Diuretics
for pulmonary edema.
Paralytic
drug 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)
o
Positioning and deep breathing =turn the pt frequently and assist to get OOB to chair.
o
Surgical 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 exchange
o
Fluid volume and tissue blood flow are restored through IV fluid therapy and drug therapy.
o
Rapid infusion of IV fluids (fluid resuscitation) = needed to maintain sufficient blood volume for
normal cardiac output, mean arterial pressure and tissue oxygenation.
o
The resuscitation involves hourly infusion volumes that are greatly in excess of the 125 ml to 150
ml per hour common infusion rates
o
*Fluid replacement formulas are calculated from the time of injury and not from the tim of
arrival at the hospital.
o
Monitoring = 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).
o
Burn pts can develop hypovolemic shock and need invasive cardiac monitoring
o
Drug 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.
o
Surgical 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 Pain
o
*The priority nursing actions include continuously assessing the pts pain level, using appropriate
pain reducing strategies and preventing complications
o
Drug 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.
o
Complementary and integrative therapy = relaxation, meditative breathing, guided imagery,
music therapy, massage and healing or therapeutic touch.
o
Environmental changes = quiet environment, using nonpainful tactile stimulation and increase
pts control can increase comfort. Help the pt change positions every 2 hours.
