The nurse cares for a client with second and third-degree burns covering 40% of their total body surface area (TBSA). When performing a dressing change, which action should the nurse perform?

Nursing care of a client with extensive second- and third-degree burns covering a large total body surface area requires strict attention to thermoregulation, infection prevention, pain control, and wound management. Burn injuries destroy the skin barrier, significantly increasing heat and fluid loss while exposing the client to high risk of hypothermia and infection. During dressing changes, environmental control and careful technique are essential to maintain physiological stability and promote wound healing. Rationale: A. Setting the room temperature to 85 °F (29.4 °C) helps prevent hypothermia during burn care. Clients with extensive burns lose the protective function of the skin, resulting in massive heat loss through evaporation and radiation. A warm environment reduces metabolic stress, supports circulation to healing tissues, and improves patient comfort during prolonged dressing changes. B. Teaching that dry dressings will help debride wounds is incorrect because burn wounds require moist wound healing principles. Dry dressings may adhere to the wound bed, causing trauma and pain during removal and potentially delaying healing. Modern burn care typically uses moist sterile dressings or topical antimicrobial agents to promote autolytic debridement and tissue regeneration. C. Sterile gloves are not typically required for removing old burn dressings; clean gloves are used for removal, while sterile technique is reserved for application of new dressings. Using sterile gloves for removal is unnecessary and may increase resource use without improving infection control. The priority is maintaining asepsis during application, not during removal of contaminated materials. D. Waiting until after the dressing change to perform range of motion exercises is not appropriate because early mobilization is essential in burn care. Range of motion should be incorporated during or immediately after dressing changes when pain is controlled to prevent contractures and maintain joint flexibility. Delaying movement increases the risk of long-term functional impairment and stiffness in affected areas.