A patient with facial burns suddenly becomes restless with stridor. What is the nurse's priority action?
Explanation & Rationale
A. Administer IV morphine: Restlessness and stridor in a patient with facial burns strongly suggest impending airway obstruction due to edema or inhalation injury. Administering morphine may further depress respiratory drive and mask worsening airway compromise. Pain control is important but does not address the immediate threat of airway occlusion. B. Call for stat airway support: Stridor indicates upper airway narrowing, and in the setting of facial burns, progressive edema can rapidly lead to complete airway obstruction. Early airway intervention, including preparation for endotracheal intubation, is critical before swelling makes intubation difficult or impossible. Securing the airway is the highest priority in burn management C. Elevate the HOB: Elevating the head of the bed may help reduce facial edema and promote ventilation, but it is a supportive measure rather than a definitive intervention. It does not prevent rapid airway closure caused by burn-related swelling. Immediate airway management takes precedence. D. Obtain ABG: Arterial blood gas analysis provides information about oxygenation and ventilation but does not treat airway compromise. Waiting for ABG results could delay lifesaving airway intervention. Clinical signs such as stridor and restlessness warrant immediate action to secure the airway.