Which of the following types of hepatitis are transmitted primarily by the fecal-oral route? Select all that apply.

Chemical burns from industrial solvents require immediate intervention to prevent ongoing tissue damage caused by continued chemical reaction with the skin. Unlike thermal burns, chemical agents may continue to destroy tissue until they are adequately removed or diluted. Emergency management focuses on rapid decontamination to limit depth of injury and systemic absorption of the chemical. Prompt irrigation is the most critical first action in reducing further harm.

Rationale:
A. Initiating running water irrigation of the affected area is the priority intervention because it rapidly dilutes and removes the chemical agent from the skin. Continuous flushing helps stop the ongoing tissue destruction caused by the industrial solvent. Early decontamination significantly reduces burn depth, systemic absorption, and long-term complications.

B. Administering liberal oral fluids may be important later for hydration support, but it does not address the immediate chemical injury. The primary concern in chemical burns is stopping ongoing tissue damage at the site of exposure. Fluid administration becomes secondary after decontamination and stabilization of the burn area.

C. Covering the burn with a sterile dressing immediately is not the priority because it may trap the chemical agent against the skin. This can prolong exposure and worsen tissue damage if decontamination has not been completed. Dressing application is only appropriate after thorough irrigation and removal of the chemical substance.

D. Performing a pain assessment and administering analgesics is important in burn management but is not the first priority in chemical burns. Ongoing tissue destruction must be stopped before focusing on comfort measures. Analgesia is provided after initial decontamination to ensure the underlying cause of pain has been addressed.

Management of acute angina with sublingual Nitroglycerin requires prompt action to restore myocardial oxygen balance and prevent progression to myocardial infarction. Nitroglycerin works by causing vasodilation, which decreases cardiac workload and improves coronary blood flow. Standard teaching includes stopping activity, resting, and taking one tablet at the onset of chest pain. If pain persists after the first dose, emergency intervention and additional doses must follow a specific safe sequence.

Rationale:
A. Continuing normal activity is inappropriate because physical exertion increases myocardial oxygen demand and can worsen ischemia. The client should immediately stop activity and rest in a sitting or lying position to reduce cardiac workload. Rest enhances the effect of nitroglycerin and helps prevent worsening chest pain or progression to infarction.

B. Calling for emergency medical assistance before taking the second tablet is correct because persistent chest pain after the first dose may indicate unstable angina or myocardial infarction. Emergency services should be contacted after 5 minutes if pain is not relieved. Prompt medical evaluation is critical since delayed treatment increases the risk of permanent myocardial damage.

C. Taking two more tablets at the same time is unsafe and not recommended. Nitroglycerin should be administered one tablet every 5 minutes, up to a maximum of three doses. Taking multiple tablets simultaneously increases the risk of severe hypotension, dizziness, and syncope without improving safety or effectiveness.

D. Stopping all medications is incorrect and potentially dangerous. The client should continue prescribed cardiovascular medications unless specifically instructed otherwise by the provider. Abrupt discontinuation of drugs such as beta blockers, antiplatelets, or antihypertensives can worsen cardiac instability and increase the risk of complications.

E. Taking a third sublingual tablet after another 5 minutes is correct if chest pain persists after the second dose. The standard protocol allows one tablet every 5 minutes for a total of three doses while awaiting emergency help. Continued pain after the third dose strongly suggests a serious cardiac event requiring immediate advanced treatment.