemia, airway compromise, burn shock, potential sepsis in the healing stage, loss of fluid and electrolytes, anemia dt destroyed RBC, burn shock (alterations in circulation after)

symptoms of inhalation injury can be delayed for how long? response?

24 hr; monitor

major burns is how much of TBSA?

>30%

emergency treatment for burns

cover burn, don’t let them run (O2 makes it worse), don’t cool for a long time (drops body temp→ circulatory collapse), remove jewelry→ heat conductor, chemical→ flush with water

minor burn treatment

mild soap/tepid water, blister removal if chemical but otherwise controversial, cover with ointment, dressing q24hr of BID, give tetanus immunization if 5 yrs since last

I/O goal

<30 kg maintain UO 0.5-1 mL/kg/hr, >30 kg 30 mL/hr

hospitalized care for major burns

abx not prophylactically, silver sulfadiazine topically, contracture risk, pain management before dressing changes

nursing implications

watch K and Na (confusion, weakness, seizures), pulses qh (edema can put pressure on pulses and weaken them→ inadequate BF→ necrosis), make sure wounds not touching (heal together), safety- stir things well in microwave

sepsis: early & late signs

decreased LOC, increased restlessness, lethargy; hypotension