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Zorluk: OrtaPhysiological Adaptation

A nurse is assessing a client who was admitted 12 hours ago with deep partial-thickness and full-thickness thermal burns over 40% of their total body surface area. Which of the following clinical findings should the nurse identify as expected physiological responses during this emergent (resuscitative) phase? (Select all that apply.)

  1. Serum potassium level of 6.2 mEq/L (6.2 mmol/L)Cevap
  2. Hematocrit of 56% (0.56)Cevap
  3. C
    Arterial blood gas showing a pH of 7.50 and a bicarbonate (HCO3-) of 29 mEq/L (29 mmol/L)
  4. D
    Strong, bounding peripheral pulses with a widening pulse pressure
  5. Sinus tachycardia with a heart rate of 118 beats/minCevap
  6. F
    Urine output of 120 mL/hr of pale, dilute urine

Cevap

The expected clinical findings are a serum potassium level of 6.2 mEq/L, a hematocrit of 56%, and sinus tachycardia with a heart rate of 118 beats/min.
During the emergent phase of a major burn injury (the first 24-48 hours), massive capillary permeability allows fluid, plasma proteins, and electrolytes to rapidly shift from the vascular space into the interstitial space. This extreme intravascular volume loss leads to hemoconcentration, which is reflected by an elevated hematocrit. The sympathetic nervous system responds to the resulting hypovolemia by increasing the heart rate (tachycardia) in an attempt to maintain cardiac output. Additionally, the destruction of millions of cells releases massive amounts of intracellular potassium directly into the bloodstream, resulting in hyperkalemia.

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1
Identify the phase of the burn injury based on the timeline.
The client is 12 hours post-injury, placing them in the emergent (resuscitative) phase, which lasts for the first 24 to 48 hours.
Different phases of burn care have vastly different, and sometimes opposite, expected physiological adaptations.
2
Recall the major pathophysiological changes that occur during the emergent phase.
Massive capillary permeability causes a systemic inflammatory response, leading to fluid shifting from the vascular space into the interstitial space (third-spacing). Concurrently, major cellular destruction occurs at the burn sites.
Understanding the underlying mechanism allows for logical deduction of assessment findings rather than pure memorization.
3
Evaluate each option against the anticipated pathophysiological shifts.
Cellular destruction releases intracellular potassium (causing hyperkalemia). Vascular fluid loss leaves blood cells concentrated (causing elevated hematocrit). Hypovolemia triggers sympathetic compensation (causing tachycardia) while decreasing kidney perfusion (causing decreased urine output) and tissue perfusion (causing metabolic acidosis).
This confirms which clinical findings are expected adaptations versus abnormal complications or incorrect interpretations.

Anahtar Kavram

Burn Injury: Emergent Phase Pathophysiology
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Konular

Physiological Adaptation

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