A 5-year-old child has suffered second-degree thermal burns over 30% of her body. Forty-eight hours after the burn injury; the nurse must begin to monitor the child for which one of the following complications?

1. A

   Fluid volume deficit

2. B

   Fluid volume excess

3. C

   Decreased cardiac output

4. D

   Severe hypotension

Appeared in: NORCET 5 mains

Explanation

Listen in Hindi

• The question asks for a complication to monitor at 48 hours post-burn, which marks the beginning of the acute or diuretic phase.
• During this phase, capillary permeability normalizes, and the large volume of fluid that had shifted into the interstitial tissues begins to remobilize back into the intravascular space.
• This fluid remobilization, combined with ongoing intravenous fluid administration, places the child at high risk for circulatory overload, also known as fluid volume excess (hypervolemia).
• The nurse must monitor for signs of fluid overload, such as respiratory distress, crackles on auscultation, and a bounding pulse.

Why Other Options Were Wrong

• Option A: Fluid volume deficit is the primary and most life-threatening concern during the initial 24-48 hours (emergent phase) of a burn injury, not after 48 hours when fluid begins to shift back into the vasculature.
• Option C: Decreased cardiac output is a direct consequence of the severe fluid volume deficit (hypovolemia) that occurs in the initial emergent phase. As fluid returns to the vascular space after 48 hours, cardiac output is expected to normalize or even increase.
• Option D: Severe hypotension is a hallmark sign of burn shock resulting from profound fluid volume deficit in the first 24-48 hours. After 48 hours, as fluid volume is restored and potentially becomes excessive, blood pressure is more likely to be normal or elevated.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Pathophysiology of fluid shifts and complications in major burn injuries in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Nurses play a critical role in managing fluid therapy for burn patients, which requires understanding these physiological shifts. Nursing care involves transitioning from aggressive fluid resuscitation to careful maintenance to prevent overload.
• Key nursing assessments include hourly intake and output, daily weights, monitoring vital signs for changes (e.g., from hypotension to hypertension), and frequent respiratory assessments for signs of pulmonary edema (crackles, dyspnea).
• What if the patient was an elderly adult with pre-existing heart failure? The risk of fluid volume excess would be even higher and would occur more rapidly, necessitating even more cautious fluid management and potentially the early use of diuretics.

How to Approach the Question

• First, identify the key elements of the clinical scenario: a pediatric patient with a significant (30%) burn.
• Next, pinpoint the most critical piece of data: the timeframe, which is 'Forty-eight hours after the burn injury'.
• Recall the distinct pathophysiological phases of a major burn injury. Associate the first 0-48 hours with the 'emergent' or 'resuscitative' phase, where the primary problem is fluid loss (hypovolemia).
• Recognize that the period around 48-72 hours marks the beginning of the 'acute' or 'diuretic' phase, where the fluid shift reverses, leading to a risk of fluid overload (hypervolemia).
• Evaluate the options based on this timeline. Fluid volume deficit, decreased cardiac output, and hypotension are all complications of the initial emergent phase. Fluid volume excess is the key complication to monitor for as the acute phase begins.

Concept Tested & Keywords

• Concept Tested: Pathophysiology of fluid shifts and complications in major burn injuries.
• Stem keywords: 5-year-old child, second-degree thermal burns, 30% of her body, Forty-eight hours after
• Lead-in keywords: monitor, complication
• Clinical cues: The timeframe 'Forty-eight hours after the burn injury' is the most critical piece of information, as it indicates a shift in the underlying pathophysiology from the emergent to the acute phase.

Question ID

QP_ktXGUegws-8QYuw-0Jb

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 695-697, 691-693