The nurse in the emergency department receives report on 4 clients. Which client should be seen first?

Question

Quizplus · Accepted Answer

Heatstroke occurs when excessive environmental heat exposure and/or overexertion (eg, athletics) cause hyperthermia and depletion of fluid and electrolytes (sweating, increased respirations), specifically sodium. Eventually, hypothalamic thermoregulation fails and sweat production stops, causing a rapid elevation of core temperature. Symptoms include: Temperature ≥104 F (40 C) Hot, dry skin Hemodynamic instability (tachycardia, hypotension) Altered mental status/neurological symptoms (confusion, lethargy, coma) Risk for permanent neurological injury or death from heatstroke is related directly to the degree and duration of hyperthermia. Treatment involves stabilization of ABCs and rapid cooling interventions (eg, cool water immersion, cool IV fluid infusion). Antipyretics are ineffective as hyperthermia is unrelated to the inflammatory process (infection). (Option A) Epinephrine auto-injectors (eg, EpiPen) for emergency treatment of allergic reactions can be accidentally injected, potentially causing adverse effects related to adrenergic activation (eg, tachycardia and hypertension). This client requires monitoring and supportive care (eg, antihypertensive medications). (Option B) A child with vaginal lacerations requires evaluation for possible sexual abuse (ie, physical examination, evidence collection, mandatory reporting). This client needs treatment but is not the priority. (Option C) An abscess requires treatment with antibiotics and, possibly, surgical intervention. However, this client is presently stable and not the priority. Educational objective: Heatstroke is a medical emergency characterized by a body temperature ≥104 F (40 C); hot, dry skin; tachycardia and hypotension; altered mental status; and neurological dysfunction. Clients require rapid cooling interventions to decrease the risk of permanent neurological injury or death.

The Nurse in the Emergency Department Receives Report on 4