This is an extra credit question: A nurse is caring for a client receiving hemodialysis.

Exhibits

A nurse is for a client who has received hemodialysis. Which of the following assessment findings require follow-up?

Choice A reason: Thick secretions blocking airways are characteristic of conditions like chronic obstructive pulmonary disease or pneumonia, not pulmonary embolism. In pulmonary embolism, a clot obstructs pulmonary arteries, reducing blood flow to alveoli, not airflow. This leads to ventilation-perfusion mismatch, causing hypoxemia despite adequate breathing, making this explanation incorrect.

Choice B reason: A pulmonary embolism blocks pulmonary arteries, reducing blood flow to certain lung regions despite normal ventilation. This creates a ventilation-perfusion mismatch, where alveoli are ventilated but not perfused, leading to hypoxemia and respiratory distress. This is the primary mechanism of pulmonary embolism, making it the correct explanation for the family.

Choice C reason: This option suggests adequate blood flow but inadequate air to alveoli, which describes conditions like airway obstruction or atelectasis, not pulmonary embolism. In pulmonary embolism, the issue is reduced blood flow due to arterial obstruction, not insufficient air reaching alveoli, as breathing remains adequate, making this incorrect.

Choice D reason: Thickened alveolar-capillary membranes, impairing oxygen diffusion, occur in conditions like pulmonary fibrosis or edema, not pulmonary embolism. In pulmonary embolism, the primary issue is vascular obstruction, not membrane thickness, leading to reduced perfusion and hypoxemia despite normal alveolar structure, rendering this explanation scientifically inaccurate.

Choice A reason: Infection is a significant risk in burns due to loss of the skin barrier, allowing pathogens like Pseudomonas to invade. However, in the acute phase, airway obstruction from head and neck burns is more immediately life-threatening. Infection control is critical but secondary to ensuring a patent airway in the ABCDE approach.

Choice B reason: Paralytic ileus can occur in burn patients due to stress response or hypokalemia, impairing gastrointestinal motility. While serious, it is not an immediate threat to life compared to airway obstruction. The ABCDE approach prioritizes airway, making ileus a lower priority in the acute management of head and neck burns.

Choice C reason: Extensive burns to the head, neck, and chest pose a high risk of airway obstruction due to edema from thermal injury to the upper airway. Swelling can rapidly compromise breathing, requiring urgent assessment and possible intubation. In the ABCDE approach, airway is the top priority, making this the critical focus.

Choice D reason: Fluid imbalance, particularly hypovolemia, is a major concern in burns due to plasma leakage. While critical, it is addressed after airway and breathing in the ABCDE approach. Airway obstruction from head and neck burns can cause rapid death, making it the priority over fluid resuscitation in the initial assessment.