NUR 401 Fluid and Electrolytes

Fluid and Electrolytes

Review of DKA and Burns

Different Types of Burns:
Thermal
Chemical
Inhalation
Radiation
Electrical

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Burns

Fill in the Blanks

Your client has burns to the left anterior arm, chest and abdomen, and left anterior and posterior leg. What is the % of burns according to the Rule of Nines?

Math Response

According to the Parkland Formula, how much fluid will your client receive in total for the first 24 hours? (75 kg)

Type answer here

Correct Answer: 12150

Deg^°

Rad

Math Response

How much fluid will you need to administer within the first 8 hours? The burn occurred 2 hours ago.

Type answer here

Correct Answer: 6075

Deg^°

Rad

Math Response

What will the rate (ml/hr) be for the fluids for the first 8 hours? (round to a whole #)

Type answer here

Correct Answer: 1013

Deg^°

Rad

Multiple Select

During the emergent phase of the burn, what are priorities? (SATA)

• replace lost fluids

• pain control

• prevent infection

• encourage food intake

• consult physical therapy

Multiple Choice

A client presents to the ED from a house fire. Which finding would be the MOST concerning?

• Mild burns on the skin
• Soot on the face

• HR 112 bpm

• RR 26, SpO2 100%

Multiple Choice

A client presents to the ED after sustaining an electrocution while working on electricity in a house. Which intervention is PRIORITY upon the client's arrival to the ED?

• Initiate IV fluids

• Obtain blood pressure

• Obtain an EKG

• Administer pain medication

Multiple Choice

A client is being brought to the ED after a meth lab explosion. What should be done prior to the client entering the ED?

• Provide pain medication

• Ensure the client has been decontaminated

• Initiate IVF

• Start treatment for the burns

DKA

Multiple Choice

Within the BMP, which lab can give the RN the best measurement for acidosis?

• Potassium

• Anion Gap

• Magnesium

• Creatinine

Multiple Choice

A client has a glucose of 132 mg/dL and the anion gap is 25. The client is still on an insulin drip. What should the nurse do?

• Continue the insulin drip and monitor the glucose

• Stop the insulin drip

• Call the doctor to get the drip discontinued

• Administer dextrose

Multiple Choice

Mark is a 56 yo male who has been brought in by EMS for altered  mental status. He was found lying on the ground outside talking to a butterfly. He has been placed on a bed and a venous blood gas has been obtained. What lab is the most concerning?

• Glucose

• Potassium

• pH

• Creatinine

Multiple Choice

The RN is unable to obtain PMH from Mark, but on assessment he is tachypnic @ 29 breaths per min, skin is pale, he has a delayed capillary refill time, HR 132, SpO2 92%. Which intervention is priority for the client at this time?

• Initiate NS IV bolus

• Apply oxygen

• Initiate insulin protocol

• Obtain CT of head

Multiple Choice

What type of insulin should be used to initiate Marks drip?

• Regular

• Humalog

• Glargine

• NPH

Multiple Choice

Marks laboratory data returns. What is the primary concern with Mark?

• AKI

• Hyperkalemia

• Sepsis

• DKA

Multiple Select

Which treatments would be appropriate for Mark at this time?

• NS IVF bolus

• Insulin drip

• Kayexalate

• Administer broad-spectrum antibiotics

• CRRT

Math Response

Utilizing the Insulin drip protocol, How many units of insulin/hr will Mark recieve?

Weight: 96 kg

For initial infusion rates: 

• Begin Regular insulin at 0.1 unit/kg/hr (max of 15 units/hr)

Type answer here

Correct Answer: 9.6

Deg^°

Rad

Math Response

What will the rate/hr need to be set on the pump?

Concentration: 100 units/ 100 mL

Type answer here

Correct Answer: 9.6

Deg^°

Rad

Math Response

After the first hour, Marks glucose is rechecked and it is 1656 mg/dL. What will be the new rate of the infusion? (previous glucose 1673; previous rate 9.6 ml/hr)

Type answer here

Correct Answer: 11.6

Deg^°

Rad

Multiple Select

It is the next day and the nurses has been titrating Mark's insulin and monitoring his labs. His most current labs are shown. Which action would be appropriate at this time?

• Replace electrolytes

• Stop the insulin infusion

• Stop the IVF

• Add D5 to the IVF

Multiple Choice

According to the protocol. Which prescription would be appropriate for the magnesium replacement? Magnesium level 1.2mg/dL, Creatinine 1.9

• magnesium oxide tablets 400 mg QID

• Magnesium sulfate 4 g in 100 ml IVPB over 4 hours

• Magnesium sulfate 2 g in 50 ml over 2 hours

Multiple Choice

What does base excess measure in the laboratory data?

• Base excess measures the oxygen levels in the blood.
• Base excess indicates the presence of carbon dioxide in the body.
• Base excess reflects the hydration status of the patient.
• Base excess measures the metabolic component of acid-base balance in the blood.

Multiple Choice

Mark is now alert and oriented x4. His glucose is down to 232 mg/dL. He tells you is a type 1 diabetic, but he is unable to afford his insulin. Why is insulin important for type 1 diabetics?

• Their body does not know how to use the insulin so they need the extra insulin for energy

• Their body does not produce insulin, so they need exogenous insulin to help aid in energy production

• They have too much sugar and their body is just overwhelmed by all of it the insulin is going crazy.

• I DON'T KNOW!!

Multiple Choice

Mark's current lab data glucose 134 mg/dL, but his gap is 23. Would it be appropriate to stop his insulin now? Why or why not?

• No, it is not appropriate to stop his insulin because he is still in acidosis according to his gap.

• No, he is still confused and his sugar is high so the drip needs to stay going.

• Yes, the gap indicates he is no longer acidic so we can stop insulin.

• Yes, his glucose level is acceptable now so the drip should be discontinued.

Multiple Choice

Why is dextrose added to IVF for diabetics?

• Dextrose is added to IVF for diabetics to provide a controlled source of glucose. and to help keep the glucose from dropping.

• Dextrose is added to IVF to prevent dehydration in diabetics.
• Dextrose is used to replace lost electrolytes in diabetics.
• Dextrose is added to IVF to increase insulin production.

Multiple Choice

Which complication can develop from dropping the glucose too quickly?

• Cerebral edema

• Ketoacidosis
• Diabetes Insipidus
• Hyperglycemia

Multiple Choice

What would be a sign of cerebral edema in your patient?

• Altered level of consciousness or confusion.
• Increased heart rate or palpitations.
• Extremity swelling

• Hypertension

Open Ended

Questions?