80. A nurse is preparing to obtain a wound drainage specimen for culture from a client who has a nonhealing burn injury. In what order should the nurse collect this specimen? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Rationale:

• Location of pain: Severe pain out of proportion to the injury, especially with passive stretch, is a classic sign of compartment syndrome. DVT also presents with localized pain in the affected limb, typically worsening over time due to venous congestion.
• Temperature of extremity (Compartment Syndrome & DVT): A cool extremity in compartment syndrome indicates compromised arterial blood flow due to increased pressure within the fascial compartment. In DVT, the extremity may be warm early on, but impaired circulation can eventually result in coolness and cyanosis.
• Nail bed assessment (Compartment Syndrome): Cyanotic or dusky nail beds reflect inadequate oxygen delivery from restricted blood flow, commonly seen in advanced compartment syndrome. This is a late and critical sign requiring urgent intervention to prevent permanent tissue damage.
• Location of edema (Compartment Syndrome & DVT): Localized swelling occurs in compartment syndrome due to rising intracompartmental pressure. In DVT, venous obstruction leads to fluid accumulation and unilateral leg edema, often accompanied by warmth and discomfort.
• Respiratory assessment (Fat Embolism Syndrome): FES often presents with sudden onset dyspnea, tachypnea, and hypoxemia due to fat globules entering the pulmonary circulation. These respiratory symptoms typically arise 24–72 hours after long bone trauma.
• Skin assessment (Fat Embolism Syndrome): A petechial rash, especially on the chest, upper arms, and neck, is a distinguishing feature of FES. It results from occlusion of dermal capillaries by fat globules and is considered a hallmark sign of the condition.
• Neurological status (Fat Embolism Syndrome): Altered mental status, confusion, and decreased alertness can occur in FES due to cerebral fat embolization. Neurologic involvement differentiates FES from other conditions like DVT or compartment syndrome, which typically do not cause cognitive changes.

Rationale:
A. "If my heart starts racing, my provider might need to adjust my dosage.": This statement shows understanding. Tachycardia is a common sign of overtreatment with levothyroxine, which may lead to hyperthyroidism. The provider should be notified to adjust the dosage if such symptoms occur.

B. "I will keep a journal of my daily food intake to show the provider.": While nutrition is important, this is not a routine requirement for levothyroxine management. The effectiveness of therapy is primarily monitored through thyroid function tests, not dietary logs.

C. "Once my weight is back to normal, I can gradually reduce and then stop the medication.": This indicates a misunderstanding. Levothyroxine is a lifelong therapy for most clients with hypothyroidism, and stopping it can lead to a return of symptoms and complications.

D. "I'm not forgetful, so I do not need a pill reminder system.": While this may be true for some, consistent daily dosing is critical with levothyroxine. Even clients with good memory may benefit from reminder systems to ensure adherence and maintain stable hormone levels.