A patient with 50% total body surface area (TBSA) burns has received 12 hours of fluid resuscitation. His vital signs are: BP 118/78 mmHg, heart rate 95/min, and urine output 20 mL/hr. Is the patient adequately resuscitated?

1. A

   Fluid Overload

2. B

   Adequate hydration

3. C

   Inadequate fluid resuscitation

4. D

   Impending renal failure

Appeared in: NORCET 10 Prelims-2026

Explanation

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• The primary and most reliable indicator for assessing the adequacy of fluid resuscitation in a major burn patient is urine output.
• The target urine output for an adult is between 30 to 50 mL/hr (or 0.5 to 1.0 mL/kg/hr).
• The patient's urine output of 20 mL/hr is well below this minimum threshold, signaling insufficient fluid volume and poor perfusion to the kidneys.
• While the blood pressure (118/78 mmHg) and heart rate (95/min) appear stable, they are less sensitive indicators of volume status in the early phase of burn shock compared to urine output.
• Therefore, the clinical picture points towards inadequate resuscitation, requiring an increase in the rate of intravenous fluid administration.

Why Other Options Were Wrong

• Option A: Fluid overload would be characterized by signs of hypervolemia, such as a high urine output, bounding pulses, distended neck veins, and potentially crackles in the lungs (pulmonary edema). The patient's low urine output is the opposite of what would be expected.
• Option B: Adequate hydration is defined by meeting the physiological targets for resuscitation. Since the patient's urine output is below the minimum required 30 mL/hr, hydration is not adequate.
• Option D: While prolonged and severe under-resuscitation can lead to acute kidney injury (renal failure), a low urine output in the initial 24 hours is primarily interpreted as a sign of correctable hypovolemia. The immediate conclusion and action is to increase fluids, not to diagnose irreversible renal failure.

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Clinical Relevance

• Nursing practice connection: Knowing Assessment of fluid resuscitation adequacy in a burn patient helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses must meticulously monitor urine output every hour in patients with major burns, as it is the most sensitive non-invasive indicator of end-organ perfusion and resuscitation adequacy.
• Titrating IV fluid rates based on urine output is a critical nursing responsibility to prevent both under-resuscitation (leading to shock and organ failure) and over-resuscitation (leading to compartment syndrome and pulmonary edema).
• What if? If the patient's urine output was 60 mL/hr, the nurse should assess for other signs of fluid overload and anticipate an order to decrease the IV fluid rate, as this output exceeds the target range.

How to Approach the Question

• Identify the core question: The question asks to evaluate the adequacy of fluid resuscitation in a major burn patient.
• Analyze the patient data provided: A 50% TBSA burn is severe. Note the vital signs: BP 118/78, HR 95, and especially the urine output of 20 mL/hr.
• Recall the primary goal and key indicator for burn resuscitation. The most crucial parameter is urine output, which reflects renal perfusion.
• Compare the patient's urine output to the standard target. The target for an adult is 30-50 mL/hr. The patient's output of 20 mL/hr is clearly below this target.
• Evaluate the options based on this comparison. A low urine output signifies inadequate fluid volume. Therefore, 'Inadequate fluid resuscitation' is the correct conclusion.
• Consider other vital signs in context. While BP and HR are within normal limits, they are less sensitive indicators than urine output in the initial hours of resuscitation. Do not be misled by them.

Concept Tested & Keywords

• Concept Tested: Assessment of fluid resuscitation adequacy in a burn patient.
• Stem keywords: 50% TBSA burns, fluid resuscitation, vital signs, urine output 20 mL/hr
• Lead-in keywords: adequately resuscitated
• Clinical cues: Urine output of 20 mL/hr is a critical value indicating poor renal perfusion.
• Clinical cues: 50% TBSA burn is a major burn requiring significant fluid resuscitation.

Question ID

Q3ZRiMne-f4NIk-dlQ-c2c

Copy ID

Reference Book

E6 Nursing Vital Signs p. 154-156

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 695-697