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Diureticsfor pulmonary edema. Paralyticdrug such as atracurium or vecuronium, to remove all breathing control from the pt, making mechanical ventilation easier. (Must also receive sedation,analgesia and antianxiety rugs while on the paralytic drugs)oPositioning and deep breathing =turn the pt frequently and assist to get OOB to chair. oSurgical management = tracheotomy might be needed when long term intubation is expected. Chest tubes are used to expand the lung when a pneumothorax or hemothorax has occurred. Escharotomies can relieve the restriction and permit greater respiratory movement. Preventing Hypovolemic shock and inadequate gas exchangeoFluid volume and tissue blood flow are restored through IV fluid therapy and drug therapy. oRapid infusion of IV fluids (fluid resuscitation) = needed to maintain sufficient blood volume for normal cardiac output, mean arterial pressure and tissue oxygenation. oThe resuscitation involves hourly infusion volumes that are greatly in excess of the 125 ml to 150ml per hour common infusion rateso*Fluid replacement formulas are calculated from the time of injury and not from the tim of arrival at the hospital. oMonitoring = pt responses is critical to determine the adequacy of resuscitation for hydration and blood perfusion of the brain, heart and kidneys. o*Regardless of the total amount of fluid calculated as needed for the pt, the amount of fluid given depends on how much IV fluid per hour is needed to maintain the hourly urine output at a 0.5 ml/kg (30ml/hr). oBurn pts can develop hypovolemic shock and need invasive cardiac monitoringoDrug therapy = *Diuretics do not increase cardiac output; they actually decrease circulating volume and CO by pulling fluid from the circulating blood volume to enhance diuresis. Therefore,diuretics are not used to improve urine output for burn pts. oSurgical management = surgical procedure fot the treatment of inadequate tissue perfusion is escharotomy. (incision though he burn eschar relieves pressure caused by constricting force of fluid buildup under circumferential burns on the extremity or chest. Management of Paino*The priority nursing actions include continuously assessing the pts pain level, using appropriate pain reducing strategies and preventing complications
oDrug therapy = Opioid analgesics such as morphine, Dilaudid, fentanyl. These may depress the respiratory function and reduce intestinal motility. *Give opioids for pain only by the IV route during the resuscitation phase to prevent delayed rapid absorption leading to lethal blood levels.oComplementary and integrative therapy = relaxation, meditative breathing, guided imagery, music therapy, massage and healing or therapeutic touch. oEnvironmental changes = quiet environment, using nonpainful tactile stimulation and increase pts control can increase comfort. Help the pt change positions every 2 hours.