please when you see your orders, your physicians will write orders, call if urinary output parameters are less than this as opposed to call if less than 30 mL/hr. you may see that written out so you need to be familiar with that. The other thing myoglobin which of course is going to be the breakdown of muscle, that circulates through the kidney. Kidney is not supposed to eliminate myoglobin so it is almost like it clogs the kidney, you know, kidneys are supposed to eliminate fluid and electrolyte byproducts. Myoglobin while it is a byproduct actually the breakdown of muscle so that is not a normal component as far as what your kidney is going to eliminate. That is very heavy molecule, and as you can imagine, relatively taxing to the kidney to have to try to eliminate it. As you know, when we assess renal function with our clients, not only do we look at the urinary output, again we may look at the urinalysis to see what their specific gravity might be, you’re going to look at their BUN, their serum creatinine levels, theirsodium levels. A lot of times we’ll do these 24-hour urine samples to see what the electrolyte component of the urine is. If it’s over concentrated because they are dumping sodium in their urine or not. Again, as always, we always assess urine for the color, the odor, a lot of these medications we give can turn that urine, diptrovan, proval can turn that urine green. Let’s see odor, pseudomonas has a very distinct odor, some of your antibiotics have very distinct order to them, that you will notice in the urine. Ihate to say that I can definitely tell you what antibiotic a client is on based on the way the urine smells. What else? Foam; presence of particles or foam in the urine. Why foam? Why foam? That’s a question that I am going to leave hanging out there for you also to see if you can determine why do patients, these renal patients now, why they would end up with foam in the urine? Why would anybody end up with foam in the urine? Why is it on this slide and in this chapter? Talking about these types of patients? Foam? Make a note to remind myself to ask you this. Skin assessment. Determine the size and depth of the injury, determine the % of the total BSA affected, this is so very important because and not necessarily for you, but for those other disciplinarians we workwith such as medicine, dieticians to determine their caloric needs, going to determine what their fluid volume goal is as far as what their resuscitation based off of how much skin and the severity that they have affected with the type of burn they have. we’re going to do this by quick down and dirty. We’re going to use this rule of 9’s, uses the multiples of 9 of BSA, I will explain this in just in a second here.
Look at this picture here. Look at this picture. Rule of 9’s, we are estimating burn damage. And there are some very specific tools that we can use to get it more precise estimate of burn damage but this is a
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- Winter '16
- Nursing, Injury, full thickness burns, Burn Injury