A patient is brought to the emergency department after a house fire. He fell asleep with a lit cigarette, and the couch ignited
TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest, back, and left arm and 20% full-thickness burns to the right arm, right upper leg, and areas on the face. The patient is now in the intensive care burn unit with a heart rate of 140 beats/min, a urine output of 25 mL/hr, and clear lung sounds. The patient's symptoms are most likely attributable to a. blood loss associated with burns and wound care.
b. hemodynamic stability related to adequate fluid resuscitation.
c. over-resuscitation related to overestimation of the TBSA involved.
d. under-resuscitation because of probable inhalation injury.
D
The rate of fluid administration is adjusted according to the individual's response, which is determined by monitoring urine output, heart rate, blood pressure, and level of consciousness. Meticulous attention to the patient's intake and output is imperative to ensure that he or she is appropriately resuscitated. Under-resuscitation may result in inadequate cardiac output, leading to inadequate organ perfusion and the potential for wound conversion from a partial-thickness to full-thickness injury. Over-resuscitation may lead to moderate to severe pulmonary edema; to excessive wound edema causing a decrease in perfusion of unburned tissue in the distal portions of the extremities; or to edema inhibiting perfusion of the zone of stasis, resulting in wound conversion.
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Research has shown a psychoneuroimmunologic link between stress, the immune system, and cardiac disease through an effect of which of the following two substances?
a. B lymphocytes and glucocorticoids b. Corticotropin hormone and norepinephrine c. Interleukin-6 and C-reactive protein d. T cells and plasma cortisol
Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information
The nurse or midwife should refer a patient to a registered di-etitian for in-depth nutritional counseling when which of the following exist(s)? (Choose all that apply.) a. Preexisting or gestational illness such as diabetes b. Ethnic or cultural food patterns c. Obesity d. Vegetarian diets
A hospital has been notified that a tornado injured numerous people in a neighboring town and the hospital may receive some victims. How should the hospital administration respond?
1. Immediately implement the hospital's incident command system. 2. Wait until the first victims arrive to implement the hospital incident command system. 3. Implement the positions and functions most likely to be required by the situation and reassess once patients arrive. 4. Notify the emergency department that a drill is possible.
The nurse notices burn marks on a client's arms that were not noted in the medical record. When questioned about the marks the client responds with, "Oh, sometimes I accidentally burn myself with my cigarette."
The nurse asks, "How does that happen?" The client smiles and says, "Well, maybe it really isn't an accident.". What is the relationship between the behavior and the client's feelings? A) The client wants the nurse to know that the burns are "no big deal.". B) The client is describing a lack of control over the impulses to self-injure. C) The client is telling the nurse that these are intentional acts used to cope. D) The client is expressing suicidal intentions.