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NBCOT Exam (2024) > Burn Rehabilitation > Flashcards

Burn Rehabilitation Flashcards

1
Q

This layer of skin is also known as corium and is composed of fibrous connective tissue made of collagen and elastin.

A

Dermis

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2
Q

This layer of skin is the outermost layer of epithelium. It consists of four or five layers, depending on location and type of skin.

A

Epidermis

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3
Q

A thermal injury that destroys layers of the skin is called a…

A

Burn

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4
Q

What is the “Rule of Nines”?

A

Used when talking about total body surface area (TBSA) percentage.

The Rule of Nines divides the body into 9s or multiples of 9s to calculate the total body surface area of burns.
–The head and neck area is 9%
–Each upper extremity is 9%
–Each lower extremity is 18%
–The front and back of the trunk are each 18%
–The perineum is 1%

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5
Q

Aside from using the Rule of Nines to calculate TBSA (total body surface area), what is another, more accurate method?

A

The Lund-Browder chart is a more accurate method of calculating TBSA. It assigns a percentage of surface area to body segments, with calculations adjusted by age groups.

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6
Q

This type of burn Involves the superficial epidermis. The patient experiences short-term moderate pain. There is no blistering with minimal erythema, and it is dry. The healing time is 3–7 days. Common causes include sunburn and brief exposure to hot liquids or chemicals. There is no potential for hypertrophic scar or contractures.

A

Superficial burn

Also known as first-degree burn

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7
Q

This type of burn involves the epidermis and upper dermis layers. The patient experiences significant pain. Both wet blistering and erythema are present. The healing time is 1–3 weeks. Common causes include severe sunburn or radiation burn, prolonged exposure to hot liquids, and brief contact with hot metal objects. There is minimal potential for hypertrophic scar or contractures if healing is not delayed.

A

Superficial partial-thickness burn

Also known as second-degree burn

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8
Q

This type of burn involves the epidermis and the deep dermis layers, hair follicles, and sweat glands. The patient experiences severe pain, even to light touch.
Erythema is present, with or without blisters. These burns have a high risk of turning into a full-thickness burn because of infection; grafting may be considered to prevent wound infection. The patient may have impaired sensation. Common causes include flames, firm or prolonged contact with hot metal objects, and prolonged contact with hot, viscous liquids. The scar potential is high. The healing time varies from 3–5 weeks.

A

Deep (partial-thickness) burn

Also known as second-degree burn (with superficial partial thickness burn)

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9
Q

This type of burn involves the epidermis and dermis, hair follicles, sweat glands, and nerve endings. The patient has no sensation to light touch except at deep partial-thickness borders. The burn is pale and nonblanching and requires skin graft. Common causes include extreme heat or prolonged exposure to heat, hot objects, or chemicals for extended periods. The scar potential is extremely high for hypertrophic scarring or contractures.

A

Full-thickness burn

Also known as third-degree burn

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10
Q

This type of burn is a full-thickness burn with damage to underlying tissue such as fat, muscles, and bone. There is charring is present; may have exposed fat, tendons, or muscles. If the burn is electrical, destruction of nerve along the pathway is present. The patient will have significant peripheral nerve damage and will require surgical intervention for wound closure or amputation. Common causes include electrical burns and severe long-duration burns (e.g., house fire). The scar potential is extremely high for hypertrophic scarring or contractures.

A

Subdermal burn

Also known as fourth-degree burn

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11
Q

Heat (e.g., flame, steam, hot liquid, hot object) and Cold (e.g., dry ice) are examples of which mechanism of burn injury?

A. Chemical
B. Thermal
C. Radiation
D. Electrical

A

B. Thermal

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12
Q

Acid (e.g., sulfuric acid, hydrochloric acid) and Alkali (e.g., dry lime, potassium hydroxide, sodium hydroxide) are examples of which mechanism of burn injury?

A. Chemical
B. Thermal
C. Radiation
D. Electrical

A

A. Chemical

Burn results in tissue necrosis rather than direct heat production.

Degree of tissue injury is dependent on toxicity of the chemical and exposure time.

Alkali burn is usually more severe than an acid burn.

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13
Q

High-voltage direct current (DC) and Low-voltage alternating current (AC) are examples of which mechanism of burn injury?

A. Chemical
B. Thermal
C. Radiation
D. Electrical

A

D. Electrical

NOTES:
Direct current (DC): usually causes a single muscle contraction and throws its victim from the source. Client is more likely to have blunt trauma along with the burn.

Alternating current (AC): causes greater muscle contraction and makes it more difficult for the person to voluntarily control muscles to release the electrified object. It is more dangerous than DC at the same voltage.

Extensive burned areas, including organs, depending on the electrical current’s path.

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14
Q

Sunburn, X-rays, and radiation therapy for patients with cancer are examples of which mechanism of burn injury?

A. Chemical
B. Thermal
C. Radiation
D. Electrical

A

C. Radiation

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15
Q

Which phase of burn injury rehabilitation is described below?

“Medical treatment focuses on sustaining life, controlling infection, and managing pain. It can include intravenous fluids, intubation (if inhalant injury), escharotomy (surgical incision of eschar or burned tissue to relieve pressure on extremities after burns), fasciotomy (a similar incision that extends to the fascia), wound dressings with antimicrobial ointment for infection control, and universal precautions for medical staff and family.”

A. Emergent phase
B. Acute Phase
C. Rehabilitation Phase

A

A. Emergent Phase (0–72 Hours After Injury)

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16
Q

What are 5 key concerns in the Emergent Phase (0–72 Hours After Injury) of burn injury around sustaining life?

A
  1. Risk of dehydration: Depending on the TBSA burned, the client is at risk of dehydration through evaporation.
  2. Hypo- or hyperthermia: Without protection from the skin, the client may not be able to perspire to cool the body surface or contain heat.
  3. Fluid resuscitation: Rapid leakage of the protein-rich intravascular fluid into the surrounding extravascular tissues can result in decreased plasma and blood volume and reduced cardiac output.
  4. Cardiopulmonary stability: Achieving this stability is especially important if the respiratory tract has sustained a smoke inhalation injury.
  5. Escharotomy and fasciotomy: Circulation can be compromised when burn injuries girdle a body segment. The inelasticity of the eschar (burned tissue) can increase the internal pressure within fascia compartments and lead to compartment syndrome.
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17
Q

Symptoms of paresthesia, coldness, and decreased or absent pulse in the extremities mark which emergent, burn-related condition?

A

Compartment syndrome

Surgical excision of the eschars or incision into the fascia can release the pressure within the fascia compartments.

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18
Q

Controlling infection is crucial during the Emergent Phase of burn rehab. The skin serves as an environmental barrier and protects against bacterial invasion, thus, open wound areas increase the chances of bacterial infection and can be a wound bed for bacteria to grow.

What are the 3 main types of wound dressings used?

A
  1. Topical antibiotics
  2. Biologic dressing
    –Xenografts—bovine skin, processed pig skin
    –Allograft—human cadaver skin
  3. Nonbiological skin-substitute dressings (biosynthetic products such as Biobrane®)
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19
Q

In addition to sustaining life and controlling infection, what is one other main focus for patient care during the Emergent Phase of burn rehab?

A

Pain management

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20
Q

Which phase of burn injury rehabilitation is described below?

“Treatment focuses on infection control and grafts (removal of dead tissue and replacement of skin or substitute over the wound); biological dressings may also be used to cover the wound. Team communication is important during this phase. This phase may last for days or months.”

A. Emergent phase
B. Acute Phase
C. Rehabilitation Phase

A

B. Acute Phase: 72 Hours After Injury or Until Wound Is Closed

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21
Q

Which type of skin graft is described below?

“Used when there is not sufficient donor skin to cover all of the affected area with autograft (e.g. biologic such as allografts or xenografts vs synthetic).”

A. Autograft
B. Split-thickness skin graft
C. Full-thickness skin graft
D. Meshed graft
E. Sheet graft
F. Skin substitutes

A

F. Skin substitutes

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22
Q

Which type of skin graft is described below?

“When the donor graft is “meshed” and stretched to cover a greater area of the receiving area.”

A. Autograft
B. Split-thickness skin graft
C. Full-thickness skin graft
D. Meshed graft
E. Sheet graft
F. Skin substitutes

A

D. Meshed Graft

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23
Q

Which type of skin graft is described below?

“Transplantation of the person’s own skin from an unburned donor site to the burned receiving site.”

A. Autograft
B. Split-thickness skin graft
C. Full-thickness skin graft
D. Meshed graft
E. Sheet graft
F. Skin substitutes

A

A. Autograft

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24
Q

Which type of skin graft is described below?

“The total epidermal and dermal layers plus a percentage of fat layers are taken from the donor site. Chance of graft survival is less. The outcome is functionally and cosmetically better if graft adherence occurs.”

A. Autograft
B. Split-thickness skin graft
C. Full-thickness skin graft
D. Meshed graft
E. Sheet graft
F. Skin substitutes

A

C. Full-thickness skin graft

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25
Q

Which type of skin graft is described below?

“When the donor graft is removed and laid down on the receiving area as is.”

A. Autograft
B. Split-thickness skin graft
C. Full-thickness skin graft
D. Meshed graft
E. Sheet graft
F. Skin substitutes

A

E. Sheet graft

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26
Q

Which type of skin graft is described below?

“Full epidermal and partial dermal layers are taken from the donor site. Chance of graft survival is high. These autografts are considered gold standard.”

A. Autograft
B. Split-thickness skin graft
C. Full-thickness skin graft
D. Meshed graft
E. Sheet graft
F. Skin substitutes

A

B. Split-thickness skin graft

27
Q

Why is it important to ensure proper nutrition and hydration during the Acute Phase of burn rehabilitation?

A

A high-protein diet promotes wound healing.

Maintaining proper hydration due to loss of skin as a hydrating barrier.

28
Q

Which phase of burn injury rehabilitation is described below?

“This phase continues until scar maturation (can take 6 months to 2 years). Medical treatment continues with skin grafts and reconstruction surgery as needed for movement and function. Considered complete when scar becomes pale and rate of collagen synthesis stabilizes. Continue management of components from preceding phases as needed, as well as consideration for psychosocial factors and scar monitoring/maintenance. “

A. Emergent phase
B. Acute Phase
C. Rehabilitation Phase

A

C. Rehabilitation Phase (6 Months to 2 Years)

29
Q

What at the 3 key components of every burn evaluation?

A
  1. (Not physical, but part of every evaluation) Obtain burn etiology, medical history, and secondary diagnoses.
  2. Visually assess wounds, focusing on extent and depth of injury.
  3. Assess joint mobility, strength, sensation, and functional use. Note wound location, severity, edema. Assess passive range of motion (PROM), active range of motion (AROM), strength, gross and fine motor coordination, sensation. Document pain, edema, tight eschar, or bulky dressings impacting ROM.
30
Q

(In burn rehab) When considering occupation and performance during evaluation, what are 3 main skill/functional areas to assess?

A
  1. Assess areas affecting future occupational performance, including but not limited to hand dominance, previous injuries, prior conditions
  2. Assess performance skills and patterns, daily routines, and activities. Assess ADL performance level and functional status, when client is medically stable, and leisure activities.
  3. Assess psychological status, cognitive functioning, and social support.
31
Q

What is the main goal of splinting and positioning during the Emergent Phase of burn rehab?

A

Prevention of early contracture formation through splints and position programs

Ideal to initiate OT intervention as early as 24 to 48 hours after burn

32
Q

If someone has experienced a burn on their mouth, what splinting position should they be put in?

A

Maximum vertical and horizontal opening (may alternate)
- Prefabricated microstomia devices can do this.

33
Q

If someone has experienced a burn on their neck, what splinting position should they be put in?

A

Neutral or slight extension

  • Remove pillows from under head
  • Soft collar vs. hard collar for prefabricating general splints
  • Customized thermoplastic splints
  • Towel roll behind neck or between scapulae
34
Q

If someone has experienced a burn on their axilla, what splinting position should they be put in?

A

90° of flexion and abduction, commonly referred to as scaption (UE is positioned in the plane of the scapula)
- Custom airplane splint made from thermoplastic material (e.g., DonJoy® S.C.O.I. brace [DJO; Vista, CA], which includes the shoulder, elbow, wrist, and hand); allows 30°–150° of abduction at shoulder

35
Q

If someone has experienced a burn on their elbow, what splinting position should they be put in?

A

Extension
- Custom anterior-fitting elbow extension splint
- Or can use a Knee immobilizer cut to size

36
Q

If someone has experienced a burn on their wrist, what splinting position should they be put in?

A

Neutral up to 45° of extension
- Prefabricated wrist cock-up
- Custom wrist cock-up

37
Q

If someone has experienced a burn on their hand, what splinting position should they be put in?

A

Intrinsic plus (safe position)
- Custom safe-position splint
- Finger extension splint or baseball glove splint (for deep palmar burns)

38
Q

If someone has experienced a burn on their knee, what splinting position should they be put in?

A

Extension
- Knee immobilizer
- Custom posterior-fitting knee splint

39
Q

What is the main focus of occupational therapy during the Acute Phase of burn rehab?

A

Occupational therapy focuses on continued assessment of ADLs/IADLs, psychosocial aspects, communication, cognition, ROM, muscle strength, and pain

Managing edema, continuing with splinting, and early participation in ADLs

39
Q

If someone has experienced a burn on their ankle, what splinting position should they be put in?

A

Neutral
- Burn MPO (multipodus boot)
- Custom posterior foot splint

40
Q

Name 1 assessment that can be used during the Acute Phase of burn rehab.

A

Patient and Observer Scar Assessment Scale

Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire

Brief Burn Specific Health Scale (BSHS-B)

ICF Core Sets for Hand conditions

Jebsen-Taylor Hand Function (JTHF) Test

41
Q

What are 3 ways to manage edema for burns?

A
  1. Elevation of extremities
  2. AROM exercises, if movement is allowed
  3. Wrapping (compression) with elastic bandage, unless bulky wound dressing is used
42
Q

To encourage early participation in ADLs with a patient who experienced burns, what are 3 strategies you would want to focus on?

A
  1. Adaptation: equipment, strategies, environment
  2. Oral care, self-feeding, and communication if appropriate
  3. ROM: active, active-assistive, passive
43
Q

When a client begins participating in ADLs post-burn injury, how would you support them to avoid pooling of fluid and blood in the lower extremities in dependent or standing position?

A

Apply compression wrapping to provide adequate vascular support to lower extremities before walking, standing, or prolonged sitting with feet in dependent position.

44
Q

What kind of client and caregiver education should be provided to a patient with burn injury?

A
  1. Stages of burn recovery
  2. Importance of activity and exercise participation
  3. Pain management techniques
  4. ROM exercises, safety precautions, and contracture prevention
45
Q

In regard to positioning, how should the donor site (of a skin graft post burn injury) be treated?

A

Similar to a burn site: elevated and wrapping with elastic bandage to manage edema

45
Q

What is the most important consideration for a patient with burn injury post-surgery (graft)?

(Hint: think splinting)

A

Immobilization of the affected area (generally 2-4 days)

Walking can resume after 5-7 days if lower extremities are affected

Why is it important? Immobilization allows for graft adherence

46
Q

Can a person who experienced a burn injury exercise post-surgery (graft)?

A

Exercise, daily activity, and movement of the uninvolved extremities should be continued.

Movement of other joints involved should be continued if able to avoid tension on grafts.

After immobilization period, start with gentle AROM to avoid shearing of the new grafts.

47
Q

During the inpatient rehabilitation stage of burn rehab, the wound is healing and wound closure is stable. What is the first important consideration for occupational therapy?

A

Skin conditioning, including:

  1. Skin lubrication should be performed several times a day to prevent dry skin from splitting because of shearing forces or overstretching during movement and exercise.
  2. Use skin massage to desensitize the hypersensitive grafted sites or burn scars. Massaging a tight scar band can reduce shearing forces and prevent splitting of immature or problematic scar tissue.
  3. Use sunblock or sun protective clothing; avoid unprotected sun exposure.
48
Q

Why is compression during the inpatient rehabilitation phase of burn rehab important?

A

Edema control and scar compression

This is important to do for all graft sites, donor sites, and wounds that take more than 2 weeks to heal spontaneously.

  1. Pressure bandages or garments: elastic bandages, 3M Coban, isotonic gloves with impression silicone, tubular bandages, bike pants
  2. Custom compression garments: Should be worn 24 hours a day except when bathing, massage, or other skin care activity (should have 2 pairs of the garment to replace)
49
Q

True or false: It is not necessary to splint or position a patient post-burn injury during the inpatient rehabilitation stage of burn rehab.

A

FALSE!

Continue anticontracture positioning and dynamic or serial casting as needed to prevent contracture formation.

50
Q

During the inpatient rehabilitation phase post-burn injury (post-op), what considerations should OT have for ADLS?

A
  1. Apply adaptive devices, strategies, and equipment to promote independence
  2. Identify atypical movement patterns to promote normal movement patterns
51
Q

Why is it important to address psychosocial factors or burn injury throughout the entirety of the occupational therapy process?

A

–Client may experience symptoms of posttraumatic stress disorder, depression, anxiety, and/or withdrawal reactions.
–An adjustment period may be needed when re-integrating into the community, especially if disfigurement or contracture has occurred.
–Client may require counseling, a support group, training in pain management, relaxation, and stress management.

52
Q

__________ results from tight scar band, hypertrophic scar, or prolonged immobilization.

A

Contracture

53
Q

What are 3 ways to prevent contracture post-burn injury?

A
  1. Anticontracture positioning
  2. Continous exercise and activity (as tolerated)
  3. Splinting to prevent or reverse deformity
54
Q

This type of scar is most apparent 6–8 weeks after wound closure. The scar is most active in the initial 4–6 months. Because of increased vascularity, the scar becomes firmer and thicker and rises above the original surface level of the skin. This kind of scarring can happen at the donor site, at the original burn area, or with a wound that does not close spontaneously after 2 weeks.

To treat it, OTs apply compression therapy early, and educate the patient to continue it until the scar matures in 1–2 years. Scar gel pads and/or inserts to provide compression to scar as well.

A

Hypertrophic scar

55
Q

This type of scarring presents as the formation of bone in abnormal areas. It typically occurs in soft tissue around the joint or joint capsule. Common areas in which it occurs are the elbow, knee, hip, and shoulder. Loss of ROM is rapid, and pain is localized and severe. It is characterized by a hard end feel during PROM activity. Once diagnosis is confirmed, discontinue passive stretching (including use of dynamic splints) and begin AROM exercise within the pain-free range to preserve as much joint movement as possible. It usually requires surgical intervention if functional activity is limited.

A

Heterotopic Ossification

56
Q

Pain interferes with the burn rehabilitation process. In addition to respecting the patient’s pain, what are at least 2 other interventions related to pain management can OTs do?

A

–Coordinate with nursing on scheduled pain management; breakthrough pain relief can improve compliance with therapy program (consider treating 30 minutes after pain medication is administered).

–Educate the client and family on the importance of frequent ROM exercise and activity in spite of pain to prevent deformity formation.

–Teach the client proper skin care and lubrication to avoid maceration of skin because of friction and shear during exercise and activity.

–Reinforce pain management and stress reduction management techniques throughout the whole continuum of care.

57
Q

True or false: It is common for patients who have experienced burn injuries to sweat excessively in unburned areas.

A

TRUE

Loss of the ability to sweat may occur as a result of loss of sweat glands with split-thickness skin graft. Therefore, a patient may sweat excessively in the unburned areas.

Special accommodations and modifications (air conditioning) may be required at home or in the work or school area.

58
Q

How can an OT treat pruritis (persistent itching) with a patient who is in burn rehabilitation?

A

–Use of a compression garment
–Maintenance of skin lubrication
–Use of cold packs and antihistamine medications may alleviate itching

59
Q

Peripheral neuropathic conditions can occur with high-voltage electrical burns or burns of >20% TBSA.

What are 2 interventions OTs can do to support patients with this type of burn?

A
  1. Localized compression
  2. Stretch injuries of nerves
60
Q

With _______________ (burn of specific aspect of the hand) , it is important to take care to maintain Boutonniére precaution and avoid having the client form active or passive composite flexion of the fingers during evaluation and intervention.

A

Dorsal hand burn

Do ROM to MP with IP straight and ROM to IP with MP and DIP straight. The integrity of the extensor hood should be confirmed before composite flexion is allowed.

61
Q

Sensory screening/testing is crucial for what two types of burn injuries?

A
  1. Any burn deeper than a deep partial-thickness burn (third-degree)
  2. Electrical burns

NBCOT Exam (2024) (17 decks)

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