The nurse cares for a patient in the ER who was just severely burned. The wife a

Question

The nurse cares for a patient in the ER who was just severely burned. The wife asks "Why does he need those IV infusions(IV's)?" What are the best responses by the nurse that indicates the primary reasons for the intravenous infusions (IV'S) with a burned patient (select all that apply)

a. So we have an open line for resuscitation in case his heart stops

b. So he can receive his antibiotics

c. So we can keep his BP stable

d. So we can be sure he keeps enough blood volume

e. So we can reapidly administer his pain medications

Explanation / Answer

Why Fluid management is critical in major burn injuries

Burn care should start at the site of injury and continue through pre-hospital care and transfer to the closest burn center, or to the closest emergency department (ED) with advanced life support, followed by transfer to a burn center.

Note: Administer IV fluids if transport time will be longer than 30 min and fluid resuscitation is indicated.

It is well established that fluid management is fundamental when treating burn patients during the immediate post-trauma period. The adequate volumes of IV fluids are required to prevent burns shock in those with extensive burn injuries.

Aim of fluid resuscitation

The primary function of fluid resuscitation is to:

Note: The greatest loss of plasma occurs in the first 12 hours after burn injury.                

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Antibiotic therapy in case of burns – In case of topical antibiotics application proper physiological balance of skin is required but at the same time in case of IV antibiotics, many antibiotics can cause renal impairment so the high risk medication includes the aminoglycosides such as gentamicin, streptomycin, tobramycin, amikacin and neomycin. Monitor fluid balance for the duration of the treatment and for a further 24 hours after the last dose.

In case of burn there is decrease in fluid volume depletion, leading to low BP of patient. Hence to improve cardiac output and raise blood pressure the IV infusion is required.

Pain management is very important as inadequate control can interfere with wound care. Burn pain is difficult to control because of its unique characteristics.

Recommended routes of administration of analgesia include: oral, intravenous or intranasal. Intramuscular is not recommended in patients with burn injuries. The action of pain killers interfere with fluid volumes of affected site of body as interfere with various chemical mediators.

Pain relief can be achieved with medication in following way:

Hence the proper fluid management is a vital step in case of severe burn, to initiate the whole therapy in proper and effective manner, if it is avoided it will lead to failure of therapy.

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