A nurse is caring for a client who has a halo fixation device. Which of the following actions should the nurse include in the plan of care?

Choice A Reason:
Maintaining the cervical collar in place is crucial for a client with a spinal cord injury at the level of C3-4. This action prevents further damage to the spinal cord by immobilizing the neck and maintaining proper alignment. Any movement could exacerbate the injury, potentially leading to more severe neurological deficits or even paralysis.

Choice B Reason:
Asking the client if they remember any events around the time of the injury is not the priority in this situation. While obtaining a history is important, it should not take precedence over stabilizing the spinal cord to prevent further injury. The primary focus should be on ensuring the client's safety and preventing additional harm.

Choice C Reason:
Explaining to the client that they will never be able to walk again is inappropriate and premature. The prognosis for spinal cord injuries can vary widely, and it is essential to provide accurate information based on a thorough assessment and consultation with specialists. Additionally, delivering such news requires sensitivity and should be done in a supportive manner.

Choice D Reason:
Notifying the client's parents that they are in the ED is important for family communication and support. However, it is not the immediate priority. The primary focus should be on stabilizing the client's condition and preventing further injury. Once the client is stabilized, the nurse can then inform the family.

Choice A Reason:
0.9% sodium chloride is an isotonic crystalloid solution often used for fluid resuscitation. However, it is not the preferred choice for burn patients because it lacks the necessary electrolytes to replace those lost through burn injuries. While it can be used if Lactated Ringer's is unavailable, it does not provide the same balanced electrolyte composition.

Choice B Reason:
Lactated Ringer's is the preferred fluid for initial resuscitation in burn patients. It is an isotonic crystalloid solution that closely mimics the body's plasma, providing essential electrolytes such as sodium, potassium, calcium, and lactate. The lactate in the solution acts as a buffer, helping to correct metabolic acidosis, which is common in burn patients. The Parkland formula, widely used for calculating fluid needs in burn patients, specifically recommends Lactated Ringer's for the first 24 hours.

Choice C Reason:
Dextrose 5% in water is a hypotonic solution that provides free water and calories but lacks electrolytes. It is not suitable for initial fluid resuscitation in burn patients because it does not address the electrolyte imbalances and large fluid shifts that occur after a burn injury. Using this solution could lead to further complications such as hyponatremia.

Choice D Reason:
Dextrose 5% in 0.9% sodium chloride is a hypertonic solution that provides both glucose and electrolytes. However, it is not typically used for initial burn resuscitation because the high glucose content can lead to hyperglycemia, which is detrimental to burn patients. Additionally, the solution's osmolarity can exacerbate fluid shifts and worsen edema.