Need help with burn patient

Oh. my. goodness.

All I can say is that I always thought when one's entire body's skin integrity was impaired - as in a burn patient - sterility was of the utmost importance, since there was no barrier against microbes.

As to pressure ulcers, can she reposition herself? If not, just make sure you do that Q2o.

That poor thing.

I'm a burn nurse in a busy Burn ICU. First, if this patient is in rehab then her burns are essentially closed...aka she's healed therefore sterility is not necessary. However, if you want to use sterile technique when appling the triple abx and xeroform to her open areas you wouldn't be doing any harm. As for the rest of her skin, it's healed, sterility is a moot point.

As for pressure ulcers, regardless if the patient is bedridden or not the patient either needs to be moved or taught to change her postion every few hours. If she is mobile she most likely move enough on her own to prevent breakdown. When assessing the skin for breakdown, the skin will redden just like normal skin, it may also feel "soft" and/or blister. If so, place some Xeroform over the area and try to keep the patient off that point.

As for the foley, why is bladder scanning impossible? I have used bladeder scanners on numerous patients with burnt and grafted abdomens. If you are worred about continence, start with bladder training. Clamp the foley, every 4-6 hrs unclamp the foley, or when the patient feels the urge to void. Once the patient is able to feel the urge to void urine successfully for 24 hrs, DC the foley, then I/O cath every 6 hrs PRN. It's good to worry about the open wounds to her buttocks, place a diaper on the patient until she is continent of urine, if she remains incontinent just check the buttocks dressing each time she voids, if she doesn't recover her continence she may need a foley again, but its unlikely. With bladder training patients usually regain urinary continence quite easily.

Keep us updated!!!! You can also call the burn unit the patient came from. We are more than happy to help the home health nurses with questions as this is such as specialized area.