Unit 3: Burns: Rehabilitative phase

Question 1

When does the Rehabilitative Phase begin?

Answer 1

• last phase
• begins from the time the patient is admitted to the burn center and may last for several years, even extending beyond discharge
• all members of interprofessional team are essential during this phase

Question 2

Focuses In the Rehabilitative Phase

Answer 2

• Psychological and emotional support

- Return the patient to his/her highest level of function and mobility

Question 3

-Psychological and Emotional Support

Answer 3

• may experience PTSD, body image disorder, anxiety, and/or depression
• must include mental health professionals
• may require both emotional and pharmacological interventions for mental health issues
• family members may also be affected by this traumatic experience

Question 4

Return to highest level of functioning and mobility

Answer 4

• physical and occupational therapists involved; work w/ burn patient immediately upon admission
• range of motion, positioning, splinting, ambulation, and ADLs implemented as soon as the patient is physiologically stable
• once discharged, PT and OT continue at home, at a rehabilitation facility, or in an outpatient setting

Question 5

Complications of Burns

Answer 5

• Contractures

- Scarring

Question 6

Contractures

Answer 6

-permanent tightening of the skin that may involve underlying muscles and tendons and result in limited mobility

Question 7

Most common method used to prevent the formation of contractures

Answer 7

splinting

Question 8

Splinting

Answer 8

• most commo method used to prevent contractures
• splints are place by rehabilitation therapists to maintain range of motion and function of the involved joints
• important to employ the use of splints when a burn injury crosses over a major joint, such as elbow or knee

Question 9

Scarring

Answer 9

• any area that has been grafted will have some element and degree of scarring
• as burn wounds mature over the course of months to years, hypertrophic scarring can result
• burns to the face and hands that have caused scarring are traumatic to the patient and may result in appearance changes and disfigurement
• as patients progress to discharge, they are measured and fitted for specialty pressure garments; purpose of these is to apply continuous and uniform pressure over the area of burn to prevent hypertrophic scarring

Question 10

How to prevent hypertrophic scarring?

Answer 10

• as a patient progresses to discharge, they are measured and fitted for specialty pressure garments
• purpose of these is to apply continuous and uniform pressure over the area of burn to prevent hypertrophic scarring
• garments worn 23 hours a day for up to a year or more after injury in some patients
• specialty face masks may also be utilized to help prevent scarring

Question 11

Nursing Management: Assessment and Analysis

Answer 11

-the rehabilitative phase is the longest and may last several years depending on the TBSA affected, the severity of the burns, and the complexity of the treatments
-patient monitored for infection, nutritional status, and pain
-priorities expand to promoting greater mobility, flexibility, comfort, and psychosocial health
>Nurse observes for:
-pain/discomfort
-contractures
-scarring
-disfigurement
-limited mobility
-altered/depressed mood
-flat affect
-fear
-anxiety

Question 12

Nursing Diagnoses

Answer 12

• Activity intolerance r/t pain when exercising b/c of burn injury
• Impaired physical mobility r/t pain on movement and potential scar and contracture development
• Disturbed body image r/t altered physical appearance
• Moral distress r/t anticipation of discharge to home and/or a rehabilitation center

Question 13

Nursing Assessments for the Rehabilitative phase of Burns

Answer 13

• Pain level; pain can affect participation in physical activities, further complicating recovery
• Range of motion
• Compliance w/ treatment and rehabilitation regimen
• Assess readiness for integration into society

Question 13

Nursing Assessments for the Rehabilitative phase of Burns

Answer 13

• Pain level; pain can affect participation in physical activities, further complicating recovery
• Range of motion
• Compliance w/ treatment and rehabilitation regimen
• Assess readiness for integration into society

Question 14

Nursing Actions

Answer 14

• Splinting and encouragement of rehabilitation exercises and ADLs
• Include psychology in patient treatment decisions
• Provide community resources for support upon discharge, including psychological support

Question 15

Nursing Teachings

Answer 15

• Teach patient and family members the importance of and how to apply pressure garments and/or face masks; prevents hypertrophic scarring
• Teach patient and family about burn prevention, sun protection, and prevention of hyperthermia; patients with burns may be lacking sweat glands, and new ski and/or grafted skin is sensitive to sunlight

Question 16

Evaluating Care Outcomes

Answer 16

• the focus during the rehabilitative phase is to return the patient to the highest functioning level
• outcomes: pain management, prevention of complications, improvements in mood, and increasing independence with ADLs
• nurse assists and encourages patients during physical and occupational therapy treatment regimens
• important for family and patient to verbalize and demonstrate understanding of therapy routines b/c noncompliance can quickly lead to contractures and loss of function
• nurse works closely with patient and psychologist to manage and deal with the possible psychological sequelae, which may include body image disorder, nightmares, and PTDS