Chapter 10 Skin Integrity and Wound Care IIHQ@

10.2: Dressing a Burn Wound

DEFINITION
~ a burns wou nd wi th normal saline using aseptic technique for removal of exudates and applying anti bacterial
agent

pURPOSES
:..::--
To enhance wound healing.
1.
,, To prevent complications.
;: To perform wound debridement.

--
ARTICLES
Dressing trolley with:
1. Dressing pack.
2. Sterile bandages in a bin.
3. Sterile dressing pads in a bin.
-1. Sterile vaseline gauze.
5. Silver sulfadiazine 1 %.
6. Sterile normal saline.
7. Cheatle forceps.
8. Adhesive tape and scissors.
9. Sterile scissors.
10. Sterile sheets.
11. Receptacle for waste.

TYPES OF WOUND DRESSING

1. Open dressing.
2. Closed dressing.

Open Method
The antimicrobial cream is applied with a gloved hand and the wound is left open to the air without gauze dressing. The
cream is reapplied as needed.

Advantages
1. Increased visibility of the wound.
2. Freedom for joint mobility.

Disadvantage
Increased chance of hypothermia.

Closed method
In closed method, gauze dressing is impregnated with antimicrobial cream and applied to the wound.

Advantages
I. Decrease in evaporative fluid and heat loss from wound surface.
2· Gauze dressing aids in debridement.

Disadvantages
l. Mobility limitations.
2· Wound assessment is limited.
Mf JiE Clinical Nursing Procedures: The Art of Nursing Practice

PROCEDURE
Nursing action Rationale
Helps in obtaining cooperation of patient.
l. Explain procedure to patient.
Minimizes pain during dressing.
2. Administer analgesics about 20 minutes before procedure
as per physician's order.
Moistening adherant dressing reduces discomfort when removed
3. Soak previous dressing with normal saline and remove.
Helps for cleansing of wound.
4. Provide hydrotherapy/shower bath.
5. Regulate temperature of the room at 24 degree centigrade
(80 degree Fahrenheit) and humidity at 40-50% using
portable humidifiers if available.
6. Put on mask and cap.
Prevents transmission of microorganisms.
7. Scrub hands and don sterile gown and gloves.
Removes debris, any remaining topical agent, exudates and dead
8. Clean and deb ride the wound using sterile scissors and
forceps. Trim loose eschar and separate devitalized skin. skin.

9. Clean the wound with normal saline and pat dry.

10. Inspect wound and surrounding area.
11. Apply topical medications over the wound.
12. If closed method is used for dressing, cover the wound
with vaseline gauze and place sterile dressing pad.
13. Apply bandage over the dressing pad.
14. Wash reusable articles to be sent for autoclaving. Autoclaving destroys microorganisms and spores.

15. Discard gloves and gown and wash hands.

16. Record procedure and note the odor, color, size, amount Gives information about the patient's response and wound
of exudate, signs of epithelialization and any change from healing.
previous dressing.

TOPICAL ANTIMICROBIAL AGENTS USED FOR BURN WOUNDS {TABLE 10.2.1)

1. Silver sulfadiazine 1%.
2. Mafenide acetate 10% cream or 5% solution.
3. Silver nitrate 0.5% solution.
4. Povidone-iodine 1%.
 Table 10.2. 1: Antimicrobial agents used in burns
Topical agent Description and indications
1. Sliver A white crystalline, highly insoluble
sulfadlazine 1% opaque, odorless water-soluble cream.
Exerts antimicrobial effect at level
of cell membrane and cell wall against
gram-negative and gram-positive
bacteria and yeast.
2. Mafenide Usually supplied in water miscible
acetate 10% hydroscopic cream base
cream Active against most gram-positive
organisms
Active against common gram-negative Brisk alkaline diuresis and polyuria may
organisms which infect burn wound
but has less fungal activity
Disadvantages
May increase possibility of kernict eru s.
Not to be used by pregnant women in last
trimester of pregnancy
• Exposure to sunlight produces gray
discoloration.
• Transient leukopenia can occu r
Painful during and for a whil e after
application.
A potent carbonic anhydrase inh ibitase
resulting in metabolic acidosi s t herefore
not used in 20% total burns surface area or
more.
result w hen used in pati ent with large burn
surface area.
Nursing Implications
• Use w ith either ope n treatment, light o r occlusive
d ressi ngs.
♦ App ly~ ith sterile gloved hand directly to wound or
applied to gauze dressing 0.16 cm thickness, once or
twice dai ly after thorough wound cleansing.
♦ Silver sulfadiazine will be discontinued if WBCs are less
than 1500 in an adult or less than 2000 ind child. WBC
count usually recovers m 2-4 d ays and app!iot1on m_~y
be resumed.
♦ Cream 1s applied w ith or without dressing. If po
must be reapplied every ~ 2 hours for thercip€
effectiveness
♦ Therapeutic solutio n concentration 1s mamt.3:ne>d
bulky we t dressing.
♦ Rewet the dressing every 2-4 hours.
• Hypersensitivity 1s evidenced by maculo papu!ar r t""'\
and treated with histamine or by drscontmu:.,g .i"ie

• Requires careful monitoring of pulrnonary statl.., c1 ...

Hemolytic anemia is a rare acid-base fluid balance. -"
C
complication.
3. Silver nitrate Clear solution with low toxicity and Can cause elctrolyte • Monitor electolyte balance carefully, supp:c
05% solution significant antimicrobial effect against abnormalities depleting seru m sodium, with potassium and sod;urn salt 1s rout,ne
common burn wound pathogens. chloride, potassium and magnesium. for patients with extensive bums
• Use bulky dressings, rewet every 2-4 hou :;;
Non-allergic and not usually painful on Stains normal skin brown or black. therapeutic concentration.
application. "-
Best used as prophylaxis against • Maintain patient warm and minni'tze trcr~s
infection. evaporative water loss with dry t0p l..1yet SL ..
stockinette or bath blanket.