The family of a client who has been burned asks at what point the client will no longer be at greater risk for infection. What is the nurse’s best response?
A. "As soon as he finishes his antibiotic prescription."
B. "As soon as his albumin level returns to normal."
C. "When fluid remobilization has started."
D. "When the burn wounds are closed."
Correct Answer: D. “When the burn wounds are closed.”
Intact skin is a major barrier to infection and other disruptions in homeostasis. No matter how much time has passed since the burn injury, the client remains at high risk for infection as long as any area of skin is open.
Option A: Even after the course of treatment of antibiotics, the patient is still at risk for infection if the wounds remain open. Examine wounds daily, note and document changes in appearance, odor, or quantity of drainage.
Option B: Albumin levels are monitored if there is significant edema. Implement appropriate isolation techniques as indicated. Depending on the type or extent of wounds and the choice of wound treatment (open versus closed), isolation may range from a simple wound and/or skin to complete or reverse to reduce the risk of cross-contamination and exposure to multiple bacterial flora.
Option C: Fluid resuscitation replaces lost fluids and electrolytes and helps prevent complications (shock, acute tubular necrosis). Once initial fluid resuscitation has been accomplished, a steady rate of fluid administration is preferred to boluses, which may increase interstitial fluid shifts and cardiopulmonary congestion.
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