Malcolm, a 39-year-old truck driver, was involved in a major vehicle collision on a rural highway, during which his truck overturned and caught fire. He was pulled from the wreckage by a bystander before emergency services arrived. Upon arrival at the trauma bay at Alfred Hospital, he is alert but in significant pain. On assessment, Malcolm has deep partial- to full-thickness burns covering his anterior chest, upper limbs, and both hands. Burn size is estimated at 35% TBSA using the Rule of Nines. His skin is leathery and pale with areas of eschar. He is experiencing increasing respiratory distress and is audibly wheezing with shallow breathing.   Paramedics inserted a large-bore central line into Malcolm’s right subclavian vein.  His vital signs are as follows:  T 35.6C, HR 140 bpm, RR 40 breaths/min, BP 95/54 mmHg. ABG: pH 7.49, PO2 60mmHG, PCO2 32 mmHg, and HCO3 22 mEq/L.       Q1.  Based on Malcolm’s presentation, which of the following nursing diagnosis is the highest priority?  单项选择题

A

Risk for hypovolemic shock related to fluid loss from burns

B

Acute pain related to burn injuries

C

Impaired gas exchange related to inhalation injury

D

Impaired thermoregulation related to full-thickness burns

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