Nokea
During the recovery of an extensive burn, the client is complaining about wearing the tight-fitting custom garment. What is an appropriate response by the nurse?
- A. Perhaps the garment should be resized.
- B. The garment acts as a skin layer and prevents infection.
- C. A snug fit is needed to minimize scarring and to smooth the skin.
- D. The garment can be removed for an hour each day.
Correct Answer: C
Rationale: The forming of burn scars can be minimized by the use of pressure dressings and custom-fitted garments that apply continuous pressure. Garments need to be snug in order to be effective. These garments are worn for 23 hours a day and may be prescribed for as long as 2 years. Prevention of infection is not indicated with use.
You may also like to solve these questions
Which is a disadvantage of surgical debridement?
- A. Scarring
- B. Bleeding
- C. Loss of function
- D. Contractures
Correct Answer: B
Rationale: A disadvantage of surgical debridement is bleeding. Scarring, loss of function, and contractures are not disadvantages of surgical debridement.
A client presents with a full-thickness burn to the anterior chest. The leathery skin is tight, making breathing difficult. The nurse anticipates which treatment management technique in the care of this client?
- A. Endotracheal tube insertion
- B. Tracheostomy
- C. Escharostomy
- D. Ventilator assisted breathing
Correct Answer: C
Rationale: In areas of full-thickness burns, eschar constricts the area and can impair circulation or expansion of the anterior chest wall. An escharostomy is performed to release the burn tissue on the anterior chest, freeing the chest for expansion with inspiration. Endotracheal tube insertion, tracheostomy, and ventilation do not correct the tightening of the chest and poor expansion issue.
An explosion of a fuel tanker has resulted in melting of clothing on the driver and extensive full-body burns. The client is brought into the emergency department alert, denying pain, and joking with the staff. Which is the best interpretation of this behavior?
- A. The client is in hypovolemic shock.
- B. The client has experienced extensive full-thickness burns.
- C. The paramedita administered high doses of opioids during transport.
- D. The client has experienced partial-thickness burns.
Correct Answer: B
Rationale: In full-thickness burns, nerves are damaged and consequently painless. Behavior change is not a significant symptom of hypovolemic shock. Opoids are used in the management of pain associated with partial-thickness burns but not significant in the behavior exhibited. Partial-thickness burns are associated with increased pain to the area of involvement.
What is a benefit(s) that supports the use of a closed method wound care in the management of a client with burns? Select all that apply.
- A. Provides a drier environment
- B. Promotes heat loss
- C. Creates microbial barrier
- D. Prevents exudate accumulation
- E. Reduces pain during position changes
- F. Promotes slower healing
Correct Answer: C,E
Rationale: The closed method is the preferred method of wound management for most burn victims. It creates a microbial barrier and applies direct pressure to the wound, which reduces pain during position changes. Closed wound management provides a moist environment while reducing heat loss and evaporation, which facilitates faster healing. Frequent dressing changes may be required if the wound is infected or when there is significant exudate accumulation.
The nurse is providing education to the client with multiple burns and lists the options for skin grafting and application techniques. Which is the primary benefit for using an autograft slit graft versus other types of grafts?
- A. Less scarring
- B. Less discomfort
- C. Speeds healing
- D. Rejection is unlikely.
Correct Answer: D
Rationale: In an autograft slit graft, the skin is harvested from the client's buttocks or thighs. Rejection is less likely with this type of graft because the donor and recipient are the same. There will be scarring at both the donor and recipient sites, and added discomfort is associated from the donor site. Because the slit graft is expanded through a meshing device, the scarring will appear as a mesh. Healing is delayed due to need for two wounds.