A client with end-stage cirrhosis and hepatic encephalopathy becomes increasingly confused and drowsy.
Which intervention should the nurse implement to reduce ammonia levels?

The scenario requires applying principles of wound management, pain control, and infection prevention for thermal burns. Knowledge of tissue integrity, pharmacological intervention, and sterile surgical asepsis is necessary to prevent complications like syndactyly, infection, and severe pain during treatment.

Choice A rationale

Placing gauze between digits prevents skin surfaces from touching during healing. This essential intervention stops webbing or contractures, known as syndactyly, by maintaining anatomical separation of the fingers while absorbing exudate from the injured thermal burn sites.

Choice B rationale

Topical lotions containing vitamin E are inappropriate for acute thermal burns. Lotions can trap heat or introduce contaminants into open wounds. Specialized antimicrobial agents are required instead of over the counter moisturizers to ensure proper healing and safety.

Choice C rationale

Silver sulfadiazine is a broad spectrum topical antimicrobial used to prevent and treat wound sepsis in second and third degree burns. It effectively penetrates the eschar to reduce bacterial colonization, which is critical for successful skin regeneration.

Choice D rationale

Intact blisters serve as a natural sterile barrier against environment pathogens. Piercing or debriding small blisters increases the risk of infection and tissue trauma. Blisters should remain intact unless they interfere with joint movement or are significantly large.

Choice E rationale

Burn care and debridement are excruciatingly painful procedures. Administering systemic analgesics like morphine sulfate prior to care ensures the client reaches a therapeutic peak, which facilitates cooperation, reduces physiological stress, and manages severe pain during dressing changes.

Choice F rationale

Thermal burns destroy the primary skin barrier, leaving the client highly susceptible to healthcare associated infections. Strict sterile technique during wound care and dressing changes is mandatory to prevent sepsis and promote uncomplicated healing of the damaged tissues.

End of life communication requires applying principles of therapeutic honesty and empathy. Knowledge of palliative care communication involves providing clear, realistic information about the prognosis while offering emotional support and ensuring the family understands the focus on comfort and dignity.

Choice A rationale

Offering false hope through vague mentions of medical advances is non-therapeutic. It prevents the family from beginning the grieving process and making necessary end of life decisions. Honesty is essential for maintaining trust between the nurse and the family.

Choice B rationale

This response is dismissive and minimizes the partner's distress. While well intentioned, it provides unsolicited advice rather than addressing the actual question about prognosis. It fails to acknowledge the clinical reality of terminal brain cancer and impending loss.

Choice C rationale

Using platitudes or religious generalizations is insensitive and non-therapeutic. It shuts down further communication and may offend the partner. The nurse should avoid imposing philosophical beliefs and instead focus on the patient's actual clinical status and comfort.

Choice D rationale

This response is honest, direct, and compassionate. It acknowledges the terminal nature of the illness while redirecting the focus to the goals of care, which are comfort and symptom management. It supports the family through realistic expectations.