Circulating intravascular volume is decreased with prolonged vomiting and poor fluid intake. Low intravascular volume causes decreased renal blood flow and prerenal azotemia (i.e., increased blood urea nitrogen [BUN] and creatinine).
Oliguria, or low urine output (i.e., <30 mL/hr), indicates inadequate renal perfusion and suggests that acute kidney injury (AKI) is developing. Without prompt medical evaluation and treatment, AKI can quickly progress to permanent renal damage.
The nurse should anticipate administering IV fluids to improve renal perfusion along with monitoring kidney function for improvement or worsening (e.g., BUN, creatinine).

Airway management is a priority for clients with suspected inhalation injuries (e.g., hoarse voice, restlessness, singed nasal hair). Clients with large burns or burns to the face or neck are at high risk for life-threatening airway inflammation due to smoke and heat inhalation. The nurse should first administer high-flow oxygen via a non-rebreather mask. A non-rebreather mask rapidly delivers high-flow oxygen to improve oxygenation until the client is stabilized. Clients with suspected inhalation injuries are often prophylactically intubated to maintain airway patency even if they do not demonstrate signs of respiratory distress.

Medical procedures, like vaccinations, can be painful and stressful for young clients (e.g., toddlers [1-3 years old]). Toddlers think literally and desire independence and control over their surroundings. This is expected in Erikson’s psychosocial development stage, autonomy vs. shame and doubt. Offering choices empowers toddlers and helps them feel in control of the situation, reducing anxiety. Allowing the toddler to complete age-appropriate tasks independently should also be encouraged.

The nurse should prioritize immediately stabilizing the neck in a neutral position until further assessment is completed. Immobilizing the cervical spine prevents movements that can harm the spinal cord and cause permanent loss of sensory and motor function below the level of injury. Rigid cervical collars prevent flexion, extension, and rotation of the spine with the goal of minimizing further injury to the spinal cord. Additional interventions can be completed once the cervical spine is immobilized.

Sleep hygiene refers to positive habits that promote consistent, good-quality sleep. Teaching was effective if the client understands the following teaching points:
Adequate physical activity is important for maintaining good sleep quality; however, exercising within 3 hours of bedtime can interfere with the ability to fall asleep.
Eating a light snack before sleep prevents hunger, which can cause insomnia. Clients should avoid large meals before bed as digestion can last several hours, disrupting sleep.
The bed should only be used for sleep and sexual activity to promote restfulness. Clients should avoid reading and watching television in the bedroom as this associates wakefulness with being in bed.