Final answer:
The APRN must prioritize initiating intravenous fluid therapy to manage dehydration and prevent hypovolemic shock in a patient with a severe burn injury. Monitoring of vital signs and urine output is also critical, along with preventative measures against infection.
Step-by-step explanation:
An advanced practice registered nurse (APRN) caring for a patient with a 20% total body surface area (TBSA) burn injury must act quickly to manage the potential for hypovolemic shock due to massive evaporative water losses and fluid and electrolyte shifts. The priority action is to initiate intravenous fluids (IV fluids) to counteract dehydration and fluid lost in the burn injury. This not only replenishes lost fluids but also helps to restore circulatory volume, preventing circulatory hypovolemia and its associated risks. In addition to IV fluids, close monitoring of the patient's vital signs and urine output is crucial to guide the resuscitation and ongoing management.
As part of the multifaceted care required in burn management, infection prevention is also paramount. The APRN needs to ensure sterile procedures and consider prophylactic antibiotics if indicated, given the heightened susceptibility of burn areas to infection. This will require direct supervision of treatments and the diligent observation for signs of infection or other complications.
Preserving the patient's life and preventing irreversible hypovolemic shock requires a collaborative effort in which the APRN coordinates with a healthcare team, possibly including surgeons, nurses, and specialists in burn care and dialysis if needed.