Nurse Troyzan has just received the change-of-shift report in the burn unit. Which of the following client requires the most immediate care?
A. A 50-year-old who was admitted with electrical burns 24 hours ago and has a serum potassium level of 5 mEq/L.
B. A 40-year-old with partial-thickness leg burns which has a temperature of 101.9°F and blood pressure of 89/42 mm Hg.
C. A 30-year-old who returned from debridement surgery 3 hours ago and is complaining of pain (Pain scale of 7/10).
D. A 25-year-old admitted 4 days previously with facial burns due to a house fire that has been crying since recent visitors left.
Correct Answer: B. A 40-year-old with partial-thickness leg burns which has a temperature of 101.9°F and blood pressure of 89/48 mm Hg.
The client’s vital signs indicate that life-threatening complications of sepsis may be developing. Burn wound infections are one of the most important and potentially serious complications that occur in the acute period following injury. If the patient’s host defenses and therapeutic measures (including excision of necrotic tissue and wound closure) are inadequate or delayed, microbial invasion of viable tissue occurs, which is the hallmark of an invasive burn wound infection.
Option A: Classically, hyperkalemia has been regarded as a complication in patients with electrical burns. The etiology of hyperkalemia includes metabolic acidosis, destruction of red blood cells, rhabdomyolysis, and the development of renal failure.
Option C: Oral NSAIDs and acetaminophen are of benefit in treating minor burns, usually in the outpatient setting. For hospitalized burn patients, opioids are the cornerstone of pharmacologic pain control. Patient-controlled analgesia (PCA) with IV opioids is a safe and efficient method of achieving flexible analgesia in burn-injured patients.
Option D: Symptoms of depression and anxiety are common and start to appear in the acute phase of recovery. Acute stress disorder (occurs in the first month) and post-traumatic stress disorder (occurs after one month) are more common after burns than other forms of injury.
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