Question

1. A 7-year-old boy is a patient in the intensive care unit you work at. He was on a camping trip with his family when he accidentally fell on the campfire causing severe second- and third-degree burns over 60% of his body. The clinical care team tells his parents that it will be critical to maintain their son’s airway and keep his fluid levels high. The father is confused and asks you why his son’s fluid level is important after a burn. How would you explain this to him? After your explanation, the father nods that he understands. He then asks how you will measure his son’s fluid levels. How would you respond? As a clinician with knowledge of physiology, which aspects of this boy’s condition would you be most concerned about?

2. A 43-year-old man presents to the clinic you work at for a follow-up blood pressure check accompanied by his 9-year-old daughter. He is noted to still have hypertension (high blood pressure). The physician prescribes an angiotensin-converting enzyme (ACE) inhibitor. The 9-year-old daughter asks you how this medication works. How would you explain this to her in a way she can understand? What might be other suggestions (besides medications) you would make to this patient to help him decrease his blood pressure? Why?

3. You are the chair of the board of pediatric health that reports to the state government. A recommendation has been made to the board to require that children have a blood test for major diseases of electrolyte balance at every checkup, regardless of whether the clinician feels the client has symptoms that require a test. As the chair of the board, given your knowledge of electrolyte imbalances, what issues would you consider in making the recommendation or not? Would you recommend to the state that they should require the pediatric blood testing or not? Why?

4. A 4-year-old girl presents with her parents to the emergency room you work at. Her parents explain that the flu is going around her day care and that their daughter began to feel sick 4 days ago. She has been unable to eat since then, with prolonged vomiting for 3 days. She is admitted to the hospital for rehydration and correction of her acid–base disturbance. Her parents are highly concerned about how she could have developed an acid–base disturbance from the flu. How do you respond to this concern by the parents? Her parents tell you that they tried to give their daughter a pediatric hydrating drink they found at the store, but she was unable to keep it down. They ask you in the future if this would have helped their daughter from developing an acid–base disturbance. How do you respond to this question by the parents?

6. A 64-year-old woman presents to the urgent care office complaining of shortness of breath and coughing up “yellow mucus.” She has a history of smoking one pack a day for 20 years and renal failure. Upon examination, she is noted to have a fever and low blood pressure. After a chest x-ray, she is diagnosed with right lower lobe pneumonia with subsequent sepsis and a resultant metabolic acidosis. The patient is admitted to a local hospital for intravenous antibiotics and further observation. As her health care provider, what sequence of events led to her developing metabolic acidosis? How did her body attempt to compensate for this? How would her renal failure have affected her compensatory mechanisms?

Answer 1

a) In burns,The body’s barrier against water loss is no longer there. When the protective covering does not exist, fluid seeps from the burned area causing dehydration and electrolyte imbalance. Unless fluids are replaced immediately, renal shut down and hypovolemic shock will occur. Skin is both a physical barrier, preventing water loss, and also a chemical barrier, preventing the growth of bacteria.

When a person is burned and depending on the severity of burn, the blood vessels including the capillaries may be affected. Combined with the release of chemical substances into the blood, this will lead to increased capillary permeability to fluids, leading to the leaking of fluids from the blood vessels into the tissues. The higher the percentage of burned skin, the more severe the loss of fluid will be and the greater the dehydration will be.

b)Fluid replacement is one of the important objectives in the initial treatment of burned patients. The amount of fluid needed and the method of fluid given depends on the surface area of the skin burned as well as other factors. There are many formulas used to calculate the amount of fluid needed for resuscitation; one of them is called the Parklund Formula in which after the amount of fluids is calculated, it is given through an IV route and the type of fluid is usually Ringer Lactate because it’s composition is simillar to the extracellular fluid.

c)maintanance of airway,breathing ,circulation are the impotant concern

• Perform an ABCDEF primary survey

A—Airway with cervical spine control, B—Breathing, C—Circulation, D—Neurological disability, E—Exposure with environmental control, F—Fluid resuscitation

• Assess burn size and depth (see later article for detail)

• Establish good intravenous access and give fluids

• Give analgesia

• Catheterise patient or establish fluid balance monitoring

• Take baseline blood samples for investigation

• Dress wound

• Perform secondary survey, reassess, and exclude or treat associated injuries

• Arrange safe transfer to specialist burns facility 2. A)Angiotensin-converting enzyme (ACE) inhibitors help relax your veins and arteries,.to lower your blood pressure. Arteries and veins are beareres of blood in your body.to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder b) There are several types of drugs used to treat high blood pressure, including Beta-blockers-Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure Calcium channel blockers-Calcium channel blockers are drugs used to lower blood pressure. They work by slowing the movement of calcium into the cells of the heart and blood vessel walls, which makes it easier for the heart to pump and widens blood vessels. As a result, the heart doesn't have to work as hard, and blood pressure lowers Alpha-blockers-Alpha blockers. Alpha blockers are used in combination with other drugs to treat high blood pressure and can treat prostate problems in men. Alpha blockers lower blood pressure by keeping the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins Alpha-agonists-Drugs that enhance central alpha 2 activity, such as clonidine, guanfacine and the active metabolite of methyldopa, can significantly lower BP and are effective in the long-term control of hypertension, either alone or in combination with other drugs 3.b)in my openion,I will not recommend the conducting a blood test for major diseases of electrolyte balance at every checkup, regardless of signs and symptoms is not necessary,as well as practicable.every electrolyte imbalances have specific causes and signs and symptoms,which shows the need for evaluation of blood levels of electrolytes An illness that causes severe vomiting, diarrhea, and a high fever increases the risk of a fluid and electrolyte disturbance, as does taking medication that causes excessive urination. Profuse sweating from physical exertion can also increase the risk of dehydration. Fluid and electrolyte disturbances are common in children with a serious underlying medical condition. For instance, children with chronic kidney disease, a condition that affects the ability of these organs to maintain proper fluid and electrolyte levels, are at risk. Conditions that affect the production of thyroid hormones and parathyroid hormones, which help regulate calcium and other electrolytes, can also make a child susceptible to a fluid and electrolyte imbalance. Children with heart disease may retain sodium and water, and develop abnormal electrolyte levels.