The nurse is caring for a 10-year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is?

1. A

   Urinary output of 30 ml per hour

2. B

   No complaints of thirst

3. C

   Increased hematocrit

4. D

   Good skin turgor around burn.

Appeared in: GMCH Chandigarh - 2019

Explanation

• The most reliable non-invasive indicator of adequate fluid resuscitation in a burn patient is urine output, as it directly reflects kidney and vital organ perfusion.
• For pediatric patients, the target urine output is generally 1 mL/kg/hour.
• A 10-year-old child has an average weight of approximately 30-35 kg, making a urine output of 30 mL/hour a key indicator that fluid replacement is sufficient.

Why Other Options Were Wrong

• Option B: Thirst is a subjective symptom and is unreliable in a critically ill child who may be in pain, sedated, or experiencing stress, all of which can alter the sensation of thirst.
• Option C: An increased hematocrit indicates hemoconcentration due to fluid loss into the interstitial space (third-spacing). It is a sign of inadequate fluid replacement, not adequate.
• Option D: Assessing skin turgor on or near burned tissue is unreliable. The area will be edematous and the skin damaged, which prevents an accurate assessment of tissue hydration.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Assessment of adequate fluid resuscitation in pediatric burn patients to guide bedside assessment, documentation, and the next nursing action.
• Nurses must meticulously monitor hourly urine output via a Foley catheter to titrate intravenous fluid rates. This prevents both under-resuscitation (leading to shock and organ failure) and over-resuscitation (leading to pulmonary edema and compartment syndrome).
• What if? - If the patient's urine output dropped to 15 mL/hour, the nurse's immediate priority would be to increase the rate of IV fluid infusion as per protocol and notify the provider, as this indicates hypovolemia and inadequate perfusion.

How to Approach the Question

• First, identify the core of the question: how to assess fluid status in a pediatric burn patient.
• Recall the 'gold standard' for monitoring burn resuscitation. While vital signs and labs are important, urine output is the most sensitive real-time indicator of end-organ perfusion.
• Evaluate each option based on this principle. Does it directly and reliably measure perfusion?
• Calculate the expected urine output for the patient's age. A 10-year-old child needs about 1 mL/kg/hr. Assuming an average weight of ~30 kg, 30 mL/hr is the correct target.
• Eliminate the distractors: Thirst is subjective, increased hematocrit indicates dehydration, and skin turgor is invalid on burned skin.

Concept Tested & Keywords

• Concept Tested: Assessment of adequate fluid resuscitation in pediatric burn patients.
• Stem keywords: 10-year-old, burn unit, adequate fluid replacement, assessment parameter
• Lead-in keywords: indicate
• Clinical cues: Patient age (10-year-old) is critical for determining the correct urine output target.
• Negative lead-in flag: false

Question ID

QD-T_XOP_5m_oI-WdeQTFi

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 695-697, 575-577