The nurse assesses a patient who experienced a spinal cord injury at the T5 level 24 hours ago. Assessment findings are:
Temp: 99.0°F
HR: 46 beats/min
BP: 78/52 mmHg
RR: 20 breaths/min
SaO2: 94% on 2L NC
Which of the following interventions should the nurse anticipate?

Choice A reason: The electrician who suffered external burn injuries a month ago is stable enough to be concerned with discharge plans. This indicates that his burns have been managed and he is in a phase of recovery where he is preparing for discharge. Although his request is important, it is not an immediate priority compared to more acute conditions.

Choice B reason: The older adult client admitted yesterday with partial- and full-thickness burns over 40% of the body is in a critical condition and needs continuous monitoring, especially with high fluid administration. However, their condition is currently being managed with IV fluids. While this client requires close observation, there is no immediate indication of a life-threatening change that demands immediate intervention compared to the firefighter's situation.

Choice C reason: The adult client admitted a week ago with deep partial-thickness burns over 35% of the body who is reporting pain is also in need of pain management and ongoing care. However, pain, while significant and requiring treatment, does not take precedence over the potential airway compromise and respiratory distress posed by smoke inhalation and facial burns in the firefighter.

Choice D reason: The firefighter with smoke inhalation and facial burns who has just arrived on the unit must be assessed first due to the immediate risk of airway compromise and respiratory distress. Smoke inhalation can lead to rapid swelling of the airways, making it a critical emergency. Facial burns also increase the risk of airway obstruction. Prompt assessment and intervention are essential to ensure the firefighter's airway remains patent and to provide necessary respiratory support.

Choice A reason: Instructing the client to exercise the fingers and wrist is not the immediate priority. While maintaining mobility is important in burn care, the absence of a radial pulse indicates a potential vascular compromise that needs urgent attention.

Choice B reason: Calling the healthcare provider to report the loss of the radial pulse is the correct and immediate action. The absence of a radial pulse suggests that the edema is causing compartment syndrome, which can lead to tissue ischemia and necrosis if not promptly treated. This is a medical emergency requiring immediate intervention, possibly including a fasciotomy to relieve pressure.

Choice C reason: Continuing to assess the arm every hour for additional changes is important, but it is not the immediate priority. The absence of a radial pulse indicates a critical issue that needs immediate reporting and intervention, rather than waiting for further changes.

Choice D reason: Administering morphine IV can help manage the client's pain, which is significant at 8/10. However, it does not address the underlying issue of the absent radial pulse and potential compartment syndrome. Pain management is important but secondary to resolving the vascular compromise.