I dont get this answer, Help!!

amybethf · Jun 30, 2008

Because urine output

Hands and Heart · Jun 30, 2008

What amybethf said. Don't read into the question. Just use the information given: low urine output and 3 day ago burn patient. The destruction of cells leads to the fluid shifting. Thus increasing the fluids will increase the fluid volume in the intravascular space.

RNMeg · Jun 30, 2008

Why would the patient be in renal failure from a burn? The burn and the low urine output is the only info we're given in the question..cell damage leads to fluid shift and possible dehydration. Need to increase fluids :specs:

shrimpchips, LPN · Jun 30, 2008

there's nothing pertaining to renal failure in that question.... :)

suzy253, RN · Jun 30, 2008

absolutely--don't read into the question. My friend has a habit of doing that and ends up screwing himself.

Daytonite, BSN, RN · Jul 1, 2008

a patient that suffered a burn 3 days ago is recovering on your unit and the urine output continues to remain at 26 ml/hr. what order do you anticipate the doctor giving?
a) increase iv fluids
b) decrease iv fluids
c) change the iv fluid to a different solution
d) change the urinary catheter
the answer is a. i dont understand why the doctor would want to increase fluids if the patient is in possible renal failure. can someone explain?

let me take you through the critical thinking to get to the answer.

part of studying medical diseases and medical conditions is knowing the cause, pathophysiology, signs and symptoms and complications. burns are a tissue trauma causing tissue damage. the symptoms of burns are (http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm#symptoms):

blisters
pain (the degree of pain is not related to the severity of the burn -- the most serious burns can be painless)
peeling skin
red skin
shock (watch for pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness)
swelling
white or charred skin
symptoms of an airway burn:
- charred mouth; burned lips
- burns on the head, face, or neck
- wheezing
- change in voice
- difficulty breathing; coughing
- singed nose hairs or eyebrows
- dark, carbon-stained mucus

the question does not specify the degree of burn, but it is safe to assume that the inflammatory response whose signs and symptoms are heat, redness, swelling and pain is well underway. complications of burns include anemia, hypovolemic shock, malnutrition, multiple organ failure, respiratory collapse, and sepsis.

here this question is specifically giving you a symptom of urine output continues to remain at 26 ml/hr. it would seem to be implying that this has been the same output for the last three days, as i read it. this is not a symptom of a burn. is this a symptom of one of its complications? anemia? no. there has to be a decrease in rbc's for there to be an anemia. hypovolemic shock? no, because, again, there has been no mention of blood loss or hemorrhage. malnutrition? no mention of this either. multiple organ failure? multiple organ failure is the liver, kidneys, heart and lungs all failing at the same time, is the end stage of a traumatic illness/injury and there are definite symptoms of each organ failing as well as sepsis. acute renal failure proceeds in 3 phases and oliguria does not occur immediately, sometimes never occurs at all and has a lot to do with the patient's cardiovascular status (http://www.merck.com/mmpe/sec17/ch233/ch233b.html?qt=acute%20renal%20failure&alt=sh#sec17-ch233-ch233b-628). this question clearly states that the patient is recovering on your unit. a recovering patient is not someone who is having any organ failure. respiratory collapse? this is a component of multiple organ failure. sepsis? there was no mention of the patient having any infection.

dehydration is a condition that results from excessive loss of body water (http://www.online-medical-dictionary.org/). symptoms, in increasing severity of appearance include:

dry or sticky mouth
low or no urine output; concentrated urine appears dark yellow
not producing tears
sunken eyes
markedly sunken fontanelles (the soft spot on the top of the head) in an infant
lethargic or comatose (with severe dehydration)
(http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm#symptoms)

from the merck manual of diagnosis and therapy (http://www.merck.com/mmpe/sec19/ch276/ch276b.html?qt=dehydration&alt=sh): "dehydration is significant depletion of body water and, to varying degrees, electrolytes. symptoms and signs include thirst, lethargy, dry mucosa, decreased urine output, and, as the degree of dehydration progresses, tachycardia, hypotension, and shock. diagnosis is based on history and physical examination. treatment is with oral or iv replacement of fluid and electrolytes.

dehydration results from increased fluid loss, decreased fluid intake, or both.

the most common source of increased fluid loss is the gi tract from vomiting, diarrhea, or both (eg, gastroenteritis). other sources are renal (eg, diabetic ketoacidosis), cutaneous (eg, excessive sweating, burns), and 3rd-space losses (eg, into the intestinal lumen in bowel obstruction). all types of lost fluid contain electrolytes in varying concentrations, so fluid loss is always accompanied by electrolyte loss."

the reason the answer is a) increase iv fluids is because this is a case of dehydration. the expected medical treatment is to increase the amount of fluid intake. if the patient isn't getting it orally, then it will need to be given intravenously.

to b) decrease iv fluids is just out and out wrong.

you can't c) change the iv fluid to a different solution because the stem of the question never even mentions anything about the type of iv solution that is infusing, so how could you even make a decision about this?

and, d) change the urinary catheter. there is no mention in the stem of the question of a urinary catheter or symptoms of a problem with it.

all of the websites i referenced were linked into from this thread:

https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites

donsterRN, ASN, BSN · Jul 1, 2008

Daytonite... EXCELLENT response!

goodstudentnowRN · Jul 1, 2008

For once I thought she was being funny because the question seems to be very simple. I too chose A. You cannot read too much in the question. I honor you Daytonite, you are the best!

RNFutureRN · Jul 1, 2008

Thanks everyone for explaining. And no, I wasnt being silly.

ska_riot · Jun 20, 2012

To avoid immediate risk of hypovolemic shock.

metal_m0nk, BSN, RN · Jun 22, 2012

Why would the patient be in renal failure from a burn? The burn and the low urine output is the only info we're given in the question..cell damage leads to fluid shift and possible dehydration. Need to increase fluids

Because excessive tissue damage (like extensive burns) causes protein/muscle fiber release into the blood stream. Proteins are large molecules and can accumulate in the renal tubules leading to obstruction and acute tubular necrosis. Rhabdomyolysis should be a consideration when you have a patient suffering a significant burn injury.

In the case of rhabdomyolysis, fluids would be increased, but not because of dehydration. Fluids are increased to help flush the renal system, help move myoglobin from the tubules, and prevent accumulations.

If it was a third spacing problem, the better solution (theoretically) would be to introduce a hypertonic solution that would pull fluid out of the tissues and into the blood stream.