SUMMARY. Nursing care in bum patients must take into account sources of infection, disinfection, isolation, nutrition and intravenous fluid administration. Some practical advice is given about basic nursing care.

There are two routes through which the burn wound may be contaminated by micro-organisms: autoinfection and cross-infection. The infection of burn wounds due to cross-infection is more liable to cause invasive infection, and cross-infection may also cause the spread of drug-resistant bacterial strains.
The dressings, bedding. clothing, medical instrument, furniture, and mattress which have been in contact with bum patients have been found to carry pathogenic organisms. The patient should thus be moved into a clean ward after debridement, and the attending personnel should wear a clean working suit, masks, caps, and shoes, and if necessary a sterilized suit. Hands must be washed after coming into contact with the wound surface.

Turning over the patient by means of the Turning

The turning bed helps in the alternate exposure of the anterior, posterior and lateral parts of the wound surface and prevents the aggravation of infection due to prolonged pressure and formation of bed sores. The height of the turning bed is adjustable, and the patient may be sent to the operating room and operated upon while lying on it.
The restriction of the patient's movements will cause less suffering, and will also make the nursing care of defecation and urination easier.

Patients who are mentally clear should be relieved of their anxiety and fear. They should be informed beforehand of the therapeutic significance and procedure in order to make then cooperative.
The upper and lower bed frames should be locked with adequate pressure between the frames, and soft pillows should be placed between the frames to serve as cushions in those parts where the frames cannot be closed up tightly. Two persons are needed to turn the patient over in bed.

Turning over the patient in bed is contraindicated in patients with respiratory tract bum, heart failure, or severe generalized anasarea or within the first (2-3) days of the shock phase.
The time the patient is allowed to lie in the prone position should generally be restricted to 1 hour at first; this may gradually be increased according to the patient's state of adaptation.
When an extensively burned patient is turned over into the prone position for the first time, respiration, pulse and symptoms of anoxia should be carefully considered. Instruments and medicine for emergency treatment should be prepared beforehand. Attention should be paid particularly to patients with burns of the head, face and neck.
The turning bed is usually narrow in width, and patients who have psychic symptoms or who are not cooperative should be carefully fixed, especially around the. extremities. The hand and foot supports may also be used as protection frames to prevent the patient from falling.
Bed sores may be prevented by the use of sponge pads.

The object of nursing care of defecation and urination in extensively burned patients is to prevent contamination of the wound surfaces by urine or faeces. Bed pans and urinals of various kinds should be used.

When patients with bums of the buttocks or lower extremities defecate in the supine position, the bed pan cannot be set easily and cleaning is difficult owing to the close approximation of the anus to the bed sheet * The patient should be trained to form the habit of defecating in the prone position, and the part above the anus should be covered with layers of sterilized toilet paper. The anus and perianal region should be cleaned after removing the bed pan.

In children or in patients with loss of urination contrdl a condom may be used, and it is importar watch for any oedema of the penis due to tightness - the condom. The long neck urinal can also be used.

RÉSUMÉ. Les soins infirmiers pour les brûlés doivent tenir compte des sources de l'infection, la désinfection, l'isolement, la nutrition et l'administration intraveineuse des liquides. Des conseils pratiques sont offerts pour ce qui concerne les soins infirmiers de base.