splints is reviewed with both the patient and the family, and written instructions are
provided for their use at home. The patient and family are taught to recognize abnormal
signs and report them to the physician. This information helps the patient progress
successfully through the rehabilitative phase of burn management. The patient and
family are assisted in planning for the patient's continued care by identifying and
acquiring supplies and equipment that are needed at home (Chart 57-8).
Continuing Care
Follow-up care by an interdisciplinary burn care team is necessary. Preparations should
begin during the early stages of care. Patients who receive care in a burn center usually
return to the burn clinic or center periodically for evaluation by the burn team,
modification of home care instructions, and planning for reconstructive surgery. Other
patients receive ongoing care from the surgeon who cared for them during the acute
phase of their management. Still other patients require the services of a rehabilitation
center and may be transferred to such a center for aggressive rehabilitation before going
home. Many patients require outpatient physical or occupational therapy, often several
times weekly. It is often the nurse who is responsible for coordinating all aspects of
care and ensuring that the patient's needs are met. Such coordination is an important
aspect of assisting the patient to achieve independence.
Patients who return home after a severe burn injury, those who cannot manage their
own burn care, and those with inadequate support systems need referral for home care.
For example, elderly patients commonly lack family members who can provide home
care; therefore, social services and community nursing services must be contacted to
provide optimal care and supervision after hospital discharge. During visits to the
patient at home, the home care nurse assesses the patient's physical and psychological
status as well as the adequacy of the home setting for safe and adequate care. The nurse
monitors the patient's progress and adherence to the plan of care and notes any
problems that interfere with the patient's ability to carry out the care. During the visit,
the nurse assists the patient and family with wound care and exercises. Patients with
severe or persistent depression or difficulty adjusting to changes in their social or
occupational roles are identified and referred to the burn team for possible referral to a
psychologist, psychiatrist, or vocational counselor.
The burn team or home care nurse identifies community resources that may be helpful
for the patient and family. Several burn patient support groups and other organizations
throughout the United States offer services for burn survivors. They provide caring
people (often people who have themselves recovered from burn injuries) who can visit
the patient in the hospital or home or telephone the patient and family periodically to
provide support and counseling about skin care, cosmetics, and problems related to
psychosocial adjustment. Such organizations, and many regional burn centers, sponsor
group meetings and social functions at which outpatients are welcome. Some also
provide school-reentry programs and are active in burn prevention activities. If more
information is needed regarding burn prevention, the American Burn Association can
help locate the nearest burn center and offer current burn prevention tips
Because so much attention is given to the burn wound and the treatments that are
necessary to treat the burn wound and prevent complications, the patient, family, and
health care providers may inadvertently ignore the patient's ongoing needs for health
promotion and screening. Therefore, the patient and family are reminded of the
importance of periodic health screening and preventive care (eg, gynecologic
examinations, dental care).