The rehabilitation phase begins once the wounds have fully healed and typically runs for ~12 months or more depending on the severity of the burn. The emergency is over — infection is no longer the big risk — and the enemy changes completely. Now it is scar tissue that shrinks, joints that freeze, skin that no longer moisturises or sweats itself, and a person who has to face a changed body.
🧭 This page vs. its sibling — they are NOT the same page
NG-164 (this page) = the REHABILITATION PHASE. Contracture prevention, positioning and splinting, pressure garments, water-based lotion, daily range-of-motion exercise, scar maturation, itch, sun protection, nutrition for healing, and psychosocial recovery.
NG-146 = the NUMBERS. Rule of 9's, the palm rule, Lund–Browder, pediatric proportions, the Parkland formula and worked fluid calculations.
Both share a source title. Study this one for recovery, that one for arithmetic.
🅦🅦🅔Water-based lotion · Wear pressure garments · Exercise daily (ROM). The three teaching points.
🗓️ ~12 monthsStarts when the wounds are fully healed; scar maturation keeps going for a year or two.
🦴 Contracture is the enemyScar tissue shortens. The position of comfort is the position of contracture.
🛡️ Infection is NOT the big risk nowDon't pick the infection answer for a rehab-phase question — the wounds are closed.
🧭
WHAT THE REHAB PHASE IS
STEP 1 · WHERE YOU ARE
Third phase, longest phase, least dramatic phase — and the one that decides what the patient's life looks like.
🗓️ Where rehab sits in the three phases
EXAM TIP Questions are usually solvable just by identifying the phase. Emergent = fluid · Acute = infection · Rehab = function.
🧠 “Fluid · Infection · Function.” Three phases, three one-word priorities. Say the phase first and the answer usually appears.
🧾 What "rehabilitation phase" actually means
Starts when the burn wounds are fully healed / covered
Lasts around 12 months, longer for severe burns — some scar remodeling continues for 18–24 months
Goal: return to the highest possible level of function and independence, physically, socially and psychologically
Team: nurse, physiotherapist, occupational therapist, dietitian, psychologist/social worker, plastic surgeon — reconstructive surgery is usually delayed until the scar has matured
Patient's job: the daily unglamorous work — lotion, garment, exercise, every day
🧠 “Healed is not the same as recovered.” Closed skin is the start of rehab, not the end of treatment.
🚨 Complications rehab exists to prevent
Contractures — shortened scar tissue locking a joint. The number-one preventable disability.
Loss of range of motion and muscle wasting from immobility
Chronic pruritus (itch) and dry, fragile skin
Heat intolerance — grafted areas cannot sweat
Neuropathic pain and altered sensation
Depression, anxiety, PTSD, body-image disturbance, social withdrawal
Heterotopic ossification — bone forming in soft tissue around a joint (uncommon but classically listed)
🧠 “Stiff, scarred, itchy, sad.” Four words that summarize every rehab-phase nursing diagnosis.
🦴
CONTRACTURE PREVENTION
STEP 2 · POSITION AGAINST COMFORT
Healing scar tissue physically shrinks. If you let a joint rest bent, the scar sets it there permanently.
🔬 What a contracture actually is — normal vs. contracted joint
Healed burn scar is collagen laid down in dense whorls instead of neat parallel bundles. It is less elastic and it actively shortens as it matures. Across a joint, that shortening drags the joint closed.
🧠 “Scar is a rope that keeps getting shorter.” Stretch the rope every single day or the joint gets tied shut.
🧍 Anti-deformity positioning — the whole body, joint by joint
The position of comfort is the position of contracture. Burn patients naturally curl up — flexed, adducted, pillow under the head. Every one of those is exactly wrong.
🧠 “Stretched, straight, spread and square.” Neck stretched (no pillow) · elbows/knees straight · shoulders spread to 90° · ankles square at 90°.
🚨 The neck burn & the pillow
Answer first:no pillow for an anterior neck burn. A pillow flexes the neck, and a neck flexion contracture can permanently fix the chin to the chest — it interferes with eating, airway management and appearance.
Position the neck in slight hyperextension — a small rolled towel under the shoulders, not the head
Same principle for an axillary burn — arms abducted so the armpit does not seal shut
Hand burns: splint in the functional position, and wrap digits individually
Anterior chest/abdomen burn: avoid a curled-up side-lying "comfort" posture
🧠 “Pillow = chin to chest.” If a stem mentions an anterior neck burn and one option offers a pillow for comfort, that option is the wrong answer.
✅ Splints, ROM & mobility rules
Range-of-motion exercises daily, ideally several times a day — active whenever the patient can, passive when they can't
Best time to exercise is when the patient is premedicated and after a dressing change or warm shower, when tissue is most pliable
Splints are usually worn at night / during rest, and removed for exercise, unless prescribed otherwise
Inspect skin under every splint and garment for pressure areas
Ambulate early; use pressure wraps on legs before standing to reduce pooling and pain
Do not exercise or apply pressure over a fresh graft until the surgical team clears it — the graft has to take first
🧠 “Move it or lose it — but not over a new graft.”
👕
THE W-W-E TEACHING BLOCK
STEP 3 · WHAT YOU TELL THE PATIENT
Three discharge instructions carry most of the exam weight. Learn them as one word: WWE.
⭐ W · W · E — the whole rehab teaching plan
🧠 “W-W-E: like the wrestling — you have to Wrestle the scar every day.”Water-based lotion · Wear the garment · Exercise.
🧴 W · Water-based lotion — the details
Why: the burn destroyed the sebaceous (oil) glands and sweat glands. Healed skin cannot lubricate itself, so it is dry, tight, fragile and intensely itchy.
Apply a water-based, non-perfumed moisturiser several times a day, especially after bathing
Avoid perfumed, alcohol-based or oil/petroleum-heavy products unless prescribed — they irritate or trap heat
Massage it in gently along the scar — the massage itself helps soften the scar
Bathe in lukewarm water with mild soap; pat dry, don't rub
For itch: cool compresses, loose cotton clothing, keep nails short, antihistamines as prescribed. Never scratch — it tears fragile new skin
🧠 “No glands = no grease.” The patient has to do manually what the skin used to do automatically.
👕 W · Wear the pressure garment
Why: constant, even pressure over a healing scar keeps collagen laying down flat and organized instead of piling up into a raised hypertrophic scar.
Custom fitted; worn as prescribed — commonly up to 23 hours a day, removed only for bathing and skin care
Worn for many months (often 12–24) until the scar has matured — pale, flat and soft
Must be snug but not painful; check for numbness, tingling, color change or reduced pulses
Inspect the skin underneath at every removal; report blisters or open areas
Two sets so one can be washed; replace when it stretches out and loses its pressure
Warn the patient: it is hot, tight and unglamorous, and adherence is the hardest part of rehab
🧠 “23 and 12.” About 23 hours a day, for about 12 months. Off only to wash and moisturise.
✨
SCARS & THE NEW SKIN
STEP 4 · WHAT THE SKIN CAN'T DO ANY MORE
Healed burn skin is not replacement skin. Knowing what it lost explains every teaching point.
🔬 Normal skin vs. healed burn scar — what is missing
Scar tissue has no hair follicles, no sebaceous glands, no sweat glands and less melanin. That single sentence explains dryness, itching, heat intolerance, sun sensitivity and color change.
🧠 “No hair, no oil, no sweat, no tan.” Four things the new skin cannot do — and four teaching points fall straight out of them.
📈 Scar maturation — it gets worse before it gets better
Warn the patient in advance: for the first months the scar becomes redder, thicker and itchier. That is normal maturation, not a complication. It then slowly fades, flattens and softens over 12–24 months.
🧠 “Angry at six months, quiet at eighteen.” Tell the patient this on day one so they don't panic — or give up on the garment — at month three.
☀️ Sun protection — for at least a year
Answer first: healed burn skin has less melanin and burns fast. Sun exposure also causes permanent, blotchy hyperpigmentation of the scar.
Avoid direct sun to healed areas — commonly taught as for at least 1 year / until the scar matures
Use a high-SPF broad-spectrum sunscreen on exposed healed skin, reapplied often
Better still: cover up — long sleeves, wide-brim hat, shade at midday
No tanning beds, ever
🧠 “New skin has no sunglasses.” The melanin that used to protect it burned off with the dermis.
🌡️ Heat & cold intolerance
Grafted and scarred skin cannot sweat and has poor blood-flow control, so temperature regulation is impaired.
Overheats quickly in hot weather or during exercise → heat exhaustion risk
Teach: exercise in the cool part of the day, drink fluids, take cool breaks, avoid saunas/hot tubs
Also feels the cold more — the insulating fat and vasomotor control are gone
Sensation may be reduced → check water temperature with an unburned area or a thermometer to avoid scalding
🧠 “No sweat, no thermostat.” Every hot-weather activity has to be planned.
💚
NUTRITION, MIND & GETTING LIFE BACK
STEP 5 · THE PERSON
Healing needs calories, and living needs a plan. Both are examinable.
🍗 Nutrition keeps working long after discharge
The hypermetabolic state can persist for months. A burn survivor who stops eating for healing loses the graft take, the strength and the weight they fought for.
🧠 “You cannot build a wall without bricks.” Protein is the brick, calories are the labor, vitamin C is the mortar.
🧠 The psychosocial work — do not skip this in an exam answer
A visible burn changes how the patient is seen and how they see themselves. Expect, normalize and screen for:
Body-image disturbance — avoidance of mirrors, refusing visitors, covering up even indoors
Depression & anxiety; PTSD with nightmares, flashbacks and avoidance of anything fire-related
Grief — for appearance, function, a home, or people lost in the same event
Social withdrawal, fear of staring/questions, reluctance to return to work or school
Sexuality and intimacy concerns — raise them; the patient often will not
Sleep disturbance and pain-related irritability
Nursing actions: encourage the patient to look at and touch the wound when ready; involve them in their own dressing changes to restore control; give honest, specific information about what the scar will look like in a year; refer to burn survivor support groups, psychology and social work; include family; rehearse a simple answer for strangers' questions.
🧠 “Ask about the mirror.” How a burn survivor talks about looking at themselves tells you more than any screening tool.
⭐ Discharge teaching — the one-page version
🧴LOTIONwater-based, several ×/day
👕GARMENTas prescribed, ~23 h/day
🤸EXERCISEROM every day
☀️SUNcover up · SPF · 1 year+
🥩PROTEINhigh cal, high protein
🌡️HEATcan't sweat — pace yourself
🚫NO SCRATCHcool, cotton, short nails
📞REPORTopen areas, fever, ↓ROM
💚SUPPORTgroups & counseling
Tell the patient to call if: a healed area breaks down or opens; drainage, increasing redness, swelling or fever; a joint is losing movement; the garment causes numbness, tingling or color change; pain or itch becomes unmanageable; or mood is sinking.
🧠 “Lotion · Garment · Exercise — every day, for a year.” If a patient can repeat that back, the discharge teaching worked.
🦴 Position against comfortNo pillow for neck burns · shoulders 90° · elbows & knees straight · ankles 90°.
✨ Scar peaks then fadesWorst at 3–6 months, mature by 12–24. Garments until mature.
🛡️ Infection is NOT the risk hereRehab-phase priority is function, not sepsis.
🎯 Cover & check — 8 rapid-fire questions
Q1: When does the rehabilitation phase begin and how long does it last?
It begins once the wounds have fully healed, and typically lasts around 12 months or more depending on the severity of the burn. Scar remodeling can continue for 18–24 months.
Q2: Give the three patient-education points as a mnemonic.
Q3: Is infection the main risk in the rehabilitation phase?
No. The wounds are closed, so infection is no longer the big risk — that belonged to the acute phase. The rehab-phase risks are contractures, hypertrophic scarring, loss of function and psychosocial problems.
Q4: A client has an anterior neck burn and asks for a pillow. What do you do?
Do not give a pillow. It flexes the neck and promotes a flexion contracture. Position the neck in slight extension — a small towel roll under the shoulders is acceptable — and explain why.
Q5: Why is water-based lotion needed, and what should be avoided?
The burn destroyed the sebaceous and sweat glands, so healed skin cannot moisturise itself and becomes dry, tight and itchy. Use water-based, non-perfumed moisturiser several times a day; avoid perfumed or alcohol-based products, and do not scratch.
Q6: How long is a pressure garment worn each day, and why?
As prescribed — commonly up to 23 hours a day, removed only for bathing and skin care, and continued for many months until the scar matures. Constant even pressure keeps collagen flat and organized, preventing hypertrophic scarring.
Q7: The client says the scar is redder and itchier at 4 months than at discharge. What do you say?
Reassure them: scar tissue typically peaks in redness, thickness and itch around 3–6 months and then slowly fades, flattens and softens over 12–24 months. Reinforce the lotion, garment and exercise routine — this is exactly when people give up on them.
Q8: Why must a burn survivor avoid direct sun and hot environments?
Healed skin has less melanin so it burns fast and pigments permanently and unevenly — avoid direct sun to healed areas for at least a year and use high-SPF sunscreen or clothing. Grafted skin also has no sweat glands, so the patient overheats easily and is at risk of heat exhaustion.