Question

The nurse is working in the emergency room when a client arrives with severe burns of the left arm, hands, face, and neck. Which action should receive priority? A. Starting an IV B. Applying oxygen C. Obtaining blood gases D. Medicating the client for pain

Short answer

A. Starting an IV B. Applying oxygen C. Obtaining blood gases D. Medicating the client for pain Answer: B. Applying oxygen Explanation: Among the given options, applying oxygen should be the highest priority. This is due to the potential for airway compromise as a result of the burns on the client's face and neck. Ensuring that the client's airway is not compromised is crucial in providing appropriate care.

Step-by-step solution

Identify the problem

A client has arrived at the emergency room with severe burns on their left arm, hands, face, and neck. We need to determine which action should be the highest priority for the nurse.

Analyze the options

We have four possible actions that the nurse can take: A. Starting an IV B. Applying oxygen C. Obtaining blood gases D. Medicating the client for pain Let's analyze each option and determine their importance in the context of severe burns.

Evaluate Option A - Starting an IV

Starting an IV is an important step in managing a burn client, as it allows for fluid resuscitation and administration of medications. However, there could be other more pressing concerns in this situation, such as airway management or pain control. Therefore, starting an IV might not be the highest priority.

Evaluate Option B - Applying oxygen

Applying oxygen is crucial for clients with respiratory distress, including those with burns to the face or neck, as these injuries may compromise the airway. In this scenario, the client's face and neck have been severely burned, which increases the risk for airway compromise. Therefore, applying oxygen is a critical step for this client.

Evaluate Option C - Obtaining blood gases

Obtaining blood gases is an important step in assessing a client's respiratory function, especially in cases of severe burns with potential for respiratory compromise. However, it is not an immediate intervention that should take priority over securing the airway or addressing the client's pain.

Evaluate Option D - Medicating the client for pain

Medicating the client for pain is essential for a client with severe burns, as this will ease their discomfort and allow for better cooperation during treatment. However, pain control might not be the highest priority compared to ensuring the client's airway is not compromised.

Compare the options and determine the priority action

Having evaluated each option, we can conclude that the priority action for this client with severe burns is applying oxygen (Option B). The potential for airway compromise due to the burns on the face and neck is the most critical concern, and addressing it as soon as possible is essential to provide appropriate care.

Key concepts

Burn Injury Treatment

Treatment for burn injuries requires a multifaceted approach, focusing on the severity and extent of the burns, potential complications, and the immediate needs of the patient. Severe burns, especially those affecting the face, neck, or limbs, can be life-threatening due to the risk of infection, fluid loss, and airway obstruction.

• Initial Assessment: The first step upon arrival at the emergency department is to assess the percentage of the total body surface area (TBSA) burned to gauge the severity.
• Resuscitation: Fluid resuscitation using formulas like the Parkland formula is initiated to combat the effects of burn shock. This includes starting an IV to deliver the necessary fluids.
• Wound Care: After stabilizing the patient, wound care becomes a priority, involving cleaning, debridement, and the application of topical antimicrobial agents to prevent infection.
• Pain Management: Adequate pain control is critical and involves administering analgesics, and sometimes, sedatives to ensure patient comfort and compliance with procedures.
• Interventions: Surgical interventions such as escharotomy or skin grafts may be necessary for severe burns to improve healing and restore function.

Overall, a burn injury necessitates a well-coordinated response prioritizing initial airway management, fluid resuscitation, pain management, and meticulous wound care to optimize patient outcomes.

Airway Management in Burns

In patients with burn injuries affecting the face and neck, safeguarding the airway is paramount, since the tissue damage can rapidly lead to airway obstruction due to edema. Airways compromised by burns require immediate and precise attention to prevent asphyxiation.

• Assessment: The initial assessment involves observing for signs of airway injury such as hoarseness, charred lips, soot in the oropharynx, and stridor.
• Oxygen Supplementation: Applying oxygen is a critical intervention. High-flow oxygen may be necessary to maintain adequate oxygenation levels.
• Advanced Airway Management: Intubation might be required in severe cases to secure the airway, especially if there is concern for impending obstruction or significant facial swelling.

Prompt recognition of the symptoms and risks associated with burn-related airway compromise enables healthcare professionals to take decisive action, which could include administering oxygen and preparing for possible intubation to ensure the patient's breathing remains unaffected during initial treatment.

Respiratory Assessment for Burn Patients

Conducting a proper respiratory assessment for burn patients is crucial because it can reveal the onset of respiratory compromise, which often requires immediate intervention. This assessment involves both observation and diagnostic tools to gain a complete picture of the patient's respiratory status.

• Observational Assessment: Observing the patient for signs of respiratory distress, such as labored breathing, use of accessory muscles, and cyanosis is vital.
• Auscultation: Listening to the lungs for wheezing, crackles, or decreased breath sounds can indicate inhalation injury or pulmonary edema. Auscultation is also used to monitor for any changes over time.
• Pulse Oximetry: This non-invasive tool provides immediate information about the patient's oxygen saturation, indicating if they are hypoxic.
• Blood Gas Analysis: Obtaining blood gases can give a definitive measure of respiratory function, including levels of oxygen and carbon dioxide, indicating the efficiency of the patient's lungs at gas exchange.

A thorough respiratory assessment provides critical information needed to prioritize interventions, such as providing supplemental oxygen or seeking advanced airway management in response to the patient's condition.