A patient with late-stage cirrhosis develops portal hypertension. All of the following are potential complications that can develop from this condition. Select all that apply.

Choice A reason: Carbon monoxide poisoning occurs when carbon monoxide binds to hemoglobin, preventing oxygen from binding and leading to hypoxia. Symptoms include headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion. However, a hoarse voice and a brassy cough are not typical symptoms of carbon monoxide poisoning. These symptoms are more indicative of an inhalation injury due to direct thermal or chemical damage to the airway.

Choice B reason: Pulmonary edema refers to fluid accumulation in the lungs, which can cause difficulty breathing, a feeling of suffocating or drowning, and a cough that produces frothy sputum. Although pulmonary edema can occur after significant burn injuries due to fluid resuscitation or other complications, the specific symptoms of a hoarse voice and brassy cough are more suggestive of an inhalation injury than pulmonary edema.

Choice C reason: An inhalation injury is

The correct answer. This type of injury occurs when a patient inhales smoke, hot gases, or toxic chemicals during a fire. Symptoms can include a hoarse voice, brassy cough, stridor, and respiratory distress. The hoarseness and brassy cough are classic signs of damage to the upper airway due to the inhalation of hot gases or smoke, leading to swelling and irritation of the airway tissues.

Choice D reason: Bacterial pneumonia is an infection of the lungs that can cause symptoms such as fever, chills, cough with phlegm, shortness of breath, and chest pain. While pneumonia can develop as a secondary complication in burn patients, the immediate symptoms of a hoarse voice and brassy cough are more indicative of an inhalation injury rather than bacterial pneumonia.

Choice A reason: Providing at least 5000 kcal/day is essential for a patient with burn injuries. Burns significantly increase the body's metabolic rate and caloric needs to support the healing process and prevent catabolism. Ensuring an adequate caloric intake helps meet the energy demands required for tissue repair and recovery.

Choice B reason: Starting an oral diet on the first day may not be appropriate for all burn patients, particularly those with extensive burns or those who are not yet stable. Nutrition needs should be carefully assessed, and feeding may begin via alternative methods such as enteral nutrition until the patient is ready for oral intake.

Choice C reason: Administering a diet high in protein is crucial for burn patients, as protein is essential for wound healing, maintaining lean body mass, and supporting the immune system. Protein intake should be increased to help repair damaged tissues and promote recovery.

Choice D reason: Collaborating with a registered dietitian is important to create an individualized nutrition plan that meets the specific needs of the burn patient. A dietitian can provide expertise in calculating caloric and protein requirements, recommending appropriate supplements, and monitoring the patient's nutritional status.

Choice E reason: Offering frequent high-calorie snacks helps ensure that the patient meets their increased caloric needs. Small, frequent meals and snacks can be more manageable for patients with reduced appetite or those who have difficulty consuming large meals. High-calorie snacks provide additional energy to support healing and recovery.