A client with partial thickness burns over 50% TBSA is at risk for hypovolemic shock due to fluid loss. Which patient demonstrates this risk?

A client with partial thickness burns over 50% TBSA is at risk for hypovolemic shock due to fluid loss. Which patient demonstrates this risk?

• A. Post-operative cervical spinal surgery
• B. Wasp stings
• C. Partial thickness burns over 50% total body surface area
• D. Type 2 diabetic with HHNK

Answer: (C)

Massive fluid shifts from burn injuries are the key concept. When a large portion of the skin is burned, capillary permeability increases dramatically, causing plasma to leak out of the vessels and into the interstitial space and burn wound exudate. The larger the burn area, the greater the fluid and protein loss from the intravascular space, which can drop blood volume and cardiac preload enough to cause hypoperfusion and shock.

Extensive partial-thickness burns over half the body surface area fit this pattern, because the severe surface area involved leads to substantial intravascular fluid loss and a high risk of hypovolemic shock if fluids aren’t promptly replaced.

Other scenarios don’t involve this burn-related fluid shift. A post-operative spinal surgery patient doesn’t typically experience the same massive third-spacing and wound fluid loss; wasp stings can cause anaphylaxis, but that’s due to vasodilation and capillary leak from an allergic reaction rather than burn-induced plasma loss; a Type 2 diabetic with HHNK loses fluids through osmotic diuresis, not from burn-wound fluid loss.