What is the priority nursing diagnosis during the first 24 hours for a client with full-thickness chemical burns on the anterior neck, chest, and all surfaces of the left arm?
A. Risk for Ineffective Breathing Pattern
B. Decreased Tissue Perfusion
C. Risk for Disuse Syndrome
D. Disturbed Body Image
C
During the emergent phase, fluid shifts into interstitial tissue in burned areas. When the burn is circumferential on an extremity, the swelling can compress blood vessels to such an extent that circulation is impaired distal to the injury, necessitating the intervention of an escharotomy. Chemical burns do not cause inhalation injury.
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The nurse is reviewing the results of the patient's laboratory findings and notes an elevated C-reactive protein (CRP). What does this indicate?
a. The patient had a myocardial infarction. b. The patient has inflammation in the body. c. The patient has reduced cardiac output. d. The patient's diet is high in cholesterol.
The patient is in decompensated shock. What abnormal variation in peripheral skin color does the nurse expect to find?
A) Pallor B) Cyanosis C) Erythema D) Jaundice
Lacteals
a. Increase the surface area of the mucosa of the small intestine b. Transport products of fat digestion from the small intestine to the blood c. Produce new cells for the mucosa of the small intestine d. Produce digestive enzymes
Which statement about alcohol would indicate that a patient has an accurate understanding of its effects on the body?
1. "Alcohol use can increase my risk of breast cancer." 2. "Alcohol improves my sexual functioning." 3. "Alcohol can improve my digestion by decreasing stomach acidity." 4. "Alcohol can help lower my blood pressure."