Question

The nurse is evaluating care provided to a patient with burns during the emergent phase. Which data indicates that additional fluid resuscitation is required?

1) Blood pH 7.39
2) Heart rate 112 bpm
3) Blood pressure 110/60 mm Hg
4) Central venous pressure 2 mm Hg

Answer 1

A Central venous pressure (CVP) of 2 mm Hg indicates additional fluid resuscitation may be required during the emergent phase of burn management, as it is at the lower end of the normal range and may suggest inadequate venous return.

Step-by-step explanation:

The nurse is evaluating care provided to a patient with burns during the emergent phase. The data indicating that additional fluid resuscitation is required is a Central venous pressure (CVP) of 2 mm Hg. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. A normal CVP is between 2 to 8 mm Hg. Given that the patient's CVP is at the lower end of the normal range, this might suggest inadequate venous return, a common problem in patients with severe burns who are likely to suffer hypovolemic shock.

Other options such as a blood pH of 7.39, which is within the normal range (7.35-7.45), a heart rate of 112 bpm, which is slightly elevated and not specifically indicative of the need for more fluids without additional context, and a blood pressure of 110/60 mm Hg, which is within normal range, do not necessarily indicate the need for more fluid resuscitation in this context.

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