Nursing care of fluid and electrolyte balance is important for burn patients. Fluid resuscitation is calculated using the Parkland formula of 4 ml/kg/% burn of lactated Ringer's solution over the first 24 hours. Electrolyte levels such as sodium, potassium, and glucose must be regularly monitored and maintained as they are often imbalanced after a burn. Urine output is the best indicator of adequate fluid resuscitation in significant burns. Nursing care includes maintaining intravenous lines, documenting intake and output, and assessing for signs of fluid overload or dehydration.

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)