Acute Care Nursing: Skin Grafting Report on Burn Injury Management

This report focuses on the pre-operative and post-operative management of a patient who has undergone a split-thickness skin grafting procedure following a full-thickness burn to the right hand. The introduction highlights the severity of third-degree burns and the necessity of skin grafting as a primary treatment. Pre-operative management includes a thorough assessment of the patient's medical history, vital signs, and fitness for surgery, along with guidelines for fasting and discontinuing blood-thinners to minimize complications. The roles of various inter-professional team members, such as surgeons, anesthesiologists, and nurses, are outlined, emphasizing the importance of cooling the burn area, administering tetanus prophylaxis, and providing patient and family education. Post-operative management emphasizes critical assessment of vital signs, pain control, and potential complications like infection. The report details the care provided in the recovery room, monitoring for hypertension, and wound care instructions. It also stresses the importance of discharge planning, involving the burn inter-professional team and family members to ensure continuity of care. The conclusion reiterates the importance of comprehensive pre- and post-operative care for optimal patient outcomes.

Running head: OPERATION MANAGEMENT
A patient is to have a split thickness skin graft following a full thickness burn to their
right hand
Student Name
University Name
Author Note

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Introduction
Full thickness burns are third degree burns which destroy the epidermal and the
dermis layer of the skin completely (Sun et al., 2011, pp. 20976-20981). According to World
Health Organization, any individual who suffers from a third-degree burn should be
immediately admitted to the burn unit of the nearest hospital for medical attention (Sakya et
al., 2018). The only treatment which is possible for a third-degree burn is skin grafting which
involves removing the skin from one part of the body and transplant it to another part of the
body (Mohammadi et al., 2011, pp. 36-41).
In the following essay, a patient has suffered third degree burns in the right hand
which will be involving a split-thickness skin grafting procedure to recover. The pre-
operative and post-operative management for the patient will be discussed in detail in the
following paragraphs. There are certain measures which need to be undertaken by the patient
as well as the hospital administration to deliver the best care and treatment to the patient.
Pre-operative management
The care that is provided to the patient before the operation is important as this is
what gets the patient prepared for the surgery. It is usually carried out to improve the effect of
the surgery with a positive health outcome for the patient with decreased complications
during the surgery. The first 24-hours after the burn wound have been sustained are termed
very critical by the physicians and nursing professionals (Wiechman Askay, atterson, Sharar,
Mason & Faber, 2009, pp. 522-530). The care provided to the patient in the first 24-hours
reflect on the degree of morbidity and mortality (Alharbi et al., 2012, pp. 13). When the
patient is brought in the hospital before the surgery, the physician lists all the medical records
of the prescribed medicines and history with allergies present for the patient. The vital
parameters and fitness of the patient is critically assessed before the operation to calculate an

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appropriate dosage for the anaesthetic agent and administer the patient (Bittner, Shank,
Woodson & Martyn, 2015, pp. 448-464). It is recommended that the patient should not be fed
with food and water for at least 8 hours prior the surgery. This protocol is strictly followed by
the nursing professionals and the hospital administration to avoid the onset of complication
during the surgery like vomiting. Considerable amount of research has been carried out to be
used as evidence for vomiting in the course of the surgery. The doctors and nurses have been
giving maximum attention to discontinuing the current prescription with stoppage of
administration of blood-thinners to further reduce the risk of difficulties (Stasko & Ross,
2009).
For an effective management of patients and the surgical procedure they will be
undergoing, a number of inter professionals are present. These includes physicians, nurses,
anaesthesiologist, surgeon and a cosmetologist (Stoddard, Ryan & Schneider, 2014, pp. 863-
878). The members ensure a stable surgical procedure for the patient with maximum benefit.
The anaesthesiologist in the team ensures conducts a brief physical examination of the patient
to help administer the optimum amount of anaesthetic agent. The surgeon and the
cosmetologist are the key members of the team as they conduct the surgery on the patient.
The surgeon assesses the depth of the wound as per the methods that have been proposed by
the department. Wallace rule of nine and Palmer methods are the most common methods that
have been implemented by surgeons worldwide. For a typical right hand burn, Wallace rule
of nine is used which makes up to 4.5% of the total body surface area.
Every hospital has a burn unit whose primary responsibility is to facilitate the patient
with the best care and a faster recovery process. When a patient has arrived in the hospital
with the burn wound in the right hand, the first thing which is practiced is to cool the area of
the burn with a towel dipped in cool, sterile saline. This will prove to bring relief to the
patient and reduce the risk of infections. It is after this that the patient should be administered

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tetanus prophylaxis as a form of immunization. It has been observed that patients who have
sustained less than 20% burn wound of the total body surface area, administration of
intravenous fluids is appropriate. For the regeneration of the skin in the hand, 5% albumin at
0.5mL/kg/% of total body surface area need to be administered.
Moreover, the nurses help in educating the patient as well as their family members
about the wounds and its surgical procedure. It is the responsibility of the nurse to ensure
proper dressing of the wound. In case of a hand burn injury, the fingers will be taped
individually with an application of cooling gel. There is a possibility of high exudation during
the initial days for which proper bandage must be ensured with repeated changes to determine
the improvement in the depth of the wound. It is only after this that the patient is wheeled
into the operation room for the surgery to be conducted on them.
Post-operative management
The post-operative care is the care provided to the patient after the surgery has been
performed. Furthermore, it also includes care in the post-anaesthesia stage and the follow-up
care (Compere et al., 2009, pp. 339-345). It has been observed that the first 24 hours after the
surgery is very critical for the patient. There is an increased likeliness of the patient
sustaining an infection which will hamper the recovery process of the wound and the scar.
According to the World Health Organization, the parameters that need to be assessed
critically after the surgical procedure are the vital signs of the patient, pain control, breathing
pattern, extubated and pre- and post-operative pain (Welchek, Mastrangelo, Sinatra &
Martinez, 2009). In addition to these, the ability of the patient of urine and gastrointestinal
fluid output and intravenous fluid is also evaluated. The patient is drowsy from the effect of
anaesthesia and should not be left unattended.

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Just immediately after the operation has been conducted, the patient is transported to
the recovery room and stays there for 40-45 minutes. The nurse in the recovery room is
informed about the nature of the operation that has been conducted on the patient with the
names of the drugs that have been administered to them (Yim et al., 2010, pp. 322-328). It is
by this nurse that the vital parameters, the quantity of urine and its colour are assessed.
Orthostatic parameters like pulse, blood pressure, respiratory rate and the oxygen saturation
level are critically measured. There is a high likeliness of the patient suffering from
hypertension immediately after the operation as the drugs still show their effect. The patient
is stabilized in the recovery room by the nurse and then the status of the patient is shared with
the relatives. Once the patient is haemodynamically stable, they are shifted to the general
ward for the relatives to meet them.
After the grafting has been performed in the right hand of the patient, the physician
assesses the wound of development in the condition. The nursing professional should assist
the patient in cleaning the operative area with a saline solution without soaking the wound
directly. This will ensure proper improvement of the wound and better health outcome for the
patient. The patient will be staying in the hospital for a few days to ensure proper healing of
the graft and the donor site. Moreover, the doctor also assesses the formation of blood vessels
and their connection to the skin within 36 hours of the operation. If this is not the case, it is a
sign that the body is rejecting the graft (Kaufman et al., 2012, pp. 1004-1016). The nursing
professionals deployed to care for the patient, instruct them to take care of the graft to avoid
getting it infected. The donor site typically heals within one to two weeks after the operation
but the graft takes longer to heal. The nurse will guide the patient to not undertake any
rigorous physical activity that may lead to the graft tear and injure it further. This will
possibly lead to another surgical procedure with a fresh graft.

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During the discharge planning process, the involvement of the burn inter professional
team and the family members of the patient is required. The multi-professional team will
ensure a swift implementation of the discharge planning process. Early discussions about the
discharge will help the relatives to ensure greater understanding of the care that is required to
be provided to the patient after they are released from the hospital. The nutritional
requirements of the patient need to be mentioned to the relatives with the instructions for a
home based care for the burn wound.
Conclusion
In concluding remarks, it can be understood that a burn injury in the right hand of the
patient requires critical care pre- and post-operation to ensure a better recovery. There are
certain measures which needs to be undertaken by the healthcare organization to ensure the
best quality of care is provided to the patient as well as the family members. When the patient
is brought in the hospital with a burn wound, immediate first aid needs to be provided to
ensure no infection is spread with immediate administration of tetanus prophylaxis. After the
grafting has been performed in the right hand of the patient, the physician assesses the wound
of development in the condition. During the discharge planning process, the involvement of
the burn inter professional team and the family members of the patient is required. if the
following measures are undertaken by the hospital administration, the management of the
patient regarding the surgery will be pleasant.

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