Promoting Activity Tolerance
Nursing interventions that must be carried out according to a strict regimen and the
pain that accompanies movement take their toll on the patient. The patient may become
confused and disoriented and lack the energy to participate optimally in care. The nurse
must schedule care in such a way that the patient has periods of uninterrupted sleep. A
good time for planned patient rest is after the stress of dressing changes and exercise,
while pain interventions and sedatives are still effective. This plan must be
communicated to family members and other care providers.
The patient may have insomnia related to frequent nightmares about the burn injury or
to other fears and anxieties about the outcome of the injury. The nurse listens to and
reassures the patient and administers hypnotic agents, as prescribed, to promote sleep.
Reducing metabolic stress by relieving pain, preventing chilling or fever, and
promoting the physical integrity of all body systems help the patient conserve energy
for therapeutic activities and wound healing.
The nurse incorporates physical therapy exercises in the patient's care to prevent
muscle atrophy and to maintain the mobility required for daily activities. The patient's
activity tolerance, strength, and endurance gradually increase if activity occurs over
increasingly longer periods. Fatigue, fever, and pain tolerance are monitored and used
to determine the amount of activity to be encouraged on a daily basis. Activities such as
family visits and recreational or play therapy (eg, video games, radio, TV) can provide
diversion, improve the patient's outlook, and increase tolerance for physical activity. In
elderly patients and those with chronic illnesses and disabilities, rehabilitation must
take into account preexisting functional abilities and limitations.
Improving Body Image and Self-Concept
Patients who have survived burn injuries frequently suffer profound losses. These
include not only a loss of body image due to disfigurement but also losses of personal
property, homes, loved ones, and ability to work. They lack the benefit of anticipatory
grief often seen in a patient who is approaching surgery or dealing with the terminal
illness of a loved one.
As care progresses, the patient who is recovering from burns becomes aware of daily
improvement and begins to exhibit basic concerns: Will I be disfigured or be disabled?
How long will I be in the hospital? What about my job and family? Will I ever be
independent again? How can I pay for my care? Was my burn the result of my
carelessness? As the patient expresses such concerns, the nurse must take time to listen
and to provide realistic support. The nurse can refer the patient to a support group, such
as those usually available at regional burn centers or through organizations such as the
Phoenix Society. Through participation in such groups, the patient will meet others
with similar experiences and learn coping strategies to help him or her deal with losses.
Interaction with other burn survivors allows the patient to see that adaptation to the
burn injury is possible. If a support group is not available, visits from other survivors of
burn injuries can be helpful to the patient coping with such a traumatic injury.
A major responsibility of the nurse is to constantly assess the patient's psychosocial
reactions. Questions to consider include the following: What are the patient's fears and
concerns? Does the patient fear loss of control of care, independence, or sanity itself? Is
the patient afraid of rejection by family and loved ones? Does he or she fear being
unable to cope with pain or physical appearance? Does the patient have concerns about
sexuality, including sexual function? Being aware of these anxieties and understanding
the basis of the patient's fears enable the nurse to provide support and to cooperate with
other members of the health care team in developing a plan to help the patient deal with
these feelings.