Following an explosion at a local chemical lab, several people have sustained burns and are now in the triage area.

Which patient should be attended to first?

Choice A rationale
The Trendelenburg position, which involves laying the patient flat on their back with their legs elevated higher than their head, is not recommended for patients with septic shock. This position can increase intracranial pressure and does not improve circulation or oxygenation.
Choice B rationale
Changing the patient’s position slowly is important in managing an elderly patient with septic shock. Rapid changes in position can cause a drop in blood pressure (orthostatic hypotension), which can lead to falls or decreased perfusion to vital organs.
Choice C rationale
Reducing the oxygen flow is not recommended for patients with septic shock. These patients often have difficulty with oxygenation and may require supplemental oxygen to maintain adequate oxygen levels.
Choice D rationale
Increasing the IV fluid flow is part of the initial management of septic shock to restore perfusion, but it should be done based on careful assessment and monitoring of the patient’s response to fluids. Overzealous fluid resuscitation can lead to fluid overload and complications such as pulmonary edema.

Choice A rationale
Sorbitol is a type of sugar alcohol used as a sweetener in many diet foods. It is also used in certain medications as a laxative to relieve constipation. However, it is not typically associated with liver failure and would not likely be questioned by the nurse in this context.
Choice B rationale
Lactulose is a type of sugar that is broken down in the large intestine into mild acids that draw water into the intestine, which then helps soften the stools. It is often used to treat constipation and is also used to reduce high blood ammonia levels in patients with liver disease. It would not typically be questioned by the nurse for a patient with chronic liver failure.
Choice C rationale
Neomycin is an antibiotic that is used to reduce the amount of ammonia produced by bacteria in the intestines. High levels of ammonia can cause hepatic encephalopathy, a serious complication of liver disease. Therefore, neomycin can be beneficial for patients with chronic liver failure and would not likely be questioned by the nurse.
Choice D rationale
Acetaminophen, also known as paracetamol, is a common over-the-counter medication used to relieve pain and reduce fever. However, high doses or long-term use of acetaminophen can cause liver damage. In fact, acetaminophen overdose is a common cause of acute liver failure. Therefore, the nurse should question an order for acetaminophen for a patient with chronic liver failure.