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Wound Care Exam 2 > Burn Management > Flashcards

Burn Management Flashcards

1
Q

What are the three peak incidences for burns?

A

Children 1-5 2 to scalds
Adolescents 2 to accidents with flammable liquids
Men 16-40

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2
Q

Which demographic has the highest incidence of burns?

A

Men 16-40

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3
Q

What is the amount of time needed for follow-up post burn injury?

A

Minimum of 1 year

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4
Q

What are the four classifications of burns?

A

Superficial
Superficial partial thickness
Deep partial thickness
Full thickness

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5
Q

What are some characteristics of a superficial burn? (3)

A

Tender to touch
Dry, bright red, or pink skin that blanches under pressure
No edema or blisters

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6
Q

A superficial burn involves what layer(s) of the skin?

A

The epidermis only

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7
Q

What is the healing time for a superficial burn?

A

2-3 days with no scarring

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8
Q

A superficial partial thickness burn involves what layer(s) of the skin?

A

Epidermis and papillary layer of the dermis

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9
Q

What are some characteristics of a superficial partial thickness burn? (4)

A

Moist, weeping, (intact) blistered skin
Will blanch under pressure
Painful due to exposed nerve endings
Wound drainage

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10
Q

What is the healing time for a superficial partial thickness burn?

A

7-10 days with minimal scarring

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11
Q

A deep partial thickness burn involves what layer(s) of the skin?

A

Epidermis and dermis down to reticular layer - includes nerve endings, hair follicles, and sweat glands

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12
Q

What are some characteristics of a deep partial thickness burn? (5)

A 
Mottled areas of red with white eschar
May have large ruptured blisters
Sluggish capillary refill
Significant edema
Decreased sensation
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13
Q

What is the healing time for a deep partial thickness burn?

A

3-5 weeks, split thickness skin graft is usually required

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14
Q

A full thickness burn involves what layer(s) of the skin?

A

Epidermis and dermis

Subcutaneous tissue may also be involved

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15
Q

What are some characteristics of a full thickness burn? (6)

A

Covered with eschar (black/deep red/white)
Necrotic, charred
Leathery, dry, rigid
Exposed deep tissues (tendon, muscle or bone)
Insensate
Peripheral vascular system damaged –> fluid leaks into interstitial spaces –> edema
Split thickness skin graft required

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16
Q

What is an escharotomy?

A

an incision through the eschar to expose the fatty tissue below

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17
Q

Why would a patient have an escharotomy?

A

To combat compartment syndrome

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18
Q

What is a subdermal burn?

A

A burn from the dermis down through the subcutaneous tissue, muscle, and bone

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19
Q

What would cause a subdermal burn?

A

Prolonged contact with flame, hot liquid, electricity, etc

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20
Q

What would a subdermal burn look like?

A

Charred or mummified

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21
Q

Will a subdermal burn need intervention?

A

Yes, it will not heal without intervention such as fasciotomy, escharotomy, grafting
Amputation is usually required however

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22
Q

What is the breakdown of percentages of the TBSA classification for burns? (Rule of 9’s)

A

Head - 9%
Arms - 9% each
Trunk - 18% each for ant/post
Legs - 18% each

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23
Q

What are three types of burns?

A

Thermal
Chemical
Electrical

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24
Q

Which type of burn is most common?

A

Thermal

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25
Q

What are some severity factors for thermal burns? (3)

A

Contact time
Temp
Type of insult

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26
Q

What are some severity factors for chemical burns? (4)

A

Alkali > acid
Contact time
Concentration
Amount of chemical

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27
Q

What are some severity factors for electrical burns? (3)

A

AC > DC
Contact time
Voltage

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28
Q

What are some things to watch for with an electrical burn? (3)

A

Entrance and exit wounds
Cardiac arrythmias
Respiratory arrest

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29
Q

What is an inhalation injury?

A

An injury from inhaling smoke/hot air

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30
Q

The absence of a smoke detector increases the risk of death in a fire by what %?

A

60%

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31
Q

What is Stevens Johnson Syndrome (SJS)?

A

An immune complex mediated hypersensitivity disorder involving the skin and mucous membranes

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32
Q

What is SJS caused by?

A

Drugs, viral infections

33
Q

How do you classify the severity of a burn? (5)

A 
TBSA burned
Depth of wound
Age of pt
PMH
Part of body burned
34
Q

Why would you see shock in a burn pt?

A

Hypovolemia ( ↑HR, ↓ BP, ↓ urine)
Loss of plasma and extracellular fluid
TBSA > 30%

35
Q

When would you see hypermetabolism in a burn pt?

A

> 50% TBSA (may be 2.5 BMR)

36
Q

What is involved the medical management of a burn? (7)

A 
Maintain airway
Determine extent/depth of injury
Prevent fluid loss
Prevent pulmonary and CV issues
Clean pt and wounds
Place dressings
Surgical management
37
Q

What are the three phases of burn management?

A

Resuscitive phase
Wound coverage phase
Reconstructive phase

38
Q

What is involved in the resuscitive phase? (4)

A

IV therapy to compensate for fluid loss
Escharotomy as needed
NPO first 24 hr
CV support as needed

39
Q

What is involved in the wound coverage phase? (3)

A

Excision/debridement
Dressings
Grafting if needed

40
Q

What are some common dressings used in burns? (5)

A

Silvadene - use on non-grafted burn or donor site
Acticoat/Mepilex - impregnated with Ag
Collagenase - for deeper burns or grafts with slough/eschar
Bacitracin - for grafts or donor sites
Sulfamylon - used on grafts with poor adherence (soupy or fragile)

41
Q

What are four options for skin grafts?

A

Autograft (STSG)
Allograft (cadaver skin)
Xenograft (pig)
Skin substitute (Integra)

42
Q

What is the only skin graft that is permanent?

A

Autograft

43
Q

What are some advantages of using a sheet STSG? (3)

A

Durable
Limits contraction
Cosmetic

44
Q

What are some disadvantages of using a sheet STSG?

A

Difficult adherence

45
Q

What are some advantages of using a mesh STSG? (3)

A

Covers more area
Better if wound bed is irregular
Better if wound bed is contaminated

46
Q

What are some disadvantages of using a mesh STSG?

A

Less durable

Contracts more

47
Q

What are some common STSG donor sites?

A

Thigh
Leg
Back
Buttock

48
Q

How many times can a donor site be harvested?

A

3-4

49
Q

How would you treat a donor site?

A

As a partial thickness wound

50
Q

What factors need to be present in the graft recipient area? (4)

A

Adequate vascularity
Complete contact between graft and wound
Adequate immobilization
Few bacteria

51
Q

What are some physical therapy goals for burn pts? (7)

A 
Decrease edema
Prevent contracture
Maintain/improve strength and activity tolerance
3 day hold after STSG to LE for gait
Pt edu
D/C planning
Manage scarring
52
Q

What are some benefits of ace wrapping a burn?

A

Supports graft or burn area
Promotes circulation
Preventing hemorrhaging
First phase of scar control

53
Q

What shape will you use for ace wrapping a burn?

A

Spiral or figure 8

54
Q

Can a pt sleep in an ace wrap?

A

No

55
Q

When should ROM be performed?

A

Upon admission

56
Q

What are some benefits of ROM? (5)

A 
Reduce edema
Promote circulation
Prevent contractures
Preserve jt mobility
Promote max functional independence
57
Q

What kind of burns have a greater chance of scar contracture?

A

Deeper burns

58
Q

How pliable is burn scar tissue?

A

1/3 of normal skin

59
Q

How should you keep burn scar tissue?

A

Elongated

60
Q

How do you know if burn scar tissue is tight?

A

If it’s white, it’s tight

61
Q

What are some contraindications to exercise in burn pts? (4)

A

Exposed joints
Exposed tendon over PIPs
DVT
Comparment syndrome

62
Q

How much exercise is too much exercise for burn patients?

A

You cannot over-exercise

63
Q

How long should a skin graft be immobilized?

A

5-14 days

64
Q

Do we want burn patients to be comfortable?

A

NO. THEY WILL FORM CONTRACTURES AND DIE!!!

65
Q

What are some complications of facial burns?

A

Ectropion of eye

Ectropion of mouth

66
Q

What is an ectropion of the eye?

A

The lower lid pulls away from the eye

67
Q

What are some complications an ectropion of the eye? (3)

A

Excessive tear production
Conjunctivitis
Keratitis

68
Q

What are some complications an ectropion of the mouth?

A

Difficulty managing secretions, liquids

69
Q

What are potential some complications of a shoulder burn? (3)

A

Flexion or adducation contracture
Scapular retraction of protraction contracture
Limited chest wall expansion

70
Q

What are potential some complications of a wrist burn? (2)

A

Flexion or extension contracture

Inability to ulnar deviate

71
Q

What are potential some complications of a hip burn? (2)

A

Flexion contracture

Inability to fully extend hips during gait

72
Q

What are potential some complications of a knee burn? (2)

A

Flexion contracture

Inability to fully extend knees during gait

73
Q

What are potential some complications of a ankle burn? (2)

A

PF contracture

For deep partial and full thickness, which cross posterior ankle, consider multipodus boot

74
Q

What are potential some complications of a MTP/IP burn? (2)

A

Can affect wearing shoes or push-off during gait

Use aggressive ROM

75
Q

What is the most important rule of positioning for burn patients?

A

POSITION OF COMFORT = POSITION OF CONTRACTURE

76
Q

What percentage of burn patients will develop hypertrophic scarring?

A

80% - the use of compression therapy is indicated for most burns

77
Q

What benefits from compression therapy confer?

A

Mechanical thinning effect
Decreases blood flow to area
Reorganizes collagen bundles
Decreases tissue water content

78
Q

How long will patients need to wear compression garments after a burn?

A

1-2 years, 23 hours per day

Wound Care Exam 2 (4 decks)

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