Integumentary Disorders Q 27 - Gyan Darpan : Learning Portal
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Saturday 2 April 2022

Integumentary Disorders Q 27

A female client with second- and third-degree burns on the arms receives autografts. Two days later, the nurse finds the client doing arm exercises. The nurse knows that this client should avoid exercise because it may:
    A. Dislodge the autografts.
    B. Increase edema in the arms.
    C. Increase the amount of scarring.
    D. Decrease circulation to the fingers.

Correct Answer: A. Dislodge the autografts.

Because exercising the autograft sites may dislodge the grafted tissue, the nurse should advise the client to keep the grafted extremity in a neutral position. None of the other options results from exercise. Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection.

Option B: Restricting mobility immediately following an STSG is thought to protect against subdermal edema and shear forces, factors that interrupt revascularization leading to STSG failure. However, there is limited evidence to support that absolute restriction of motion results in superior STSG adherence and that mobility does not produce shearing forces as commonly believed.
Option C: Postoperative hand burn management following a skin graft can be challenging and takes meticulous coordination to mitigate contracture risk and ensure the best functional outcome. Patients who undergo split-thickness skin grafting (STSG) to the hand are often immobilized postoperatively for graft protection.
Option D: The most common surgical dressing used is a silver-impregnated glove wrapped with either moistened gauze or a cotton outer glove. This is then followed by a resting hand splint fitted and applied in the post-anesthesia care unit. The dressing and splint remain in place for 3 to 5 days postoperatively at which time the graft is evaluated and ROM is initiated following this prescribed immobilization period.

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