While caring for a client with a full thickness burn covering 40% of the body, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should review which of the client's laboratory values?
Hematocrit.
Blood pH level.
Platelet count.
White blood cell (WBC) count.
The Correct Answer is D
A. While hematocrit levels provide information about blood volume status, they are not directly relevant to infection status or wound healing in burn patients.
B. Blood pH levels can indicate acid-base imbalances, but they do not specifically inform the nurse about the presence of infection.
C. Platelet count is important for assessing coagulation and bleeding risks, but it does not provide direct information regarding infection.
D. White blood cell (WBC) count is critical in assessing for infection, as an elevated WBC count can indicate the presence of an infection, particularly in a client with significant burns who is at increased risk for sepsis.
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Correct Answer is B
Explanation
A. While having the client sign permits is important, it is not the priority action in this situation.
B. Notifying the healthcare provider about the client's current heparin therapy is critical, as it may influence the timing of surgery and the risk of excessive bleeding during and after the procedure.
C. While explaining the potential for bleeding is important, it should occur after ensuring the surgical team is aware of the heparin use.
D. Observing injection sites for bruising is relevant but does not address the immediate concern regarding heparin use and potential bleeding during surgery.
Correct Answer is D
Explanation
A. While obtaining a keyboard designed to limit wrist flexion may be beneficial for ergonomics, it does not specifically address the symptoms or management of Raynaud's syndrome.
B. Taking a multivitamin with vitamin D may not have a direct impact on Raynaud's syndrome and is generally unrelated to the specific concerns of this condition.
C. Keeping hands elevated during breaks does not effectively address the primary concern of temperature regulation that affects Raynaud's syndrome.
D. Using a space heater is a practical measure that can help keep the workspace warm, thereby reducing the likelihood of Raynaud's attacks, which are triggered by cold temperatures and stress.