A patient with full-thickness burns over 40 Which complication is vital for the nurse to anticipate and monitor?

Choice A rationale While electrolyte imbalances occur in burn victims, hyperkalemia is actually more common in the acute phase due to massive cell lysis and the release of intracellular potassium into the extracellular space. Hypokalemia might occur later during the diuretic phase or due to gastrointestinal losses. The normal serum potassium range is 3.5 to 5.0 mEq/L. Monitoring potassium is vital, but the immediate threat to metabolic stability in a large surface area burn is the loss of thermoregulation rather than a decrease in potassium. Choice B rationale The skin is the primary organ for thermoregulation. With 40 percent full thickness burns, the client loses the ability to prevent evaporative heat loss and maintain a stable core temperature. Hypothermia can lead to coagulopathy, cardiac arrhythmias, and impaired wound healing. The nurse must anticipate this because the loss of the epidermal barrier and the administration of large volumes of room temperature fluids significantly increase the risk. Maintaining a warm environment and using warmed fluids are standard burn protocols. Choice C rationale Hypoglycemia is not a typical primary complication of acute burn injury. In fact, the stress response associated with major burns often leads to the release of catecholamines and cortisol, which cause hyperglycemia through increased gluconeogenesis and glycogenolysis. While metabolic demands are extremely high and nutritional support is eventually needed, the immediate physiological threat is not a drop in blood glucose. Normal fasting blood glucose ranges from 70 to 100 mg/dL, but burn patients often require insulin for stress induced elevations. Choice D rationale Hypertension is unlikely in the early stages of a 40 percent burn. The more significant risk is burn shock, which is characterized by hypotension due to massive fluid shifts from the intravascular space to the interstitial space. This capillary leak results in decreased cardiac output and low blood pressure. Monitoring for hypotension and signs of poor organ perfusion is a priority during fluid resuscitation. Hypertension would be an unusual finding unless the client had pre-existing cardiovascular disease.