Fundamentals of Nursing Q 423
A nurse is caring for a client with severe burns of the face and head. The nurse will place the client in which position?
A. Trendelenburg.
B. Head of bed elevated.
C. Supine position.
D. Prone position.
Correct Answer: B. Head of bed elevated.
For clients with burns on the face and head, the best position is to elevate the head of the bed to reduce the occurence of facial edema. Elevation will encourage drainage of fluid and allow it to be reabsorbed by the body. The swollen part should be higher than the rest of the limb so that gravity can assist.
Option A: Placing the patient in Trendelenburg position would aggravate the facial edema. Physiochemical changes in the extracellular spaces cause protein denaturation, increasing the oncotic pressures, increasing local edema. It is also important to be aware of the requirement for fluid resuscitation, which increases the hydrostatic gradient, ultimately pushing more fluid into the extracellular space, compounding the tissue edema from the initial insult.
Option C: If the client has facial swelling it is extremely important to maintain an upright position. The client should avoid lying flat as this encourages fluid collection in the face and head which can lead to difficulty opening the eyes and may also affect breathing.
Option D: If the patient is placed in a prone position, fluid would accumulate in the face. Burns cause a local cytokine-mediated inflammatory response, creating hyperpermeability of the microvasculature, leading to tissue swelling. For the patient who sustains any facial burns or inhalation injuries, local swelling can occur rapidly and immediately.