Question

For a burn patient, the nurse should assess the following in the initial stage:
1. Hyperkalaemia
2. Hyponatremia
3. Hypernatremia
4. Metabolic alkalosis

Answer 1

Correct Answer - Option 2 : Hyponatremia

Concept:-

• There is a loss of sodium in the burn patient therefore hyponatremia often occurs, hyperkalemia is also characterized by this period due to massive tissue necrosis.
• After a burn injury, sodium and water retention occurs in the kidneys, and potassium is lost in the urine.
• Hyponatremia in these cases rarely results from sodium deficiency but is usually from excess water retention and entry of sodium into cells.

• Burn is the transfer of energy from one source to another which leads to tissue damage, destruction, protein denaturalization, and ionization of content.

Key Nursing Interventions

• Maintain airway
• Monitor vital signs every 15 minutes
• Establish an IV line
• Infuse IV fluids as ordered to maintain fluid status
• Calculate fluid requirement for 24 hours Insert an indwelling urinary catheter Insert an NG tube to prevent aspiration because of paralytic ileus opioid analgesic to treat pain.
• Burn patients are more prone to develop hypothermia, so keep the room warm and cover the patient.
• Apply topical antibacterial agents as prescribed. For example, Silver nitrate, mafenide acetate, silver sulfadiazine
• Note: Silver nitrate-produce stains, mafenide acetate-may cause temporary burning or stinging sensation.

Hyponatremia

• A serum sodium level less than 135 mEq/L is known as hyponatremia.
• Causes
  • Low sodium consumption
  • Increased loss of sodium
  • Overhydration
• Use of diuretics
  • Increased ADH hormone 
  • Addison's disease
  • Hypoaldosteronism.
• Signs and symptoms
  • Confusion, drowsiness, muscle weakness, seizure.

Hyperkalemia

• Serum level of potassium more than 5 mEq/L.
• Causes
  • Kidney failure Potassium-sparing diuretics
  • Burn wound
  • Tissue injury
  • Addison's disease.
• Signs and symptoms
  • Prolonged PR interval, spiked/peaked T wave.

Hypernatremia

• A serum sodium level of more than 145 mEq/L is known as hypernatremia.
• Causes
  • Dehydration
  • Diabetes insipidus
  • Cushing syndrome
  • Hyperaldosteronism 
  • Prolonged cortisone use.