NORCET 2 - 2021 (shift-1)
Medical & Surgical Nursing
Easy
In a burn patient, what is the fluid of choice in an emergency?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- Ringer's Lactate (RL) is the preferred crystalloid solution for initial fluid resuscitation in burn patients.
- Its electrolyte composition is most similar to blood plasma, making it highly effective for restoring intravascular volume.
- The lactate in the solution is metabolized by the liver to bicarbonate, which helps to buffer the metabolic acidosis that frequently accompanies severe burns.
- Compared to Normal Saline, RL has a lower chloride concentration, reducing the risk of hyperchloremic metabolic acidosis during large-volume resuscitation.
Why Other Options Were Wrong
- Option B: Normal Saline (NS) contains a high concentration of chloride (154 mEq/L). When administered in the large volumes required for burn resuscitation, it can lead to hyperchloremic metabolic acidosis, worsening the patient's acid-base imbalance.
- Option C: Dextrose 5% in water (D5W) is inappropriate for burn resuscitation. Once the dextrose is metabolized, it behaves as a hypotonic solution, providing free water that does not stay in the intravascular space to support blood pressure. It can also cause hyperglycemia.
- Option D: Dextrose 10% (D10W) is also unsuitable for burn resuscitation. It provides an even larger glucose load than D5W, significantly increasing the risk of severe hyperglycemia and osmotic diuresis, which can worsen dehydration.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Fluid and electrolyte management in burn injuries in acute care settings.
- In an emergency, the nurse's priority is to establish large-bore IV access (preferably two sites, through unburned skin if possible) and immediately begin fluid resuscitation as prescribed, often using the Parkland formula as a guide.
- Accurate monitoring is critical. The nurse must hourly track urine output, which is the primary indicator of adequate resuscitation. The target is typically 0.5-1 mL/kg/hr for adults.
- Nurses must continually assess for signs of both under-resuscitation (hypotension, tachycardia, low urine output) and over-resuscitation (pulmonary edema, compartment syndrome).
How to Approach the Question
- First, identify the core clinical scenario: an emergency involving a burn patient.
- Recall the primary pathophysiological problem in early burn shock: massive fluid loss from the intravascular space (hypovolemic shock) and metabolic acidosis.
- The goal of emergency treatment is therefore to rapidly replace lost volume and support circulation. The ideal fluid should be isotonic and help correct acidosis.
- Evaluate the options based on these criteria: RL is isotonic and contains a buffer (lactate). NS is isotonic but lacks a buffer and has high chloride. Dextrose solutions are not effective volume expanders for resuscitation.
- Conclude that Ringer's Lactate best meets the requirements for initial burn resuscitation.
Concept Tested & Keywords
- Concept Tested: Fluid and electrolyte management in burn injuries
- Stem keywords: burn patient, fluid of choice, emergency
- Lead-in keywords: what is
- Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Question ID
QRWADR0zl5V4ulFFtWrJhJ
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 695-697
Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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