A client presents with superficial burns and multiple intact blisters on the forearm.
During dressing change, several blisters rupture and the underlying skin is exposed. Which action should the nurse take?

The scenario requires applying principles of wound management, pain control, and infection prevention for thermal burns. Knowledge of tissue integrity, pharmacological intervention, and sterile surgical asepsis is necessary to prevent complications like syndactyly, infection, and severe pain during treatment.

Choice A rationale

Placing gauze between digits prevents skin surfaces from touching during healing. This essential intervention stops webbing or contractures, known as syndactyly, by maintaining anatomical separation of the fingers while absorbing exudate from the injured thermal burn sites.

Choice B rationale

Topical lotions containing vitamin E are inappropriate for acute thermal burns. Lotions can trap heat or introduce contaminants into open wounds. Specialized antimicrobial agents are required instead of over the counter moisturizers to ensure proper healing and safety.

Choice C rationale

Silver sulfadiazine is a broad spectrum topical antimicrobial used to prevent and treat wound sepsis in second and third degree burns. It effectively penetrates the eschar to reduce bacterial colonization, which is critical for successful skin regeneration.

Choice D rationale

Intact blisters serve as a natural sterile barrier against environment pathogens. Piercing or debriding small blisters increases the risk of infection and tissue trauma. Blisters should remain intact unless they interfere with joint movement or are significantly large.

Choice E rationale

Burn care and debridement are excruciatingly painful procedures. Administering systemic analgesics like morphine sulfate prior to care ensures the client reaches a therapeutic peak, which facilitates cooperation, reduces physiological stress, and manages severe pain during dressing changes.

Choice F rationale

Thermal burns destroy the primary skin barrier, leaving the client highly susceptible to healthcare associated infections. Strict sterile technique during wound care and dressing changes is mandatory to prevent sepsis and promote uncomplicated healing of the damaged tissues.

The management of indwelling urinary catheters requires strict adherence to evidence-based practices to prevent catheter-associated urinary tract infections. This scenario involves applying knowledge of aseptic technique, mechanical drainage patency, and the prevention of bacterial colonization within the urinary system.

Choice A rationale

Regular irrigation increases the risk of introducing pathogens into the sterile urinary tract by breaking the closed drainage system. Irrigation is only indicated for obstructions, such as blood clots, to maintain necessary catheter patency.

Choice B rationale

Daily perineal care should be performed with soap and water rather than antiseptic solutions. Antiseptics can irritate the urethral meatus and disrupt normal flora, potentially increasing the risk of bacterial overgrowth and subsequent infection.

Choice C rationale

Maintaining a prompt and unobstructed flow of urine is vital. Kinks or twists cause urine stasis, which allows bacteria to migrate upward into the bladder, significantly increasing the risk of developing a urinary tract infection.

Choice D rationale

Catheters should only be replaced based on clinical indications, such as obstruction or infection, not on a fixed schedule. Frequent, unnecessary changes increase the risk of urethral trauma and the introduction of exogenous microorganisms.