3. A client is admitted to the emergency department with a full thickness burn to the right arm. Upon assessment, the arm is edematous, fingers are mottled, and radial pulse is now absent. The client states that the pain is 8 on a scale of 1 to 10. The nurse should: a. Administer morphine sulfate Iv push for the severe pain b. Call the healthcare provider (HCP) to report the loss of the radial pulse-quiz c. Continue to assess the arm every hour for an additional change d. Instruct the client to exercise the fingers and wrist.
Question
- A client is admitted to the emergency department with a full
thickness burn to the right arm. Upon assessment, the arm is
edematous, fingers are mottled, and radial pulse is now absent. The
client states that the pain is 8 on a scale of 1 to 10. The nurse
should:
a.
Administer morphine sulfate Iv push for the severe pain
b. Call the healthcare provider (HCP) to report the loss of the
radial pulse-quiz
c. Continue to assess the arm every hour for an additional change
d. Instruct the client to exercise the fingers and wrist.
Solution
The nurse should choose option b. Call the healthcare provider (HCP) to report the loss of the radial pulse. The loss of a radial pulse in this context could indicate compromised circulation to the arm, which is a medical emergency. While pain management is important, it is secondary to ensuring adequate blood flow to the affected limb. Regular assessment (option c) is part of ongoing care, but immediate action is required in this situation. Exercising the fingers and wrist (option d) could potentially exacerbate the problem if there is indeed a circulatory issue.
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