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: NORCET 8 Prelims-2025

Explanation

Listen in Hindi

• Urinary output is the most reliable and objective indicator of tissue perfusion and adequate fluid resuscitation in burn patients.
• The target urine output for a school-aged child is 0.5 to 1 mL/kg/hour.
• For a 10-year-old weighing approximately 30-35 kg, a target of 30 mL/hour indicates adequate renal blood flow and circulating volume, confirming the effectiveness of fluid replacement therapy.

Why Other Options Were Wrong

• Option B: Thirst is a subjective symptom and is unreliable in critically ill patients, who may have an altered level of consciousness, be receiving pain medication, or be unable to communicate effectively.
• Option C: An increased hematocrit signifies hemoconcentration due to plasma loss into the interstitial space (third-spacing). This indicates inadequate fluid replacement, not adequate.
• Option D: Skin turgor is an unreliable indicator in burn patients because the surrounding tissue is often edematous (swollen) and damaged, which prevents an accurate assessment.

Related Visual

• Visual 1: Diagram: The Lund-Browder chart for estimating Total Body Surface Area (TBSA) in children, which is a critical first step in calculating fluid needs.
• Visual 2: Flowchart: The steps of the Parkland formula for calculating fluid requirements in the first 24 hours post-burn, emphasizing the adjustment of fluids based on urine output.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Assessment of fluid resuscitation adequacy in pediatric burns to guide bedside assessment, documentation, and the next nursing action.
• Monitoring hourly urine output is a critical nursing responsibility in the acute phase of burn management to prevent acute kidney injury (AKI) from hypovolemia.
• Failure to maintain adequate urine output can be an early sign of impending hypovolemic shock, requiring immediate escalation and adjustment of fluid infusion rates.
• What if the patient was an infant (<1 year old)? The target urine output would be higher, typically 1-2 mL/kg/hour, due to their higher metabolic rate and lower renal concentrating ability.

How to Approach the Question

• First, identify the core clinical question: How do you assess adequate fluid replacement in a burn patient?
• Recall the pathophysiology of burns: massive fluid shifts from the intravascular to the interstitial space lead to hypovolemia and risk of shock.
• Evaluate each option for its reliability and objectivity. Ask yourself: 'Is this a direct measure of organ perfusion?'
• Recognize that urinary output directly reflects renal perfusion, which is a sensitive marker for overall circulatory volume.
• Eliminate options that are subjective (thirst), indicate the opposite of the desired state (increased hematocrit), or are physically impossible to assess accurately in this condition (skin turgor near a burn).
• Select the option that provides the most objective, quantifiable, and reliable data for guiding therapy, which is urinary output.

Concept Tested & Keywords

• Concept Tested: Assessment of fluid resuscitation adequacy in pediatric burns
• Stem keywords: 10-year-old, burn unit, fluid replacement, assessment parameter
• Lead-in keywords: adequate
• Clinical cues: Patient is a 10-year-old child, which requires knowledge of pediatric-specific parameters.
• Clinical cues: The setting is a burn unit, indicating a critical care context where fluid shifts are a major concern.

Question ID

QUAP9pRbOfF662dBlPYx1X

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