The nurse is caring for a patient who has suffered a significant burn and notes that a transfusion is ordered.
Which blood product is most likely to be ordered for this patient?

Choice A rationale

Iron is a crucial component of hemoglobin and is essential for erythropoiesis. However, a significant burn injury primarily causes massive fluid shifts and plasma loss from the intravascular space into the interstitial spaces, leading to hypovolemia and hemoconcentration. Iron supplementation would not address the immediate, life-threatening fluid and protein depletion that characterizes the initial phase of a major burn.

Choice B rationale

PRBCs, or packed red blood cells, are used to restore oxygen-carrying capacity in the event of significant blood loss or anemia. While a burn patient may eventually become anemic, the immediate and most critical need following a major burn is the replacement of lost plasma volume and proteins, which is not effectively addressed by PRBCs alone.

Choice C rationale

A severe burn causes a substantial loss of plasma proteins, including albumin, globulins, and clotting factors, from the circulation due to increased capillary permeability. Fresh frozen plasma (FFP) is rich in these proteins and clotting factors, making it the most appropriate choice to restore intravascular volume, oncotic pressure, and hemostasis, thereby combating hypovolemic shock.

Choice D rationale

Albumin is a major plasma protein and is effective for increasing oncotic pressure and drawing fluid back into the vasculature. However, fresh frozen plasma (FFP) is a more comprehensive choice as it contains albumin along with other essential plasma proteins, coagulation factors, and immunoglobulins, which are all depleted following a severe burn injury

Choice A rationale

Increasing tidal volume would further exacerbate the respiratory alkalosis. Tidal volume, the amount of air moved into and out of the lungs with each breath, directly influences the partial pressure of carbon dioxide ($PaCO_2$). Increasing it would remove more $CO_2$, causing the pH to rise further from the normal range of 7.35-7.45 and $PaCO_2$ to fall below the normal range of 35-45 mmHg. This action is contraindicated as the patient is already alkalotic.

Choice B rationale

Increasing the fraction of inspired oxygen ($FIO_2$) is unnecessary and potentially harmful. The patient's $PaO_2$ is 80 mmHg, which is within the normal range of 80-100 mmHg. Therefore, the patient is not hypoxemic. Increasing oxygen delivery in a patient with COPD can suppress the hypoxic drive to breathe, which is a significant risk for respiratory depression and increased $PaCO_2$ levels. This action would not correct the underlying respiratory alkalosis.

Choice C rationale

Leaving the ventilator at the current settings would be inappropriate because the patient is in respiratory alkalosis. The blood gas results show a pH of 7.50, which is elevated, and a $PaCO_2$ of 29 mmHg, which is low. This indicates that the ventilator settings are causing the patient to hyperventilate and eliminate too much carbon dioxide. Adjustments are necessary to normalize the blood gas parameters and prevent further complications.

Choice D rationale

Decreasing the respiratory rate would be the most appropriate intervention. The patient's blood gas results show respiratory alkalosis (pH 7.50, $PaCO_2$ 29 mmHg), which is caused by the patient breathing too fast and "blowing off" too much $CO_2$. Reducing the respiratory rate will allow $CO_2$ to accumulate, raising the $PaCO_2$ and lowering the pH back toward the normal range (pH 7.35-7.45; $PaCO_2$ 35-45 mmHg). *.