Burn Care in the Home
More and more burns are being treated exclusively in outpatient settings, including wound clinics, physicians’ offices, and emer-gency department clinics. The outpatient setting is appropriate for the care of minor burns and most moderate burns. However, a number of factors must be considered in determining the ap-propriate site of care. These factors include the age of the patient, the extent and depth of the burn, the availability of family sup-port systems and community resources to assist the patient, the patient’s adherence to the prescribed plan of care, and the dis-tance from home to the outpatient setting.
Initially, looking at and touching the burn wound may be difficult and even frightening to some family members and pa-tients. However, with encouragement and support, most can handle burn wound care with little need for daily professional care. Instructions, both verbal and written, are given to the pa-tient about burn wound care, pain management strategies, the need for adequate nutrition, and the importance of exercise and rest. Instruction is also given about signs and symptoms of in-fection that should be reported to the physician. The impor-tance of notifying the physician about complications early and of keeping follow-up appointments is emphasized to the patient and family.
Nursing assessment of the elderly burn patient should include particular attention to pulmonary function, response to fluid resuscitation, and signs of mental confusion or disorientation. A careful history of preburn medications and preexisting illnesses is essential.
Nursing care promotes early mobilization, aggressive pul-monary care, and attention to preventing complications. Because of lowered resistance, burn wound sepsis and lethal systemic septicemia are more likely in elderly patients. Moreover, fever may not be present in the elderly to signal such events. There-fore, surveillance for other signs of infection becomes even more important.
Rehabilitation must take into account preexisting functional abilities and limitations, such as arthritis and low activity toler-ance. Elderly patients commonly lack family members who can provide home care, so social services and community nursing ser-vices must be contacted to provide optimal care and supervision after hospital discharge.