A patient comes to the emergency department with circumferential burn. On duty nurse should assess for complication of?

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

A circumferential burn is one that wraps completely around a body part, creating a tourniquet-like effect as tissue swells.
If the burn is on the neck or face, swelling can lead to life-threatening airway obstruction.
If the burn is on the chest, the tight, inelastic eschar can restrict chest wall movement, causing poor respiratory effort and failure.
If the burn is on a limb, it can compress blood vessels, leading to compartment syndrome and the loss of peripheral pulses.
Because the question does not specify the location of the burn, the nurse must assess for all these potential complications, making 'All of the above' the most complete and correct answer.

Option A: This is a critical complication, but it is not the only one. Limiting the assessment to only airway obstruction would miss other life-threatening issues if the burn were on the chest or a limb.
Option B: This is a major risk, but it is specific to circumferential burns of the torso. It is not the only possible complication.
Option C: This is a severe complication indicating compartment syndrome, but it is specific to limb burns. The nurse must also consider respiratory complications.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Assessment of complications in circumferential burns in acute care settings.
The nursing priority for a patient with a circumferential burn is a rapid primary survey (ABCDE: Airway, Breathing, Circulation, Disability, Exposure).
Nurses must report signs of compromise immediately (e.g., stridor, decreased oxygen saturation, absent pulses via Doppler). This is critical because the patient may need an emergency escharotomy (a surgical incision through the eschar) to relieve pressure and restore breathing or circulation.
All jewelry and constricting clothing must be removed immediately from a circumferentially burned limb to prevent further constriction as swelling progresses.

How to Approach the Question

First, identify the key term in the question: 'circumferential burn'.
Recall the pathophysiology: a burn that encircles a body part acts like a tourniquet, restricting what's inside.
Think systematically about how this tourniquet effect would impact different body parts based on the ABCs (Airway, Breathing, Circulation).
Consider the neck: a burn here would compress the airway, leading to obstruction.
Consider the chest: a burn here would restrict the chest wall, leading to poor respiratory effort.
Consider a limb: a burn here would compress blood vessels, leading to an absent pulse.

Concept Tested & Keywords

Concept Tested: Assessment of complications in circumferential burns
Stem keywords: circumferential burn, emergency department, complication
Lead-in keywords: assess for
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 691-693, 697-699, 616-618

Practise the full NORCET 3 - 2022 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.