Following fluid resuscitation, which parameter indicates a stable condition?
1. Systolic blood pressure (BP) more than 90 mm Hg
2. Urine output < 0.5
... [Show More] mL/kg/hr
3. Heart rate more than 120 beats/minute
4 .Mean arterial pressure (MAP) less than 65 mm Hg
1. Systolic blood pressure (BP) more than 90 mm Hg
Hourly assessments of the adequacy of fluid resuscitation are best made using clinical
parameters. Urine and cardiac parameters are most commonly used. Urine output should be 0.5
to 1 mL/kg/hr and 75 to 100 mL/hr for an electrical burn patient with evidence of
hemoglobinuria or myoglobinuria. The MAP should be greater than 65 mm Hg, systolic BP
greater than 90 mm Hg, and heart rate less than 120 beats/minute. MAP and BP are best
measured by an arterial line.
When planning for burn management, which patients should the nurse refer to a burn center?
Select all that apply.
1. Patients with hydrochloric acid burns
2. Patients of all ages with first-degree burns
3. Patients of all ages with third-degree burns
4. Patients with 25% deep partial-thickness burns
5. Patients with 5% superficial partial-thickness burns
1. Patients with hydrochloric acid burns
3. Patients of all ages with third-degree burns
4. Patients with 25% deep partial-thickness burns
Patients suffering from hydrochloric acid burns, also known as chemical burns, should be
referred to a burn center. Patients of all ages with third-degree burns are severe in condition and
should be treated in a burn center. All patients with partial-thickness burns more than 10%
should be referred to a burn center, as they are severe types of burns and need specialized
treatment, care, and isolation. Patients of all ages with first-degree burns can be managed in the
hospital and assessed. Patients with 5% superficial partial-thickness burns need not necessarily
be referred and can be managed in the hospital.
A patient is brought to the emergency department (ED) with severe burns on the legs and feet.
Which factors lead the nurse to believe the patient may have full-thickness burns? Select all that
apply.
1. Touch sensation is impaired.
2. Blanching with pressure is observed.
3. Lack of blanching with pressure is observed.
4. Wounds appear mottled white, pink to cherry-red.
5. Wounds appear waxy white, dark brown, or charred. [Show Less]