The patient with third degree burns to bilateral lower legs is undergoing hydrotherapy to debride eschar tissue from the wounds. Prior to the procedure, the patient received a bolus of intravenous morphine in addition to the continuous infusion for pain control. During the procedure, the patient’s level of consciousness decreases to only rousable by painful stimuli. The patient’s temperature is 36.4°C, respiratory rate is 14 breaths per minute, heart rate is 82 bpm, and oxygen saturation is 93% on room air. The nurse ends the hydrotherapy session and contacts the provider to request which intervention?

Question

The patient with third degree burns to bilateral lower legs is undergoing hydrotherapy to debride eschar tissue from the wounds. Prior to the procedure, the patient received a bolus of intravenous morphine in addition to the continuous infusion for pain control. During the procedure, the patient&rsquo;s level of consciousness decreases to only rousable by painful stimuli. The patient&rsquo;s temperature is 36.4&deg;C, respiratory rate is 14 breaths per minute, heart rate is 82 bpm, and oxygen saturation is 93% on room air. The nurse ends the hydrotherapy session and contacts the provider to request which intervention?

Accepted Answer

Obtain blood specimen for serum electrolyte panel. Hydrotherapy places the patient with open wounds at risk for severe hyponatremia, which can manifest as decreased level of consciousness. If untreated, the hyponatremia can progress to seizures, coma, and brain herniation. Therefore, the initial intervention is to determine the patient&rsquo;s sodium level and treat appropriately. Although the patient received morphine prior to the procedure, the patient&rsquo;s vital signs do not reflect opioid overdose. A CT scan of the head could tell if the brain was herniated, but hopefully this has not yet happened. The patient is currently ventilating and oxygenating well; endotracheal intubation is not indicated at this time.

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