All of the following laboratory test results on a burned client’s blood are present during the emergent phase. Which result should the nurse report to the physician immediately?
A. Serum sodium elevated to 131 mmol/L (mEq/L)
B. Serum potassium 7.5 mmol/L (mEq/L)
C. Arterial pH is 7.32
D. Hematocrit is 52%
Correct Answer: B. Serum potassium 7.5 mmol/L (mEq/L)
All these findings are abnormal; however, only the serum potassium level is changed to the degree that serious, life-threatening responses could result. With such a rapid rise in the potassium level, the client is at high risk of experiencing severe cardiac dysrhythmias and death.
Option A: Serum sodium is abnormal, but not to the same degree of severity, and would be expected in the emergent phase after a burn injury. Severe cutaneous injuries such as burn injuries and blast injuries result in the loss of both water and sodium. For burn patients, hypernatremia that occurs within a few days of injury may be associated with increased risk of death.
Option C: Acid-base studies were carried out on 76 consecutive burn patients admitted within 36 hours of injury. Admission blood pH and base excess (BE) values all decreased in a linear relationship to the extent of the burn. Blood Pco-2 changes were unrelated to the extent of the burn. Significant acidosis developed within 2 hours of burn injury.
Option D: The hematocrit (Hct) is the percentage of the volume of the whole blood that is made up of red blood cells. In burns, the patient has lost a lot of fluid from leaky blood vessels. There are more red cells than fluid so the hematocrit is high.
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