When there is necrosis of the tissue due to burn injury, the patient is at risk of developing \ \ \ \ \ \ . - RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

Medical & Surgical Nursing

Medium

Appeared in: RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

Explanation

Severe burn injuries cause extensive tissue necrosis, which is the death of body tissue.
Necrotic tissue releases large quantities of tissue factor (thromboplastin) into the systemic circulation.
Tissue factor is a potent activator of the extrinsic coagulation cascade, leading to widespread, uncontrolled clotting in small vessels throughout the body.
This pathological process is known as Disseminated Intravascular Coagulation (DIC), a life-threatening condition characterized by both thrombosis and subsequent hemorrhage.
The other options, thrombocytopenia and hemorrhage, are consequences of DIC, not the primary condition itself.

Option A: Neutropenia (low neutrophil count) is not a direct or immediate result of burn-related tissue necrosis. The initial response to a severe burn is inflammation, which typically causes leukocytosis (an increased white blood cell count), specifically neutrophilia (an increased neutrophil count).
Option C: Thrombocytopenia (low platelet count) is a hallmark sign of DIC, but it is not the primary disorder. It is a consequence of the widespread clotting that consumes platelets.
Option D: Haemorrhage (bleeding) is a clinical manifestation of the later, 'consumptive' phase of DIC. It occurs because all the clotting factors and platelets have been used up in forming microthrombi.

Visual 1: Flowchart - Illustrating the pathophysiology of DIC, starting from 'Severe Burn Injury' -> 'Tissue Necrosis' -> 'Release of Tissue Factor' -> 'Systemic Activation of Coagulation' -> 'Microthrombi Formation & Consumption of Clotting Factors/Platelets' -> 'Organ Ischemia & Bleeding (Hemorrhage)'.
Visual 2: Image - Showing the clinical signs of DIC, such as widespread petechiae (pinpoint red spots) and ecchymosis (bruising) on a patient's skin.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiological complications of severe burn injuries to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in monitoring patients with severe burns (especially those with greater than 20% total body surface area involvement) for the subtle onset of DIC.
Key nursing assessments include checking for oozing from IV sites, incisions, or mucous membranes, and monitoring for changes in vital signs, urine output, and mental status that could indicate organ hypoperfusion from microthrombi.
Early reporting of abnormal coagulation studies (e.g., rising D-dimer, falling fibrinogen) and clinical signs of bleeding or clotting is critical for patient survival.

How to Approach the Question

First, identify the key elements in the question: 'necrosis of the tissue' and 'burn injury'. This points to a complication arising from massive tissue damage.
Think about the systemic consequences of large-scale tissue destruction. When cells are destroyed, their contents are released into the bloodstream.
Recall that damaged tissue releases tissue factor (thromboplastin), a powerful initiator of the blood clotting cascade.
Evaluate the options in this context. Ask yourself which option represents a systemic, pathological process triggered by widespread coagulation.
Disseminated intravascular coagulation (DIC) is the syndrome defined by this exact mechanism.
Recognize that thrombocytopenia (low platelets) and hemorrhage (bleeding) are results or signs of DIC, not the primary disease process itself. Neutropenia is related to the immune system and is not the direct consequence.

Concept Tested & Keywords

Concept Tested: Pathophysiological complications of severe burn injuries.
Stem keywords: necrosis, burn injury, risk
Lead-in keywords: developing
Clinical cues: The presence of tissue necrosis is the key cue, pointing towards a process initiated by massive tissue damage.

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