A client who has sustained a burn injury is at risk for developing contractures. Which clinical finding would indicate to the nurse that contractures are developing?

Rationale:

A. Folate-deficiency anemia arises from insufficient folate (vitamin B9), which is necessary for DNA synthesis and red blood cell production. While inadequate folate intake can contribute, this type of anemia is more often associated with malabsorption syndromes, alcoholism, certain medications (like methotrexate), or increased requirements during pregnancy, rather than general poor nutrition in the population at large.

B. Sickle cell anemia is a hereditary disorder caused by a mutation in the beta-globin gene, producing hemoglobin S. This mutation causes red blood cells to become rigid and sickle-shaped, leading to hemolysis and vascular occlusion. Nutritional deficiencies do not cause sickle cell anemia, though adequate nutrition can help manage complications.

C. Pernicious anemia is caused by a vitamin B12 deficiency due to lack of intrinsic factor, a protein produced by gastric parietal cells that is required for B12 absorption. While dietary B12 intake can influence this condition, the primary defect is impaired absorption, not dietary insufficiency.

D. Iron-deficiency anemia is the most common nutritional anemia worldwide, resulting from inadequate iron intake, chronic blood loss (e.g., menstruation, gastrointestinal bleeding), or increased requirements (such as during pregnancy or growth spurts). Iron is a critical component of hemoglobin, the protein in red blood cells responsible for oxygen transport. Without sufficient iron, the body produces small (microcytic), pale (hypochromic) red blood cells, which cannot carry oxygen efficiently. This leads to hallmark symptoms such as fatigue, pallor, shortness of breath, dizziness, and decreased exercise tolerance. Iron-deficiency anemia is directly linked to dietary insufficiency and can be prevented or treated with iron-rich foods (e.g., red meat, leafy greens, legumes) and iron supplementation when necessary.

Rationale:

A. Anemia results in reduced oxygen-carrying capacity of the blood due to low red blood cell or hemoglobin levels. This can cause cerebral hypoxia, leading to dizziness, lightheadedness, or even fainting.

B. Fatigue is a hallmark symptom of anemia because tissues receive less oxygen, impairing cellular metabolism and energy production. Clients often report generalized weakness and decreased exercise tolerance.

C. To compensate for decreased oxygen delivery, the body increases respiratory rate, resulting in dyspnea or shortness of breath, particularly during exertion.

D. Anemia typically causes tachycardia as the cardiovascular system attempts to maintain oxygen delivery to tissues. A decreased heart rate is not a typical sign of anemia.

E. Anemia generally leads to pallor, especially of the skin, mucous membranes, and nail beds, rather than redness (erythema). Pallor occurs due to reduced hemoglobin and decreased perfusion.