RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Medical & Surgical Nursing
Medium
The most effective route of relieving pain during the emergency phase of burn injury is?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Explanation
- In the emergency phase of a burn, the body goes into shock, causing poor blood flow to peripheral tissues like skin and muscle.
- The intravenous (IV) route delivers medication directly into the bloodstream, bypassing the compromised tissues and ensuring the drug works quickly and reliably.
- This route allows for 100% bioavailability and rapid onset of action, which is critical for managing severe pain in an emergency.
- IV administration allows nurses to carefully adjust (titrate) the dose of pain medication to achieve effective pain control while monitoring for side effects like respiratory depression.
Why Other Options Were Wrong
- Option B: Absorption from the subcutaneous (fatty) tissue is slow, erratic, and unpredictable during burn shock due to massive fluid shifts (edema) and poor circulation.
- Option C: Similar to the subcutaneous route, intramuscular absorption is unreliable because of reduced blood flow to the muscles during shock. There's also a risk of a delayed overdose when circulation is restored and the pooled medication is suddenly absorbed.
- Option D: The oral route has a slow onset of action and variable absorption. In the emergency phase of a burn, patients are often unable to take medications by mouth due to the risk of paralytic ileus (a paralyzed gut), nausea, or the need to be kept NPO (nothing by mouth) for surgery.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacokinetics and Pain Management in Burn Injuries in acute care settings.
- In burn care, securing reliable IV access is a top priority for fluid resuscitation and medication administration.
- Nurses must continuously monitor vital signs, especially respiratory rate and oxygen saturation, when administering IV opioids like morphine or fentanyl, as they can cause respiratory depression.
- Always have the opioid-reversal agent, naloxone, readily available when titrating IV opioids for severe pain.
How to Approach the Question
- First, identify the critical context of the question: 'emergency phase of burn injury'.
- Recall the key pathophysiology of this phase, which is 'burn shock'. This involves massive fluid shifts, edema, and poor peripheral perfusion.
- Evaluate each administration route in the context of burn shock.
- Intravenous (IV) route: Bypasses absorption issues, delivering the drug directly to the central circulation. This is ideal in shock states.
- Subcutaneous (SC) and Intramuscular (IM) routes: Rely on absorption from peripheral tissues, which is severely compromised by poor blood flow and edema. This makes them unreliable.
- Oral route: Relies on GI absorption, which is slow and often impaired due to the risk of paralytic ileus in critically ill patients.
Concept Tested & Keywords
- Concept Tested: Pharmacokinetics and Pain Management in Burn Injuries
- Stem keywords: burn injury, emergency phase, pain relief, route
- Lead-in keywords: most effective
- Clinical cues: emergency phase of burn injury
- Negative lead-in flag: false
Question ID
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Reference Book
E6 Pharmacology Nurses Shanbhag 3e p. 14-16
E6 Pharmacology Nursing Lilley 11e Part 1 p. 41-43
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7983-7985
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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