A client in the emergency department presents with chest pain, diaphoresis, and ST-segment elevation on ECG. Which condition should the nurse suspect?

Choice A reason: Infection is a significant risk in burns due to loss of the skin barrier, allowing pathogens like Pseudomonas to invade. However, in the acute phase, airway obstruction from head and neck burns is more immediately life-threatening. Infection control is critical but secondary to ensuring a patent airway in the ABCDE approach.

Choice B reason: Paralytic ileus can occur in burn patients due to stress response or hypokalemia, impairing gastrointestinal motility. While serious, it is not an immediate threat to life compared to airway obstruction. The ABCDE approach prioritizes airway, making ileus a lower priority in the acute management of head and neck burns.

Choice C reason: Extensive burns to the head, neck, and chest pose a high risk of airway obstruction due to edema from thermal injury to the upper airway. Swelling can rapidly compromise breathing, requiring urgent assessment and possible intubation. In the ABCDE approach, airway is the top priority, making this the critical focus.

Choice D reason: Fluid imbalance, particularly hypovolemia, is a major concern in burns due to plasma leakage. While critical, it is addressed after airway and breathing in the ABCDE approach. Airway obstruction from head and neck burns can cause rapid death, making it the priority over fluid resuscitation in the initial assessment.

Choice A reason: Hemodialysis rapidly removes fluid and solutes, which can cause significant hemodynamic shifts, including hypotension, in unstable patients. It involves high blood flow rates and ultrafiltration, stressing the cardiovascular system. For a hemodynamically unstable patient with acute renal failure, hemodialysis is less suitable due to its potential to exacerbate hypotension and circulatory collapse.

Choice B reason: Peritoneal dialysis uses the peritoneal membrane for slow fluid and solute exchange, which is gentler on hemodynamics. However, it is less efficient for rapid correction of hypervolemia and hyperkalemia in acute renal failure. It also carries risks of peritonitis and is impractical in critically ill patients with abdominal trauma or instability.

Choice C reason: Continuous venovenous hemodialysis (CVVHD) is ideal for hemodynamically unstable patients. It provides slow, continuous fluid and solute removal, minimizing cardiovascular stress. CVVHD effectively manages hypervolemia and hyperkalemia in acute renal failure by maintaining steady-state clearance, reducing the risk of hypotension compared to intermittent hemodialysis, making it the best choice.

Choice D reason: Plasmapheresis removes plasma components, not fluid or electrolytes like potassium, and is used for conditions like autoimmune disorders, not acute renal failure. It does not address hypervolemia or hyperkalemia and can cause hemodynamic instability due to rapid plasma exchange, making it inappropriate for this patient’s needs.