Book
Nursing Guidelines for Burn Treatment
- Local Treatment- Basic Principles
- Regular dressing changes to prevent infection, reduce heat and fluid loss, limit energy loss, and improve patient comfort. Dressings should be occlusive (elastic), help relieve pain, allow movement, and prevent contractures.
Basic Principles
- Strict adherence to sterilization principles.
- Dressing changes require morphine administration for the patient who is not sedated.
- The first dressing change is performed in the operating room under general anesthesia; subsequent dressing changes can be done in the operating room under general anesthesia or at the bedside with morphine administration.
Method
- For the first dressing, shave any areas with hair (armpit, groin, pubic area) if the burns involved adjacent tissues; scalp (front for facial burns, or entirely for scalp burns). Trim nails.
- Clean the burn using povidone-iodine foam solution (1 part 7.5% povidone-iodine + 4 parts 0.9% saline or sterile water). Gently scrub using a gauze pad, being careful not to cause bleeding.
- Rinse with 0.9% saline solution or sterile water.
- Dry the skin by patting with sterile gauze.
- Apply silver sulfadiazine directly with clean hands (wear sterile gloves) in a uniform layer of 3-5 mm thickness over all burn areas (except eyelids and lips) for children over 2 months old and adults.
- Apply a greasy dressing (or sterile gauze) in a back-and-forth motion (do not use a circular motion).
- Cover with sterile gauze, in a single layer without folding any ends.
- Apply a compressive bandage, leaving it loose without tightening.
- Elevate limbs to prevent edema; stabilize in an extended position.
Frequency
- Routine: every 48 hours.
- Daily in case of additional infection or in certain areas (e.g., perineum).
Monitoring
- Dehydration (ischemia) of the burned limb is the main complication in the first 48 hours. Evaluate signs of dehydration (ischemia): cyanosis or pallor of the limb, decreased sensation, hyperalgesia, poor capillary refill.
- Daily monitoring: pain, bleeding, wound healing, and infection development.
