Page 252 - Critical Care Notes

4223_Tab09_230-248 29/08/14 8:26 AM Page 246

MULTISYS
■ Adjust fluids based on patient needs. Greatest volume fluid leak is in the
first 24–36 hr after burn injury and peaks in 6–8 hr. Administer IV fluids
cautiously if pulmonary or cerebral edema suspected.
■ Use of colloids controversial.
■ Provide IV fluid boluses if ↓ BP, low urine output. Consider hemodynamic
parameters and Hgb in view of patient’s condition and comorbidities.
■ Consider insertion of pulmonary artery catheter to monitor hemodynamics.
■ Insert arterial line to monitor BP and obtain blood specimens. BP by cuff is
inaccurate.
■ Palpate peripheral pulses. Use Doppler if necessary.
■ Provide continuous ECG monitoring.
■ Insert NG tube if burn is >20% of the TBSA. Note GI bleeding.
■ Assess GI status, noting bowel sounds, abdominal distention, and nausea.
Administer antiemetics if nausea and vomiting present.
■ Keep patient NPO initially. Assess nutritional status and provide feedings
orally, enterally, or parenterally. Maintain aspiration precautions.
■ Insert Foley catheter. Monitor intake and output with goal of 30–50 mL
of urine/hr. Note hematuria. Burgundy-colored urine is composed of
hemochromogen and myoglobin (hemoglobinuria and myoglobinuria).
■ Consider bladder pressure monitoring if TBSA burn >30%.
■ Weigh patient daily. Note height on admission to unit.
■ Monitor electrolyte balance.
■ Monitor serum glucose levels and treat per protocol.
■ Assess neurological status for restlessness, confusion, difficulty concentrat-
ing, and changes in LOC.
■ Assess warmth, capillary refill time, sensation, and movement of extremities.
■ Keep HOB elevated 30°–45°. Elevate burned extremities.
■ Monitor for infection and sepsis. Prevent nosocomial infection. Provide
aseptic management of burn areas and invasive lines. Administer antibi-
otics as indicated.
■ Provide DVT and stress ulcer prophylaxis.
■ Administer tetanus vaccine prophylactically.
■ Provide active and passive range-of-motion exercises.
■ Treat anemia. Consider blood transfusions. Monitor coagulation factors.
■ Provide warm environment through the use of clean sheets and blankets,
or warm IV fluids.
■ Monitor temperature, and prevent chills and shivering.
■ Consider high-dose ascorbic acid in first 24 hr after burn.
■ Provide psychosocial support to patient and family. Be alert for signs of
depression. Provide antianxiety medications.
■ In elderly patients, balance the risk of hypovolemia and fluid overload.
246