The nurse assesses a burn patient's urine to be reddish-brown in color. Which of the following would be indicated for this patient?
1. provision of intravenous fluids to maintain a urine output of 30 cc per hour
2. irrigating the patient's bladder with a sodium bicarbonate solution
3. interventions to raise the urine pH to an alkaline level
4. withholding sodium bicarbonate to the patient
3
Rationale: If a patient has experienced muscle damage from exposure to an electrical current or a crush-type injury, the urine may be a red to reddish-brown color. This discoloration results from myoglobin in the urine. If myoglobin is present in the urine, adequate urine output of 75 to 100 cc per hour, and not 30 cc per hour, must be maintained. The solubility of myoglobin increases in an alkaline environment, so maintaining alkaline urine will increase the rate of myoglobin clearance. By adding 50 mEq of sodium bicarbonate to each liter of intravenous fluids, a slight alkalinization of the blood is maintained, ensuring that the urine is also alkaline. Interventions to raise the urine pH to an alkaline level must be done. Irrigating the patient's bladder with sodium bicarbonate will not raise the urine pH. Withholding sodium bicarbonate to the patient will exacerbate the condition and could lead to renal failure.
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