Burn management Flashcards
high risk populations
- elderly *mobility issues, decrease safety
- young children *mobile
- physically disabled *no judgement, in w/c harder to get out of way
- mentally ill
- workers in hazardous conditions
classification of burns
- determined by the following factors:
- type of burn
- depth of burn
- TBSA=total body surface area involved in burn
*partial or full thickness burn
different classification for children compared to adults
splint to prevent contractors
thermal burns
caused by flames, steam, hot metal, frost bite, or work related
chemical burns
job related, acid, industrial, splash burns
electrical burns
electrical current can cause amputation
radiation burns
sun burn (mild redness to blister)
friction burn
MVA- body impacting gravel/ground
superficial partial thickness
- evaluated by physician. burn depth can change if infection comes along- can become deeper
- damage to epidermis and upper layer of dermis *pt. has intact blisters and pain. pain is good indicator means nerve endings are intact
- intact blisters and pain
- heal within 7-21 days with minimal to no scarring *diabetes healing time takes longer
- you want grey tissue away (only take off if loose and ready to go) don’t cause bleeding or increase new wound
- wet/dry
deep partial thickness
- injury to epidermis severe damage to dermis
- blotchy and whitish
- increase pressure sense
- decrease light touch
- 3-5 weeks healing, often grafted
- sensory return is limited (may never have fine sensation of light touch, pain, temp). limited ability to regulate body temp
*more narcotic tissue (will peel off), painful (hover tank for wound care), need comfort measures before hand (prior to ROM)
typical care: debridement, ROM. surgeon will let you know if AROM/PROM is appropriate.
full thickness
*not as common. usually smaller areas
- both epidermis and dermis destroyed
- may damage subcutaneous fat, muscle, and bone tissue
- wounds are white and waxy
- senstation due to destruction of dermal nerve endings
- require surgical care grading or amputation
*no PROM
resting hand spint?
work on other areas that are not full thickness
wait for amputation bc of all the increase surgeries , unless septic
medical issues related to burns
- infection
- pulmonary comps *carbon dioxide, age, increase co-morbidities, pneumonia (inhalation injuries)
- metabolic comps- *thermal causes, increase caloric intake, anoxic ep, tracheal damage, hard to keep up with nutrients, feeding tube bc aspiration, increase protein, increase calories to regulate temp, weaker bc in bed, room temp 86 degrees, help with caloric needs
- cardiac/circulatory comps- *heart is working hard to manage output, measure fluids, splint is continuously re-sized as swelling decrease
- heterotrophic ossification- *laying bony ossifits, hot swollen, decrease ROM, hurts to stand, supine to sit, ROM, 20% or more body percentage are more prone, full thickness burns and protein
- neuropathy- *larger surface area, poor sensation, increase pain-hands and feet more common painful in cold
escharotomy
surgical circumferential- give more room for fluid. make incision in forearm or wherever burn is. increase edema, decrease compression-help a-leave pressure and restore circulation
wound care
ask surgeon before de-bulking dressing to move more. always ask about wet to dry
septic shock
form of shock when toxics are released in body. *BP (drastic), increase confusion, agitation, increase temp, tachycardia, increase respiration
excision
OR-remove escar, dead nacrotic tissue, decrease scarring.
drugs
narcotics, morphine, keep caloric intake for healing not on pain, demorol, codeine,
analgesics, tylenol, inflammation, pain control
antacids, start right away (stress ulcers)
antibiotics: oral and topical
need ROM to preview deformities - match this with meds to decrease pain, unable to do so when needs are wearing off!
autograft
come from thigh, inner or thinner
from patient: permanent. more extensive burn damage
homeograft
(allograft) skin donor, temporary
staple to area until good capillary flow
just a covering to protect
xenograft
(herograph) :pigskin. temporary
stapled. speeds healing process, decrease healing time
promote more blood supply, decrease infection/bacteria
bilayer skin substitute
permanent skin substitute
sheet graft
full thickness
mesh graft
perforated to increase surface area
*want nice smooth skin on the back of the hand.
prone for scarring
scar massage
teach pt. scar massage strategies -soft
maintain mobility and ROM to decrease claw and hand deformity.
graft guidlines
grafts need to be immobilized. don’t do anything to that side. don’t mobilize any area that is freshly grafted (immobilize for 7-10 days!_ allow healing tissue to get stabile enough for mvmt.
hypertrophic scars
- increase vascularity
- increase fibroblasts
- increase myofibroblasts
- interstitial fluid
- collagen
*compliance is an issue with jobst garment and facial mask
- form in a swirl pattern
- pressure tends to flatten
- round swirls to give flatter formation (wear jobst garment)
otoform and jobst garments
- help with webbing and soft tissue contractors
- help skin heal back to place/adds compression
- also lubricates the skin
- wear 23 hours a day-not while showering
burn treatment. 3 phases
acute phase* emergent phase, pt. initially brought into ER-life or death need a lot to stabilize . a lot going on.
surgical post-operative phase
rehab phase
acute phase (eval)
eval- *not many standarized assessments
- edema* #1 can destroy tissue and mvmt later on
- need fluids to increase caloric intake . *positioning only thing that we can do.
- fx AROM * ROM to pump fluid out/have pt help as able to get more engaged when up
- strength* start to lose muscle strength immediately. mvmt right away, start to reach for things, drink, ed mobility, whatever they are able to do.
- sensation *epidermis (nerve endings affected). with gloves. can see if they can feel pressure or localize touch. limited at this pt. don’t test pain sensation!
- self-care skills * low level, oral care, using urinal, ambulate to BR, help take off dressing or splint. basic!
acute phase (treatment)
prevent loss of jt/skin mobility *minimize risk of contractures
prevent loss of strength and endurance *preserve
control edema
self-care skills
education of pt./family *let them know what you’re doing. next step of rehab.
psychosocial support *body image issues
ROM program- start every session the same give pt a sense of control start sh. move back and forth (10 reps)
have to be firm (decrease deformity later on)
start with hard stuff 1st.
couple times a day depending on case load.
burn splint or burning pam splint
30 degree of wrist ext. 70 deg. of mp flexion with IP ext.
no straps wrap it on more adherence to splint. as pt. loses more fluid re-heat and re-mold splint.
take off for exercise
easy to rupture tendons/extensors (butinare deformity) prevent early on with splint.
range hand with wrist ext. fingers flexed
or
wrist flexion, fingers ext.
surgical post - operative phase :eval
fx a/prom *do goniometry.
strength *dynomometor, pinch, 9 hole peg, jebson, track pt.
self-care AE (large handles, button, zipper aid, donning/doffing clothes, hair, makeup
sensation 2 pt. touch, localization, temp- in terms of safety. and depending on wounds.
mental status * how are they managing (depression, coping, support)
motivation * keep pt. motivated supporting pt. and family.
surgical post- operative phase: treatment focus.
positioning
splinting * static to dynamic
exercise *stretching, fine and gross motor
self-care *expand and refine skills/develop strategies
cog stim *compensate
psychosocial adjustment
rehab phase :eval
a/prom *exercise strength *compare measurements strength sensation *sems coord. *9 hole peg, jebsen ADLs
prevocational assessment
compression garments *jobsts wrap, help with don/doff
patient education *on going
rehab phase : treatment focus
positioning *more to max. fx mobility. sleeping positions-mainting alignment to decrease contractures. no pillow under knees, head and neck aligned
splinting *constantly changing pull into more finger flexion to work on grasp. help with skills they’re lacking.
sensory re-education *grafted skin never has full sensation. compensate with vision, safety awareness.
exercise *get pt. to take over stretching
ADLs
work-related skills
scar control *wearing atlas 15 spf or higher
-always be likely to burn
-moisturize year round
pt./fam education *can’t regulate temp, need to be aware/hydrate
dynamic burn splint
mp flexion
work on closing the hand
decrease claw deformity
