When should ambulation be initiated for a client who has sustained a major burn?

Initiating ambulation after the resolution of the fluid shift is crucial for several reasons in a client who has sustained a major burn. The fluid shift refers to the movement of fluids from the intravascular space into the interstitial space, which is common in burn injuries due to loss of skin integrity and increased capillary permeability. This shift can result in hypovolemia, edema, and significant physiological stress on the body.

Once the fluid shift has resolved, the patient is typically better hydrated and more stable, allowing for safer ambulation. Early ambulation is important in promoting circulation, preventing complications such as deep vein thrombosis and muscle atrophy, and facilitating the healing process. It encourages respiratory function, which is particularly vital for burn patients who may have inhalation injuries or be bedridden for long periods.

In contrast, waiting for full-thickness areas to be closed with skin grafts or the stabilization of temperature might delay ambulation unnecessarily. While these factors are important in a broader treatment plan, they are not specifically related to the immediate ability to mobilize the patient following a burn. Ambulation can begin as soon as the patient is stable enough, which is typically after addressing the fluid shifts. Hence, focusing on the resolution of fluid shifts is