Relieving Pain and Discomfort
Pain measures, discussed earlier, are continued during the acute phase of burn recovery.
Analgesic agents and anxiolytic medications are administered as prescribed. Frequent
assessment of pain and discomfort is essential. To increase its effectiveness, analgesic
medication is provided before the pain becomes severe. Nursing interventions such as
teaching the patient relaxation techniques, giving the patient some control over wound
care and analgesia, and providing frequent reassurance are helpful. Guided imagery
may be effective in altering the patient's perceptions of and responses to pain. Other
pain-relieving approaches include distraction through video programs or video games,
hypnosis, biofeedback, and behavioral modification.
The nurse assesses the patient's sleep patterns daily. Lack of sleep and rest interferes
with healing, comfort, and restoration of energy. If necessary, sedatives are prescribed
on a regular basis in addition to analgesics and anxiolytics.
The nurse works quickly to complete treatments and dressing changes to reduce pain
and discomfort. The patient is encouraged to take analgesic medications before painful
procedures. The patient's response to the medication and other interventions is assessed
and documented.
Healing burn wounds are typically described by patients as itchy and tight. Oral
antipruritic agents, a cool environment, frequent lubrication of the skin with water or a
silica-based lotion, exercise and splinting to prevent skin contracture, and diversional
activities all help promote comfort in this phase.
Promoting Physical Mobility
An early priority is to prevent complications of immobility. Deep breathing, turning,
and proper positioning are essential nursing practices that prevent atelectasis and
pneumonia, control edema, and prevent pressure ulcers and contractures. These
interventions are modified to meet the patient's needs. Low-air-loss and rotation beds
may be useful, and early sitting and ambulation are encouraged. If the lower extremities
are burned, elastic pressure bandages should be applied before the patient is placed in
an upright position. These bandages promote venous return and minimize edema
formation.
The burn wound is in a dynamic state for at least 1 year after wound closure. During
this time, aggressive efforts must be made to prevent contracture and hypertrophic
scarring. Both passive and active range-of-motion exercises are initiated from the day
of admission and are continued after grafting, within prescribed limitations. Splints or
functional devices may be applied to extremities for contracture control. The nurse
monitors the splinted areas for signs of vascular insufficiency and nerve compression.
Strengthening Coping Strategies
In the acute phase of burn care, the patient is facing the reality of the burn trauma and is
grieving over obvious losses. Depression, regression, and manipulative behavior are
common responses of patients who have burn injuries. Withdrawal from participation
in required treatments and regression must be viewed with an understanding that such
behavior may help the patient cope with an enormously stressful event. Although most
patients recover emotionally from a burn injury, some have more difficult
psychological reactions to the injury and its outcomes (Morton, Willebrand, Gerhard, et
al. 2005).
Personality characteristics, rather than the size or severity of the injury, determine the
ability of the patient to cope after burn injury (Kidal, Willebrand, Andersson, et al.,
2004). Difficulty coping along with other psychological stressors often limits the