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haileykopp haileykopp
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A month ago
The nurse would evaluate that slight hypothermia, increased blood glucose, and increased lactate levels would be expected findings in which clients? (Select all that apply.)
1. A 75-year-old man who had a massive myocardial infarction 16 hours ago
2. A 24-year-old woman who sustained full thickness burns over 30% of her body 12 hours ago
3. An 18-year-old man with a traumatic brain injury that occurred 5 hours ago and whose first Glasgow Coma Scale was 8
4. A 30-year-old who was just admitted with a severely infected abdominal wound
5.  A 56-year-old woman admitted a week ago with gastrointestinal bleeding
Textbook 

High-Acuity Nursing


Edition: 6th
Authors:
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ujesssssujesssss
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Posts: 479
A month ago
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More questions for this book are available here
The answer is 1, 4
Rationale:
1. During the first 24 hours after injury the individual's metabolic rate is likely to be unchanged or slightly decreased. This is evidenced by slight hypothermia, increased blood glucose, and increased lactate levels.
2. Clients with burns do not experience the same ebb phase response to physiologic stress as do others.
3. Clients with head injury and GCS levels of 8 or lower do not experience the same ebb response to physiologic stress as do others.
4. The ebb phase of physiologic stress is evidenced by slight hypothermia, increased blood glucose, and increased lactate levels for the first 24 hours.
5. This client is well beyond the typical 24-hour ebb phase of physiological stress that is commonly associated with slight hypothermia, increased blood glucose, and increased lactate levels.
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haileykopp Author
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A month ago
Thanks for your help!!
Mcb
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Yesterday
You make an excellent tutor!
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2 hours ago
Good timing, thanks!
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