A client with spinal cord injury is ready to be discharged home. What are the potential complications that should be monitored for in this client?

A. hypokalemia, hypernatremia, and hypoalbuminemia: Hypokalemia and hypernatremia are not expected early findings after a major burn. Potassium initially rises due to massive cell destruction, and sodium commonly falls because of fluid shifts into the interstitial space, making this pattern inconsistent with the emergent phase.

B. hyperkalemia, hypernatremia, and hyperalbuminemia: Although hyperkalemia is expected, hypernatremia is unlikely because sodium shifts into the tissues with extensive edema. Albumin levels usually fall due to increased capillary permeability and plasma protein loss, so hyperalbuminemia would not be seen.

C. hyperkalemia, hyponatremia, and metabolic alkalosis: The potassium and sodium patterns fit early burn physiology, but metabolic alkalosis does not. Massive fluid loss, hypoperfusion, and lactic acid accumulation commonly produce metabolic acidosis rather than alkalosis during the emergent period.

D. hyperkalemia, hyponatremia, and metabolic acidosis: This combination reflects typical early burn responses. Potassium rises from cellular lysis, sodium falls due to third spacing, and acidosis develops from tissue hypoxia and anaerobic metabolism.

A. preventing hypertension: While managing blood pressure is important in heart failure, the immediate concern with elevated BUN and creatinine is renal perfusion, not hypertension. Blood pressure control alone does not correct the underlying cause of kidney injury.

B. diluting nephrotoxic substances: Dilution may reduce risk from nephrotoxins, but in heart failure, fluid overload is a concern. This approach does not address the primary issue of reduced renal perfusion caused by low cardiac output.

C. replacing fluid volume: Fluid replacement in severe heart failure could worsen pulmonary edema and increase cardiac workload. The problem is not fluid deficit but inadequate perfusion to the kidneys due to poor cardiac output.

D. maintaining adequate cardiac output: Elevated BUN and creatinine in heart failure indicate reduced renal perfusion. Ensuring adequate cardiac output improves blood flow to the kidneys, supporting filtration and preventing further renal injury. This is the priority goal in care planning.