Nursing care and fluid Electrolyte balance in burn injury

1. NURSING CARE OF FLUID AND
ELECTROLYTE BALANCE IN BURN
Presented by : Aisha Sidiqa
Presented to :Ma’am Naila Asif
Pediatric Health nursing
ConM FJMU Lahore

2. CARE FOR BURN PATIENTS

3. CONTENT
• Burn injury
• Nursing care aspects
• Na+ conc.
• Ka+ conc.
• Glucose conc.
• Parkland formula
• Fluid for burn patients
• Isotonic crystalloids
• Hypertonic solutions
• Assessment of fluid intake

4. BURN INJURY
• Burn injury is the result of heat transfer from one site
to another.
• Burns disrupt the skin, which leads to
• Increased fluid loss; infection; hypothermia; scarring;
compromised immunity; and changes in function,
appearance, and body image.

6. 6 C’S OF BURN
• Clothing
• Cooling
• Cleaning
• Chemoprophylaxis
• Covering
• comforting

7. NURSING CARE ASPECTS
• Note and report signs of hypovolemia or fluid
overload.
• Maintain IV lines and regular fluids at appropriate
rates, as prescribed. Document intake, output, and
daily weight.
• Elevate the head of bed and burned extremities.
• Monitor serum electrolyte levels (eg, sodium,
potassium, calcium, phosphorus, bicarbonate);
recognize developing electrolyte imbalances

8. NA++
• Hypernatremia is a common condition and can occur
in up to 11% of severely burned patients
• Initially low as sodium exits the extracellular space
due to increased vessel permeability. Paediatrics are at
increased risk of dilutional hyponatremia.
• After resuscitation, it can be high due to fluids
(contains sodium) and sodium returning to the
extracellular space.

9. K+ IONS
• Initially high due to potassium leaks from cell lysis
and tissue necrosis.
• Common in electrical burns
• Bicarbonate and glucose plus insulin may be required
to correct this problem

10. GLUCOSE
• Children are prone to hypoglycemia due to limited
glycogen stores
• Blood glucose and electrolyte levels should be
measured regularly.
• Early enteral feeding or addition of dextrose to the
electrolyte solution

11. FLUID RESUSCITATION

12. FORMULA FOR FLUID ADMINISTRATION
• Initial 24 hours: RL 4 ml/kg/% burn (adults)
• Next 24 hours: Begin colloid infusion of 5% albumin
0.3–1 ml/kg/% burn/16 per hour

13. FOR CHILDREN
• Initial 24 hours: Ringer’s lactated (RL) solution 4
ml/kg/% burn for adults and 3 ml/kg/% burn for
children. RL solution is added for maintenance for
children:
• 4 ml/kg/hour for children weighing 0–10 kg
• 40 ml/hour +2 ml/hour for children weighing 10–20
kg
• 60 ml/hour + 1 ml/kg/hour for children weighing 20
kg or higher

14. ISOTONIC CRYSTALLOIDS
• RL solution ( ringer lactate)
• Hartmann solution (a solution similar to RL solution)
and normal saline are commonly used

15. HYPERTONIC SOLUTIONS
ADMINISTRATION
• Rapid infusion of hypertonic sodium solutions has
proven to increase the plasma osmolality and limit
cellular oedema
• Using solutions with a concentration of 250 mEq/l,
• 5% dextrose water

16. FLUID FOR BURN PATIENTS
• 2 to 4 ml of Ringer’s Lactate per kilogram of weight
per percentage of body surface area burned, with the
first half given over the first 8 hours and the
remainder given over the next 16 hours

17. ASSESSMENT OF FLUID INTAKE
• Urine output is the most reliable indicator of
adequate fluid resuscitation in significant burn
patients.
• Serum electrolyte evaluation
• Values of Sodium and potassium in the body

20. LESSON PLAN
• Instructor :Naila Asif
Subject: pediatric health nursing
Topic: Nursing care while maintaining fluids in burn
Level of students: 3rd year (GREEN GROUP)
Venue: Class Room, CON FJMU
• Date: -----------
Time: 45 minutes
Purpose: Teach fluid and electrolyte balance in burn
Pts. Goal: Students will able
to maintain Fluid balance in Burn

21. Objective Contents Time Method Source Evaluation
•Define Burn
injury
•Write
nursing care
aspects for
burn patient
•Describe the
electrolyte
imbalance .
•Describe
Formula for
fluid
resuscitation
•Assess the
fluid intake.
•Introduction
•Definition
•Nursing care
•Ions
concentratio
n
•Fluid
imbalance of
burn
•Parkland
formula
•Types of
fluids
management
•Rule of 9 for
burn
3 min
3min
4min
4min
6min
5min
7min
8min
Lecture
Bed side
teaching
Group
discussion
Demonstratio
n in class
Staff
Teacher
Patient
Family
members
Questioning
Self –
evaluation
Brain
storming

22. MCQ 1
• What is the priority nursing diagnosis for a client in
the rehabilitative phase of recovery from a burn
injury?
• [A] Acute Pain
• [B] Impaired Adjustment
• [C] Deficient Diversional Activity
• [D] Imbalanced Nutrition: Less than Body
Requirements

23. MCQ 2
• When should ambulation be initiated in the client
who has sustained a major burn?
• [A] When all full-thickness areas have been closed
with skin grafts
• [B] When the client’s temperature has remained
normal for 24 hours
• [C] As soon as possible after wound debridement is
complete
• [D] As soon as possible after resolution of the fluid
shift

24. SEQ : WHAT IS RULE OF 9 IN BURN
INJURY ASSESSMENT
• The front and back of each arm and hand equal 9% of
the body’s surface area.
• The chest equals 9% and the stomach equals 9% of
the body’s surface area.
• The upper back equals 9% and the lower back equals
9% of the body’s surface area.
• The front and back of each leg and foot equal 18% of
the body’s surface area.

25. RULE OF 9

26. FEEDBACK & QUESTION??

27. REFERENCES
• https://nurseslabs.com/burn-
injury/#:~:text=Restoring
• Wong’s essentials of pediatric nursing ( pg # 770-784)