Need help with burn patient

[sleepyjane]

Hi,

I am new rehab nurse and one of my primary patients has over 80% TBSA chemical burn. She has daily wound care: cleaned with a gentle soap and water then tripple antibiotic and xeroform to open areas and A&D to closed. The wound nurse helped me and the nurse coassigned the first day we had this patient and I was told that sterility was not necessary, but then another nurse who helped me one day said that I had to be sterile. Being a new grad and having never worked with a burn patient, I am unsure what to do. I am inclined to do what the wound nurse instructed me to do. I have read that individuals in the rehabilitative phase of a burn injury do not require sterility (???)

Also, how on earth do you identify pressure ulcers on a patient who is burned so badly? I worry that my novice assessment skills won't pick something like that up.

One more thing...this patient has a foley catheter that the MD wants taken out as soon as possible. The women has open wounds on her buttocks and between her legs and I worried about her skin and it being exposed to urine. Not to mention that bladder scanning would be impossible to check for PVR. Also, I don't think I would be able to strait cath her if she is not able to void because her lady parts was so badly burned.

Yikes...I think I am truly in over my head. But can I just tell you that it truly humbles me to work with a patient who has been through so much hell and yet her attitude remains positive.

[SuesquatchRN, BSN, RN]

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.

[shandsburnRN-CRNA]

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.