A nurse in the infectious disease division of the local health department is caring for a client. Which of the following infections should the nurse identify should be reported to the health department?

Rationale for correct choices:

• Skin feels cool to the touch: Cool skin indicates poor peripheral perfusion, which can signal early hypovolemic shock in a child with burns. Prompt assessment and interventions, such as fluid resuscitation, are necessary.
• Capillary refill 3 seconds in left foot: Delayed capillary refill reflects compromised circulation and decreased tissue perfusion. Early recognition and intervention help prevent progression to shock.
• Blood pressure 102/50 mm Hg: Mild hypotension combined with tachycardia, cool skin, and delayed capillary refill suggests early hypovolemic shock, a life-threatening complication requiring immediate attention.
• Temperature 35.8° C (96.4° F): Hypothermia can occur due to heat loss from burn injuries, increasing the risk for coagulopathy, impaired wound healing, and further hemodynamic instability.
• Output of 25 mL dark amber urine through catheter: Low and concentrated urine output indicates possible dehydration or reduced renal perfusion, which can progress to acute kidney injury if not addressed urgently.

Rationale for incorrect choices:

• Respiratory rate 20/min: Although slightly decreased from admission, this is within a near-normal range for an 8-year-old and not immediately concerning. Continuous monitoring is appropriate, but it is not an urgent priority compared with perfusion and hemodynamic indicators.
• Dressing on left hand shows small amount of moisture through gauze: Minor moisture in the dressing may reflect mild wound exudate, which requires routine monitoring and dressing changes. It does not indicate an immediate life-threatening risk.

Rationale:

A. Weight loss: Furosemide is a loop diuretic that promotes excretion of excess fluid through urine. A reduction in body weight reflects fluid loss and indicates that the medication is effectively managing fluid volume excess.

B. Decreased inflammation: Furosemide does not have anti-inflammatory properties. While it may reduce edema associated with fluid overload, it does not directly affect inflammatory processes in tissues.

C. Decreased pain: Pain reduction is not a direct effect of furosemide. Any perceived relief might occur secondarily if edema-related pressure is relieved, but it is not a primary measure of medication effectiveness.

D. Increased blood pressure: Furosemide typically lowers blood pressure by reducing intravascular volume. An increase in blood pressure would suggest that fluid overload is not being adequately managed or that another condition is influencing blood pressure.