Question

A child with 20% second- and third-degree burns is admitted to the burn center. The child weighs 44 lbs (20 kg). The nurse has started an IV infusion of lactated Ringer solution and inserted an indwelling catheter. Which of the findings indicate that the child is going into shock? Select all that apply.

A. Urinary output is 25 ml/hr.
B. Specific gravity is within normal limits.
C. Pain is 7 on a pain scale of 1 to 10.
D. Heart rate is elevated.
E. Blood pressure is dropping.

Answer 1

Signs indicating the child could be going into shock include urinary output less than 1 mL/kg body weight/hour, an elevated heart rate, and dropping blood pressure. Specific gravity within normal limits and pain are not direct indicators of shock.

Step-by-step explanation:

A child that weighs 44 lbs (20 kg) and has 20% second- and third-degree burns is at risk of going into shock. Signs indicating the child is going into shock include:

• Urinary output is 25 ml/hr, which is concerning as it is less than the 1 mL/kg body weight/hour minimum expected to maintain adequate renal filtration and indicates poor kidney function likely due to decreased blood volume and pressure.
• Heart rate is elevated, which can be a compensatory mechanism to improve cardiac output in response to reduced circulating blood volume.
• Blood pressure is dropping, a classic sign of decreased circulatory volume causing poor perfusion and oxygen delivery to tissues.

Specific gravity within normal limits (B) and pain (C) are not direct indicators of shock, although pain from the burns is certainly expected.