The nurse is planning the care of a patient who has burns to the face, neck, upper chest, and both upper arms. To prevent contracture development, the nurse should include which of the following in the patient's plan of care?
1. place the arms in an adduction position
2. instruct the patient to avoid using pillows under the head
3. limit the use of pain medications unless pain is severe
4. use bed cradles over the burned areas while patient is sleeping
2
Rationale: Antideformity positioning begins at the time of admission unless contraindicated by a complicating condition. Its use is imperative during the acute phase because it decreases scar contracture across flexor surfaces, which often compromises joint mobility and functional capacity. Using pillows under the head leads to hyperflexion of the neck and burned surfaces will be touching each other. This may lead to developing contractures of the neck. Placing the arms in adduction position leads to developing of contractures of the arms, too. Adequate analgesia should be maintained to prevent severe pain that prevents the patient from participating in range of motion exercises and remaining active in order to prevent contractures. Limiting the use of pain medication is a counterproductive nursing strategy. Using bed cradles is effective in preventing infection and irritation of burn wounds, but it has no direct effect on preventing contractures.
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