Module 13: Fluids and Electrolytes Alterations Flashcards
1
Q
Enumerate the fluid content among infants and adults.
A
(A) Infant: 70 to 80%
(B) Adult Female : 50 to 60%
(C) Adult Male: 50 to 70%
(D) Older Adult: 45 to 55%
2
Q
How much extracellular fluid (ICF) is in our body?
A
1/3 of Fluid in Blood or Plasma and Interstitial Space
2
Q
How much intracellular fluid (ICF) is in our body?
A
2/3 of Fluid within Cells
(This is important to note because when children suffer from dehydration, their ICF is easily depleted - HIGHER MORTALITY RATE).
3
Q
What is the difference between dehydration and hypovolemia?
A
(A) Hypovolemia: Both intracellular and extracellular fluid are depleted.
(B) Dehydration: Most of the intracellular fluid and plasma is depleted.
3
Q
What are the two types of extracellular fluid?
A
(A) Interstitial: Fluid in between the cells (lymph)
(B) Intravascular: Fluid within the blood vessels.
4
Q
This is the fluid in small and specialized cavities (synovium, CSF, pleura, and peritoneum).
A
Transcellular Fluid
4
Q
This is the diffusion of a water or solvent molecule through a selective permeable membrane (eg cell membrane).
A
OSMOSIS
5
Q
How does water move in osmosis?
A
From low solute concentration to a high solute concentration.
6
Q
What is another term for oncotic pressure?
A
COLLOIDAL OSMOTIC PRESSURE dependent on BLOOD PRESSURE and PROTEINS
7
Q
What exerts oncotic pressure in the blood?
A
Proteins (mainly albumin)
8
Q
What is the normal oncotic pressure at the capillary level?
A
25 mmHg
9
Q
What happens when oncotic pressure decreases?
A
A decreased in oncotic pressure or low protein levels within the blood would cause fluid to move from the intravascular space into the interstitial space.
10
Q
What does Starling’s Law of Fluids explain?
A
The movement of fluid across capillary membranes based on hydrostatic and oncotic pressures.
11
Q
What exerts hydrostatic pressure in the capillaries?
A
The pumping action of the heart; EXPRESSED AS BLOOD PRESSURE.
(ARTERIAL END: 40 mmHg; VENOUS END: 10 mmHg)
12
Q
What exerts oncotic pressure in the capillaries?
A
Blood proteins (mainly albumin; EXPRESSED AS Pi (π), not to be confused with the math constant 3.1416.
13
Q
What happens when hydrostatic pressure exceeds oncotic pressure?
A
Fluid moves out of the capillaries into the interstitial space.
14
Q
What happens when oncotic pressure exceeds hydrostatic pressure?
A
Fluid moves into the capillaries from the interstitial space.
15
Q
What is first spacing in fluid distribution?
A
Normal distribution of fluid in intracellular fluid (ICF) and extracellular fluid (ECF)
16
Q
What is second spacing in fluid distribution?
A
Abnormal accumulation of fluid in the interstitial space, such as edema
17
Q
What is third spacing in fluid distribution?
A
Fluid accumulates in a portion of the body where it is trapped and unavailable for functional use
18
Q
Give examples of third spacing.
A
Ascites, fluid sequestration in the abdomen, and edema associated with burns
19
Q
A solution with a lower concentration of solutes and a higher concentration of water compared to inside the cell
A
HYPOTONIC SOLUTION
20
Q
The ability of a solution to change the shape and size of cells by altering water movement across the cell membrane
A
TONICITY (CONCENTRATION OF SOLUTES)
21
Q
What kind of pressure does a hypotonic solution have?
A
Less osmotic pressure or osmolalality.
22
What happens to cells placed in a hypotonic solution?
Cells swell and may burst (lysis) as water enters the cell.
23
Give examples of hypotonic solutions.
¼% NS (0.225% NaCl) and ⅛% NS (0.125% NaCl)
24
A solution where the concentration of solutes and water is equal on both sides of the cell membrane
ISOTONIC SOLUTION
25
What happens to cells placed in an isotonic solution?
No change; cells maintain their normal shape and size
26
Give examples of isotonic solutions.
0.9% Normal Saline (NS), Lactated Ringer’s (for diarrhea patients; never start this in patients with kidney failure), D5W (initially isotonic but becomes hypotonic after metabolism)
27
A solution with a higher concentration of solutes and a lower concentration of water than inside the cell
HYPERTONIC SOLUTION
28
What happens to cells placed in a hypertonic solution?
Cells shrink or become "notched" (crenation) as water leaves the cell
29
Give examples of hypertonic solutions.
3% NS, 5% NS, D10% (for parenteral nutrition), D20% (only given central line), D50% (emergency; direct iv line usually antecubital)
30
What is the normal ph of blood?
7.4
30
Acids that do not leave the body through the lungs and must be excreted by the kidneys
FIXED ACIDS
31
What are two fixed acids produced by protein metabolism?
Sulfuric acid and phosphoric acid
32
What fixed acid is produced by incomplete lipid metabolism?
Ketoacid
33
What fixed acid is produced by anaerobic carbohydrate metabolism?
Lactic Acid (lactic acidosis predominantly occurs among trauma patients)
34
How do the lungs help regulate acid-base balance?
By controlling CO₂ and carbonic acid levels in the extracellular fluid (ECF) through changes in ventilation
35
How quickly do the lungs respond to changes in CO₂ levels?
Within hours
36
What happens when PaCO₂ increases in the blood (e.g., during acidosis)?
Respiration rate increases to eliminate CO₂ and reduce the acid load.
37
What is the respiratory response to acidosis?
Increased respiratory rate (hyperventilation) to exhale excess CO₂
38
How do the kidneys regulate acid-base balance?
By controlling bicarbonate (HCO₃⁻) levels in the extracellular fluid (ECF) through reabsorption or regeneration.
39
How do kidneys handle hydrogen ions (H⁺)?
They excrete excess H⁺ and regenerate or reabsorb HCO₃⁻
40
How fast is the renal response to acid-base imbalance?
Takes 2–3 days to take effect
41
What happens to renal compensation in chronic kidney disease (e.g., CRF)?
It becomes impaired, leading to chronic acid-base imbalance.
42
What are the different conditions that may cause dehydration?
(A) Burns (massive wound drainage)
(B) High fever for more than 3 days
(C) Vomiting and Diarrhea
(D) Failure to thrive
43
What rank is diarrhea as a cause of morbidity and mortality in children in third-world countries?
Second leading cause
44
How is diarrhea defined in terms of fluid loss?
Loss of 10 mL/kg of body weight.
45
What is the most common viral cause of infectious diarrhea?
Rotavirus
46
Name common bacterial causes of diarrhea.
E. coli, Salmonella, and Shigella
47
Aside from viral and bacterial infection, what is another common cause of diarrhea?
Food poisoning
48
How long is the incubation period of rotavirus (viral)?
48 HOURS
49
What is the mode of transmission of Rotavirus?
Fecal-oral route
50
What are the clinical features of Rotavirus infection?
Fever for 2 days, watery diarrhea for 1–2 days, vomiting for 5–7 days
51
What bacterial pathogen has an incubation period of 3–4 days and produces enterotoxins?
Escherichia coli (E. coli)
52
What are the symptoms of E. coli infection?
Severe cramping, bloody stools, risk of hemolytic uremic syndrome (HUS), and water diarrhea for 2 days.
53
What bacterial pathogens are also common causes of diarrhea aside from E. coli?
Salmonella, Shigella, and Campylobacter.
54
According to the PIDS & UNICEF 2025 report, what percentage of deaths among children under 5 is caused by diarrhea?
35%
55
What are major contributing factors to diarrhea in the Philippines?
Lack of access to water, sanitation, and hygiene (WASH) and unsafe water sources in rural areas
56
What percentage of the Philippine population lacks access to WASH?
50%
57
What percentage of barangays or villages in the Philippines have access to toilets?
Only 30%
58
What are the different enteropathogens found in diarrhea?
(A) Children under 2 years (ROTAVIRUS - 69%)
(B) Ecoli (13%)
(C) Salmonella (6%)
(D) Shigella (3.4%)
58
What parasite causes amoebiasis?
Entamoeba histolytica (2 TO 4 WEEKS INCUBATION PERIOD)
59
What is the prevalence rate of amoebiasis in the population?
3%–6%
60
How is Entamoeba histolytica transmitted?
Through ingestion of cysts from fecal-contaminated food and water
61
What are the common signs and symptoms of amoebiasis?
Fever, abdominal cramps, watery or bloody stools (RECURRENCE: LIVER ABSCESS IN LATER LIFE)
62
Why is Entamoeba histolytica dangerous in swimming pools?
It is resistant to chlorine
63
What is the pharmacologic treatment for amoebiasis?
Oral Metronidazole and Erceflora Kiddie
64
What is the home remedy or management for amoebiasis?
(A) Lemon juice and probiotic yogurt
(B) Replace and Increase Fluids PO
65
What bacteria commonly causes antibiotic-related diarrhea?
Clostridium difficile (C. diff)
66
Which condition may cause diarrhea after stopping a specific drug?
Opium withdrawal
67
How can immunodeficiency diseases cause diarrhea?
By impairing the body’s defense against gut pathogens and altering gut flora
68
What are the different congenital conditions that can cause diarrhea?
(A) Hirschsprung disease (toxic colon)
(B) Crohn's Disease
(C) Endocrine Disorders
69
What is the most common complication of gastroenteritis?
ECF (extracellular fluid) depletion or dehydration.
70
What are the common symptoms of gastroenteritis?
Diarrhea, vomiting, and possibly fever
71
What electrolyte disturbances are common in gastroenteritis?
Electrolyte imbalances such as low sodium, potassium, or chloride
72
What metabolic disorder may result from chloride loss in gastroenteritis?
Metabolic alkalosis
73
What acid-base imbalance may result from HCO₃ (bicarbonate) loss?
Metabolic acidosis
74
What is the recipe for Oral Rehydration Solution (ORS)?
(A) 1L of Water
(B) 2 level tablespoon of sugar or honey
(C) 1/4 teaspoon of table salt
(D) 1/4 teaspoon of baking soda
75
What is the osmolarity of the WHO oral rehydration formula?
245 mOsm/L (hypoosmolar)
76
By how much does WHO ORS reduce stool output volume?
By 25%
77
WHO ORS reduces vomiting by approximately how much?
By almost 30%
78
What is the benefit of using WHO ORS in terms of IV therapy?
It reduces the need for IV fluid replacement.
79
What are the components of the WHO ORS formula?
Tri-sodium citrate, potassium chloride, sodium chloride, dextrose, and water.
80
How much water is needed for one sachet of Ceralyte ORS?
1 liter of safe water
81
What is the homemade ORS formula recommended by WHO?
1 teaspoon salt + 6 teaspoons sugar in 1 liter of safe water
82
How much ORS is recommended per day for children under 2 years old?
50–100 mL per episode, up to 1 liter/day
83
How much ORS is recommended per day for children aged 2–9 years?
100–200 mL per episode, up to 1 liter/day
84
How much ORS is recommended per day for children older than 10 years?
As tolerated, up to 2 liters/day
85
Why should you not introduce honey to one year old children or less?
This could cause Clostridium Botulinum (pinpoint) bacteria infection commonly found on soil and honey.
86
What are the different clinical manifestations of dehydration?
(A) Weight Loss
(B) Decreased sensorium (Irritability to Lethargy)
(C) General appearance of being ill
(D) Sunken Fontanels
(E) No tears and decreased diaper changes
(F) Sunken eyeballs (late and severe sign)
86
What are the different skin changes in dehydration?
(A) Poor skin Turgor, pale, parched dry mouth (more than 5% loss)
(B) Capillary refill >2 (mod)
(C) Capillary refill >3 sec (severe)
(D) Skin Mottling (severe, rare)
(E) Loss of Skin Elasticity (late sign) - abdomen
87
What are the three best clinical signs of pediatric dehydration according to WHO?
Steiner, Dewalt & Byerly (2004)
1. Prolonged capillary refill (>2 seconds), 2. Abnormal skin turgor (skin tenting), 3. Abnormal respiratory pattern (shallow and fast breathing)
88
What is the fluid deficit (% of body weight) for no signs of dehydration?
Less than 5%
(Less than 50 mL/kg)
89
What is the fluid deficit (% of body weight) for some dehydration?
5–10%
(50–100 mL/kg)
90
What is the fluid deficit (% of body weight) for severe dehydration?
Greater than 10%
(Greater than 100 mL/kg)
91
How much ORS should be given per episode of vomiting?
2 mL/kg for each episode of vomiting
92
How much ORS should be given per episode of diarrhea?
10 mL/kg for each diarrheal stool
93
What is the ORS replacement volume for mild dehydration?
50 mL/kg over 4 hours
94
What is the ORS replacement volume for moderate dehydration?
100 mL/kg over 4 hours
95
What is the maintenance for out patient management of dehydration?
(A) Breast feeding or formula ad lib should be resumed
(B) Children should continue regular diet (no bowel rest)
(C) Restrict juices or sugary drinks
DO NOT GIVE UP ON ORAL REHYDRATION.
(A) Use Spoon, syringe or dropper
(B) May insert NGT if patient is vomiting
(C) Use Odansetron in case of severe vomiting
96
Oral rehydration is contraindicated to:
(A) Circulatory instability or shock
(B) Altered mental status
(C) Intractable vomiting
(D) Bloody diarrhea
(E) Ileus (occurs when you have low potassium levels)
(F) Abnormal serum sodium (Na) levels - HYPERNATREMIA
(G) Glucose malabsorption
97
What is the first step in managing a patient with dehydration and signs of shock?
Immediate IV fluid bolus with NS preferred or Lactated Ringer's
98
Based on the Holliday-Segar Method, how much fluid is required per day for the first 10 kg of body weight?
100 mL/kg/day
99
How much fluid per hour is needed for the first 10 kg of body weight?
4 mL/kg/hour
100
Based on the Holliday-Segar Method, how much fluid is required per day for the second 10 kg of body weight?
50 mL/kg/day
101
How much fluid per hour is needed for the second 10 kg of body weight?
2 mL/kg/hour
102
Based on the Holliday-Segar Method, how much fluid is required per day for each additional kg?
20 mL/kg/day
103
How much fluid per hour is needed for each kg beyond 20 kg?
1 mL/kg/hour
104
What is the current practice for IV fluid replacement in dehydration?
Replace the total calculated fluid requirement over 24 hours
105
How often should patient hydration status be reassessed during IV replacement?
Every 8 hours
106
Why is it important to reassess the patient every 8 hours during fluid therapy?
To check for signs of overhydration or underhydration
107
How should IV fluid replacement therapy be planned?
It should be individualized based on the patient's needs
108
How much does fever increase insensible water loss in the body?
By approximately 7 mL/kg/24 hours for each 1°C rise in temperature above 37.2°C (99°F)
109
Which electrolyte is primarily lost in ECF deficit?
Sodium (Na)
110
Which electrolyte is primarily lost in ICF deficit?
Potassium (K)
111
In dehydration of < 3 days, what is the approximate electrolyte loss ratio?
80% ECF (Na), 20% ICF (K)
112
In dehydration of ≥ 3 days, what is the approximate electrolyte loss ratio?
60% ECF (Na), 40% ICF (K)
113
What acid-base imbalance is common with diarrhea-related dehydration?
Metabolic acidosis due to bicarbonate loss in stool
114
What acid-base imbalance is common with dehydration caused by vomiting?
Metabolic alkalosis due to acid loss
115
What severe complication can occur in prolonged dehydration?
Lactic acidosis
116
What IV fluid is used to manage dehydration from vomiting?
Normal Saline (NS) + 10 mEq KCl
117
What IV fluid is used to manage dehydration from diarrhea?
D5W 0.2% NS + 20 mEq HCO₃ + 20 mEq KCl
118
What is the recommended fluid replacement for each 1 kg weight loss?
10 mL of fluid per 1 kg
119
What fluid loss amount indicates severe dehydration?
10 kg or 1000 mL loss
120
What is the difference between positive and negative fluid balance?
Positive fluid balance occurs when fluid intake exceeds fluid output, while negative fluid balance occurs when fluid output exceeds fluid intake.
121
1 gram of wet diaper is equal to?
1 mL
122
When are antibiotics given in pediatric diarrhea cases?
Only in severely ill children.
123
What guides the initial antibiotic treatment in severe cases?
Empirical coverage based on likely organisms.
124
In which conditions may antibiotics be necessary despite general caution?
HIV, Crohn’s disease, malnutrition, and immunocompromised states.
125
What are common causes of shock in children?
Anaphylaxis, sepsis, fluid loss from burns, trauma, or hemorrhage
126
What is a key early sign of pediatric shock?
Tachycardia
127
What heart rate indicates tachycardia in infants (0–1 year)?
>180 bpm
128
What heart rate indicates tachycardia in children aged 2–5 years?
>140 bpm
129
What heart rate indicates tachycardia in children aged 6–12 years?
>130 bpm
130
Why is orthostatic BP not used in pediatric patients?
It’s unreliable and not recommended for children.
131
In a normal adult IV set, how many drops is 1 mL approximately?
16–20 drops
132
In a pediatric IV set, how many drops is 1 mL?
64 drops
133
What should the nurse teach the patient or family in cases of dehydration?
(A) Call the doctor if fever lasts more than 3 days
(B) Call the doctor if home oral rehydration (ORS) is not successful
(C) Go to the ER if the following symptoms occur (especially in infants under 6 months):
(1) Respiratory changes
(2) Vomiting lasting 12 to 24 hours
(3) Diarrhea with bloody stools and abdominal pain
(4) Unusual sleepiness or lethargy
(5) Rash
(D) Continue to breastfeed your baby
(E) Limit very sweet drinks
(F) Give probiotics
(G) Start oral rehydration solution (ORS)
(H) Maintain BRAT diet (Banana, Rice, Applesauce, Toast)
(I) Maintain sanitation practices
134
This condition occurs when injury to the tissues of the body is caused by heat, chemicals, electrical current, or radiation.
BURNS (SHOULD BE VIEWED AS PREVENTABLE)
135
What type of burn accounts for the majority (62%) of burns in children aged 1 to 5 years?
Scald burns (from liquid, steam, or gas)
136
What type of burn is most common in children aged 5 to 18 years?
Flame injuries (3/4)
137
What percentage of child neglect, violence, and abuse cases involve burn injuries?
10%
138
What are the types of burns?
(A) Thermal burns
(B) Chemical burns
(C) Smoke inhalation injury
(D) Electrical burns
(E) Cold thermal injury (FROSTBITE)
139
This is the most common type of burn. This is caused by a flame, flash, scald, or in contact with hot objects.
Thermal Burns
140
Why are alkali burns more dangerous and harder to manage than acid burns?
Because they cause protein hydrolysis and liquefaction, allowing deeper tissue penetration.Damage continues even after neutralization.
140
This is a tissue injury and destruction from acids, alkali, and organic compounds.
Chemical Burn
141
What causes carbon monoxide (CO) poisoning in smoke inhalation injuries?
Inhalation of carbon monoxide gas, often from fires or enclosed smoke-filled environments.
141
How should chemical burns be managed IMMEDIATELY?
(A) Chemicals should be quickly removed from the skin.
(B) Clothing containing the chemical should be removed.
(C) Tissue destruction may continue up to 72 hours after a chemical injury.
142
What is a common but unreliable skin sign of CO poisoning?
"Cherry red" skin color (may not always be present or visible).
143
Can carbon monoxide poisoning occur without burn injuries?
Yes. CO poisoning can occur even without visible skin burns.
144
What is the immediate treatment for CO poisoning?
100% humidified oxygen via a non-rebreather mask (To displace CO from hemoglobin and restore oxygen delivery to tissues).
145
What is the cause of tissue damage in electrical burns?
Coagulation necrosis from intense heat generated by electric current. They can damage nerves and blood vessels, causing tissue anoxia and death.
146
Can electrical burns cause deep internal injury even if skin looks normal?
Yes. External wounds may appear minor, but internal damage can be severe.
147
What are the two main ways burns are classified?
(A) By degree (1st, 2nd, 3rd, 4th)
(B) By depth of skin destruction (Superficial partial, deep partial, full-thickness)
148
What characterizes a 1st-degree burn?
Affects only the epidermis; red, painful, no blisters (e.g. sunburn)
149
What layer does a 2nd-degree burn affect?
Affects epidermis and part of dermis; blistering, pain, swelling
150
What is damaged in a 3rd-degree burn?
Entire dermis and epidermis; white or charred skin, usually painless (nerve damage)
151
What is a 4th-degree burn?
Extends to muscle, bone, or tendon; black, leathery, no pain (complete nerve damage)
152
What are the types of burn depth classification according to the American Burn Association?
(A) Superficial Partial-Thickness Burn – Involves epidermis
(B) Deep Partial-Thickness Burn – Extends deeper into the dermis;
(C) Full-Thickness Burn – Destroys epidermis and entire dermis; may involve fat, nerves, bone, and muscle.
153
Why are burns on the face, neck, and chest more severe?
They can lead to respiratory obstruction due to airway involvement.
154
What is the concern with burns on the hands, feet, joints, and eyes?
These areas are critical for function and mobility, leading to disability in self-care.
155
Why are burns on the ears, nose, buttocks, and perineum more prone to complications?
These areas are at higher risk for infection due to moisture and contamination.
156
What are the risk factors for burn injury among pediatric patients?
(A) Crowded Household
(B) Poverty (low income)
(C) Poor parental education
(D) Lack of water supply
157
How many pediatric burn cases were reported from Philippine burn centers between 2003–2008?
361 cases were reported from 4 burn centers.
158
Where did most pediatric burn injuries occur in the Philippines (2003–2008)?
93.6% of pediatric burn injuries occurred at home.
159
What is the gender distribution of pediatric burn injuries in the Philippines (2003–2008)?
(A) Male: 64.8%
(B) Female: 35.12%
160
What is the age group distribution of pediatric burn injuries in the Philippines (2003–2008)?
(A) Neonates: 0.28%
(B) Infants: 17.7%
(C) Children: 67.59%
(D) Adolescents: 14.96%
161
What are the morbidity rates in pediatric burn cases in the Philippines?
(A) 15% developed hospital-acquired pneumonia (HAP)
(B) 14% acquired burn wound infection
(C) 12% had skin graft failure
162
What is the overall mortality rate in pediatric burn cases in the Philippines?
8.3% mortality rate
163
How much higher is the mortality rate for flame burns compared to scalds in children?
Mortality for flame burns is 2.24 times higher than for scalded children.
164
How much higher is the mortality rate for inhalation burns in children?
Mortality for inhalation burns is 11.98 times higher than in those without inhalation injury.
165
What is the median Total Body Surface Area (TBSA) affected in pediatric burn cases in the Philippines?
Median TBSA is 17%
166
What are the classifications of burn severity based on Philippine data?
(A) Severe: 59.83%
(B) Moderate: 6.65%
(C) Minor: 35.73%
167
What are the common types of burns in the Philippines among pediatric patients?
(A) Scald burns: 54.85%
(B) Flame burns: 32.96%
(C) Electrical, chemical, and contact burns: 12%
168
This is used to assess the total body surface area (TBSA) affected by burns. It is adequate for initial assessment in both adults and children.
Rule of Nines
169
Which chart is considered more accurate for assessing burn extent in infants?
The Lund-Browder chart is more accurate for infants and is mostly used in research.
170
Why is the Lund-Browder chart used for burn injury assessment in infants and children?
The Lund-Browder chart is used because infants and children have smaller circulating blood volume, thinner skin, and a larger head in proportion to their body.
171
What are the classifications of burn extent based on Total Body Surface Area (TBSA)?
(A) Minor burns: TBSA < 10%
(B) Moderate burns: TBSA 10–20%
(C) Major (severe) burns: TBSA > 20% (REQUIRE ALBUMIN INFUSION AND FLUID RESUSCITATION)
172
What are the key elements of emergency initial assessment in burn injury?
(A) Age
(B) Weight
(C) Time of accident
(D) Causative agent
(E) Involvement of respiratory system
(F) Total Body Surface Area (TBSA) burned
173
What classifications fall under the critical care criteria for burns?
(A) Child under 10 years of age with ≥10% Total Body Surface Area (TBSA) burn involving:
– Face
– Hands
– Feet
– Joints
– Genitals
– Perineum
(B) Inhalation injury
(C) Trauma cases with burns
(D) Severe cases of electrical burns
(E) Suspected or confirmed child abuse – requires thorough evaluation (physical and psychological and DSW referral)
174
What is the primary concern in managing pain for burn patients in the ICU?
Propofol IV drip is used for sedation and pain control but only in ICU settings.
175
What is the immediate action for burn inhalation injury?
Immediate endotracheal intubation to secure airway.
176
What should be continuously monitored to ensure proper oxygenation?
Oxygen saturation (O₂ sat) and airway patency; may require tracheostomy care.
177
Why is temperature monitoring essential in burn care?
Risk of hypothermia due to skin loss and fluid evaporation.
178
When is Foley catheterization recommended in burn patients?
For burns covering ≥20% Total Body Surface Area (TBSA) to monitor urine output.
179
What are complications of fluid and electrolyte imbalance in burn patients?
Severe edema and possible arrhythmias.
180
What is a major infection-related complication and leading cause of death in burn patients?
Acute Respiratory Distress Syndrome (ARDS)
181
What percentage of abused children with burns also present with skeletal fractures?
18.6% of cases have associated skeletal fractures.
182
What neurological signs should be assessed in suspected child abuse cases with burns?
Look for signs of intracranial and retinal hemorrhage.
183
What historical clue may indicate possible child abuse?
History of multiple ER visits for various injuries.
184
At what age can children begin to reliably provide information about their injuries?
As young as 29 months, children may relate information accurately.
185
What are the different signs of child abuse?
(A) Inconsolable crying
(B) Toilet training/toilet accidents
(C) Impaired parent-child bonding
(D) Inappropriate apathy
(E) Poor record of immunizations
186
How long does the emergent phase of burn injury last?
Up to 72 hours after the burn incident.
187
What is the TBSA threshold that can trigger systemic responses in the emergent phase?
A TBSA burn of 15–20% can result in systemic effects.
188
What are the key complications during the emergent phase of burns?
(A) Major fluid loss
(B) Onset of massive edema
(C) Development of hypovolemic shock
189
What are the vital sign changes during hypovolemic shock in burn injury?
(A) ↓ Blood pressure
(B) ↑ Pulse rate
(C) ↓ Urine output
190
What formula is used for initial fluid resuscitation in burn patients?
Parkland Formula:
4 x weight (kg) x %TBSA = total IV fluid in 24 hrs
191
How is the Parkland fluid volume administered?
(A) 50% in the first 8 hours
(B) Remaining 50% in the next 16 hours
192
How often should fluid orders be recalculated in burn patients?
Every 8-hour shift
193
What causes fluid to shift out of the vascular space during burn injury?
A decrease in colloidal osmotic pressure causes fluid to shift from the vascular space to the interstitial space.
194
What is the formula to calculate IV rate in drops per minute (gtts/min)?
IV Rate (gtts/min) = (Volume in mL ÷ Time in minutes) × Drop factor (gtt/mL
195
What is the result of fluid shifting out of the vascular space during burn injury?
Intravascular volume depletion occurs, leading to a drop in blood pressure.
196
What happens to sodium (Na⁺) during the emergent phase of burn injury?
Sodium shifts to the interstitial spaces and remains there until edema formation ceases.
197
What happens to potassium (K⁺) during the emergent phase of burn injury?
Potassium shifts into extracellular spaces due to cell injury and hemolysis of red blood cells.
198
What is the normal insensible fluid loss in a healthy individual?
30 to 50 mL/hour
199
What is the insensible fluid loss in a severely burned patient?
200 to 400 mL/hour
200
What happens to red blood cells and hematocrit in a severely burned patient?
RBCs are hemolyzed (3–15% lower), but hematocrit is elevated due to hemoconcentration.
201
What happens to clotting in a severely burned patient?
Burn-induced coagulopathy may lead to thrombosis.
202
What are the different clinical manifestations that can occur during the emergent phase of burns?
(A) Shock from pain and hypovolemia
(B) Blisters
(C) Adynamic ileus
(D) Shivering
(E) Altered mental status
(F) Impaired microcirculation and increased blood viscosity → sludging
(G) Dysrhythmias
(H) Hypovolemic shock
(I) Tissue ischemia
(J) Necrosis
203
What is the purpose of decompression procedures in burn patients?
To promote capillary circulation and prevent loss of blood and fluids in muscles; avoids compartment syndrome.
204
What surgical procedure involves cutting the fascia to relieve pressure in cases of compartment syndrome?
Fasciotomy
205
What surgical procedure involves making incisions through burned tissue (eschar) to restore circulation?
Escharotomy
206
What are common respiratory complications during the emergent phase of burn injury?
Upper airway injury, edema, mechanical airway obstruction, lower airway injury (direct insult at the alveolar level), interstitial edema, pneumonia, pulmonary edema.
(PATIENT MIGHT EXHIBIT SIGNS DURING THE FIRST 24 HOURS)
207
What causes upper airway obstruction in burn patients during the emergent phase?
Edema formation and inhalation of hot gases or smoke.
208
What causes renal ischemia in burn patients during the emergent phase?
Decreased blood flow to the kidneys, often due to hypovolemia and fluid shifts.
209
What is a major renal complication during the emergent phase of burns?
Acute tubular necrosis (ATN).
210
What is the primary goal of pain management in the acute phase of burn care?
To relieve pain and provide comfort, while preventing complications like sedation overuse or inadequate analgesia.
211
What are the nursing and collaborative management for patients under the acute phase of burns?
(A) Excision and grafting
(B) Physical and occupational therapy
(C) Nutritional therapy
(D) Psychosocial care
(E) Wound care
212
What is the advantage and disadvantage of Silver Nitrate 0.5% as a burn dressing agent?
Advantage: Effective antimicrobial agent, less expensive.
Disadvantage: Difficult to clean out.
213
What are the advantages and disadvantages of Silver Sulfadiazine 1%?
Advantage: Broad-spectrum antimicrobial activity.
Disadvantage: Can cause skin irritation and delayed wound healing in some cases.
214
What are the advantages and disadvantages of Mafenide Acetate (Sulfamylon)?
Advantage: Highly effective antimicrobial agent.
Disadvantage: Very expensive, may cause metabolic acidosis.
215
What are the advantages and disadvantages of Bacitracin?
Advantage: Inexpensive, effective for small burns.
Disadvantage: Limited antimicrobial coverage for larger burns, may be expensive for extensive use.
216
What are Cultured Epithelial Autografts (CEAs)?
CEAs are grafts obtained from the patient's own skin.
217
When are Cultured Epithelial Autografts (CEAs) used?
Used in patients with large body surface burns or those with limited skin for harvesting.
218
What type of burns require skin grafting?
3rd and 4th degree burns require skin grafting.
219
This is used for life-threatening full-thickness or deep partial-thickness wounds where conventional autograft is not available or advisable.
Artificial skin
220
This is FDA approved (2021) and is used as an alternative cover, particularly for chemical burns. It consists of keratinocyte cells.
Strata graft
221
When does the Rehabilitation Phase begin?
The Rehabilitation Phase begins when burn wounds are manageable and the patient is able to resume activities of daily living (ADLs).
222
How long does it take for mature healing to be reached in burn patients?
Mature healing is reached within 6 months to 2 years.
223
Will the skin completely regain its original color after a burn?
No, the skin never completely regains its original color after a burn, although discoloration of the scar fades with time.
224
How can skin and joint contractures be minimized during the rehabilitation phase?
Positioning, splinting, and exercise should be used to minimize contractures.
225
What type of sensory changes can occur after a burn injury during the rehabilitation phase?
The patient may experience hypersensitivity or hyposensitivity to cold, heat, and touch.
226
How can burn-injured skin be protected in the rehabilitation phase?
Burn-injured areas should be protected from direct sunlight for 1 year.
227
What are other treatment options for long term healing (OUTPATIENT) for burns?
(A) Ultraviolet radiation
(B) Ultrasound therapy
(C) Nanotechnology
(D) Creation of dressings that provide a wound healing environment
(E) Stem cell therapy – "Holy Grail" of therapy
(F) Regeneration of cartilage and organ tissue
228
What is the purpose of reconstructive surgery in burn victims?
Reconstructive surgery aims to improve mobility and function, especially for deformities resulting from 3rd to 4th degree burns.
229
How many operations and clinic visits may be required for reconstructive surgery in burn victims?
Reconstructive surgery may involve more than 10 operations and many years of clinic visits, sometimes extending up to 18 years.
230
This is performed to release skin contracture to improve function of joints.
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