A male client with a solar burn of the chest, back, face, and arms is seen in urgent care. The nurse’s primary concern should be:
A. Fluid resuscitation
B. Infection
C. Body image
D. Pain management
Correct Answer: D. Pain management
With a superficial partial-thickness burn such as a solar burn (sunburn), the nurse’s main concern is pain management. Pain is nearly always present to some degree because of the varying severity of tissue involvement and destruction but is usually most severe during dressing changes and debridement. Changes in location, character, intensity of pain may indicate developing complications (limb ischemia) or herald improvement and/or return of nerve function and sensation.
Option A: Fluid resuscitation becomes a concern if the burn extends to the dermal and subcutaneous skin layers. Fluid resuscitation replaces lost fluids and electrolytes and helps prevent complications (shock, acute tubular necrosis). Replacement formulas vary but are based on the extent of injury, amount of urinary output, and weight. Note: Once initial fluid resuscitation has been accomplished, a steady rate of fluid administration is preferred to boluses, which may increase interstitial fluid shifts and cardiopulmonary congestion.
Option B: Infection becomes a concern if the burn extends to the dermal and subcutaneous skin layers. Dependent on the type or extent of wounds and the choice of wound treatment (open versus closed), isolation may range from a simple wound and/or skin to complete or reverse to reduce risk of cross-contamination and exposure to multiple bacterial flora.
Option C: Body image disturbance is a concern that has lower priority than pain management. Traumatic episodes result in sudden, unanticipated changes, creating feelings of grief over actual or perceived losses. This necessitates support to work through to optimal resolution.
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