Answer :
For a 5-year-old with severe burns who weighs 25 kg and has a urine output of 30 ml in the last two hours, a serum sodium of 122, and a serum potassium of 5.1, the most important action for the nurse to take is to inform the doctor and initiate fluid resuscitation.
The 5-year-old's serum sodium is below the normal range (135-145 mEq/L), indicating that the child is hyponatremic. The child's serum potassium, on the other hand, is within the normal range (3.5-5 mEq/L). In the case of severe burns, fluid resuscitation is crucial in maintaining perfusion and blood pressure. Hyponatremia, on the other hand, is a sign of fluid depletion in the body.
As a result, fluid resuscitation is essential in this case. The healthcare provider will adjust the electrolyte levels during fluid resuscitation to ensure the child's blood pressure, perfusion, and electrolyte levels are balanced. The healthcare provider should be informed as soon as possible since the child's urine output is 30 ml in the last two hours, which indicates a reduced kidney perfusion. It's worth noting that serum sodium is critical for maintaining the body's water balance.
It's also worth noting that a serum potassium level of 5.1 is approaching the high end of the normal range, which may indicate the child's body is beginning to release potassium as a result of cellular damage caused by the burn injury. If untreated, the child's condition may deteriorate, leading to shock or other severe complications. The child should be monitored regularly, and his/her vital signs should be recorded frequently to ensure that there is no further deterioration.
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