Burns

Question 1

When most of the wounds are closed, a ______ or other pressure garment is the best choice to prevent hypertrophic scarring. Adding inserts increases the effectiveness of compression therapy.

Answer 1

Jobst

Question 2

Superficial (first-degree) burn

i. Involves the superficial epidermis.
ii. Pain is minimal to moderate; no blistering or erythema.
iii. Healing time is 3–__ days.

Answer 2

7

Question 3

Superficial partial-thickness (superficial second-degree) burn

i. Involves the epidermis and _____ dermis layers.
ii. Pain is significant; wet blistering and erythema are present.
iii. Healing time is 1–__ weeks.

Answer 3

upper

3

Question 4

Deep partial-thickness (deep second-degree) burn
i. Involves the epidermis and the _____ dermis layers, hair follicles, and sweat glands.
ii. Pain is severe, even to light touch.
iii. Erythema is present, with or without blisters.
iv. Burn has a high risk of turning into a full-thickness burn because of infection; grafting
may be considered to prevent wound infection.

Answer 4

deep

Question 5

Deep partial-thickness (deep second-degree) burn

v. Client may have impairment of ________.
vi. Potential for _________ scar is high.
vii. Healing time varies from 3–__ weeks.

Answer 5

sensation
hypertrophic
5

Question 6

Full-thickness (third-degree) burn

i. Involves the epidermis and ______, hair follicles, sweat glands, and nerve endings.
ii. Burn is pain free, __ sensation to light touch.
iii. Burn is pale and nonblanching.
iv. Requires skin graft.
v. Potential for __________ scar is extremely high

Answer 6

dermis
no
hypertrophic

Question 7

Subdermal burn

i. Full-thickness burn with damage to underlying tissue such as fat, muscles, and ____.
ii. Charring is present; may have exposed fat, tendons, or muscles.
iii. If the burn is electrical, destruction of nerve along the pathway is present.
iv. Peripheral _____ damage is significant.
v. Requires surgical intervention for wound closure or ________.
vi. Potential for hypertrophic scar is extremely high.

Answer 7

bone
nerve
amputation

Question 8

The emergent phase is 0-__ hours after injury and focuses on ________ life, _______ infection, and ________ pain.

Answer 8

72
maintaining
controlling
managing

Question 9

The three phases of burn recovery are ________, _______, and __________.

Answer 9

emergent
acute
rehabilitation

Question 10

The acute phase of burn recovery is 72 hours or until wound _______ (could be days or months).

Answer 10

closes

Question 11

During acute phase of burn recovery, treatment focuses on infection control and ______ (removal of dead tissue and replacement of skin
or substitute over the wound); biological dressings may also be used to cover the wound.
___________ support and team communication are important.

Answer 11

grafts

Psychological

Question 12

During rehabilitation phase of burn recovery, medical treatment continues with skin grafts and __________ surgery as needed for movement
and function.

Answer 12

reconstruction

Question 13

During the emergent phase,

Occupational therapy intervention: splinting in ___________ positions

a. Intrinsic plus for hands
b. Opposite client’s posture
c. Generally in extension for the neck, elbows, and knees
d. Shoulder in abduction and hip in extension
e. Anti–frog leg and anti–foot drop for lower extremity

Answer 13

antideformity

Question 14

During the emergent phase,

Occupational therapy evaluation: clinical observations of body parts affected by burns,
__________ gathering on prior functional status

Answer 14

information

Question 15

During acute phase,

Occupational therapy evaluation: ADLs, psychosocial aspects, communication, cognition, ROM,
muscle strength, and pain
2. Intervention: ________ and positioning in ____________ positions, edema management, early
participation in ADLs, and client and caregiver education
3. Anticontracture positioning: Positioning is critical because the position of greatest comfort is
usually the position of contracture

Answer 15

splinting

antideformity

Question 16

During acute phase,

3. Anticontracture positioning: Positioning is critical because the position of greatest ________ is
   usually the position of contracture

a. Neck: neutral to slight extension
b. Chest and abdomen: trunk extension, shoulder retraction
c. Axilla: shoulder abduction 100° to 120°, slight external rotation
d. Elbow: extension
e. Forearm: neutral to supination
f. Wrist
i. Dorsal wrist: wrist in neutral to 30° extension
ii. Volar wrist: wrist in 30°–45° extension
g. Hand: metacarpal, 70° flexion; interphalangeal 0° extension, thumb abducted and extended
h. Hip: 10°–15° abduction, neutral extension
i. Knee: extension; with anterior burn, slight flexion
j. Ankle: Neutral to 5° dorsiflexion

Answer 16

comfort

Question 17

During acute phase,

Edema management

a. _________ of extremities
b. _____ exercises, if movement is allowed
c. Wrapping with elastic bandage, unless bulky wound dressing is used

Answer 17

elevation

AROM

Question 18

During surgical and postoperative phase

1. Postoperation immobilization period
   a. Immobilization is important after skin ____ operation to allow for graft adherence.
   b. The immobilization period varies; confirm the specific period of time with the surgeon.
   Generally, it is between 3 and 10 days or until graft adherence is confirmed.
   c. Immobilization period of the donor site is usually 2–3 days, if no active bleeding occurs at
   the donor site.
   d. Walking is usually not resumed until 5–7 days after grafting in lower extremities.
2. Positioning
   a. May be the same as ___________ positioning.
   b. Surgeon may specify optimal positioning. The goal is to promote the greatest surface area
   for graft placement.
   c. Donor site should be treated similarly to a burn site, involving elevation and wrapping with
   an elastic bandage.
3. Exercise and activity
   a. Exercise and movement of the uninvolved extremities should be continued.
   b. Movement of other joints involved should be continued if able to avoid tension on grafts.
   c. After immobilization period, start with gentle AROM to avoid shearing of the new grafts.

Answer 18

graft

anticontracture

Question 19

During rehabilitation phase,

Skin conditioning
a. Skin _________ should be performed several times a day to prevent dry skin from splitting
because of shearing forces or overstretching during movement and exercise.
b. Use skin massage to _________ 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.
c. Use sunblock or sun protective clothing; avoid unprotected sun exposure.

Answer 19

lubrication

desensitize

Question 20

During rehabilitation phase,

2. Scar management (includes massage and pressure garments)
   a. Initiate compression therapy for both _______ control and ______ compression.

i. Temporary interim pressure bandages or garments
-Elastic bandages
-3M Coban™ (3M, St. Paul, MN) wrapping of the fingers
-Elasticated tubular support bandages
-Thigh-high or knee-high thromboembolism-deterrent
hose
-Spandex bicycle pants
-Isotonic gloves with impression silicone (Otoform®),
elastomer, closed-cell foam, or silicone pad inserts

ii. Measurement for custom-made compression garment
-Use of compression garments is indicated for all
donor sites, grafted sites, and burn wounds
that take more than 2 weeks to heal spontaneously.

iii. Custom-made pressure garment and insert
-Custom-made pressure garments are constructed to provide gradient pressure, starting at 35
mm Hg distally.
-The garment should be worn 24 hours a day except during bathing, massage, and other skin
care activity.
-A minimum of two sets of garments should be ordered for changing and laundering.
-To conform to body contours and prominences, additional flexible inserts or conformers are
often added under the garments to distribute the pressure more evenly.

Answer 20

edema

scar

Question 21

During rehabilitation phase,

Therapeutic exercise and activity

a. Exercise and activity should be progressively graded to regain strength and activity tolerance.
b. Client needs to be taught to perform skin ________ and massage as pretreatment skin care before exercise and activity program.
c. Includes daily stretching, ________ exercise, activity to tolerance, and coordination activities

Answer 21

lubrication

resistive

Question 22

During rehabilitation phase,

Splinting
a. Continue ___________ positioning to prevent contracture formation.
b. Use _______dynamic splint or serial casting to reverse disabling or disfiguring contracture
formation. For the hands, attend to extensor tendon injury and web space contracture
management.
c. Splint of volar surface of hand for dorsal or volar hand burns for better positioning and
comfort

Answer 22

anticontracture

dynamic

Question 23

During rehabilitation phase,

ADLs
a. Apply ________ strategies or adaptive equipment to promote independence in ADLs and a
return to a normal daily routine.
b. Identify ________ movement pattern early; client needs to relearn normal movement
patterns.

Client education to aid transition from hospital to home
a. Independent skin care protocol
b. Understanding of _______-healing process
c. Compression therapy and positioning with practice opportunity to apply garment and splint
d. Preservation of independence in ADLs and IADLs with continuing exercise and activity
program

Answer 23

adaptive
abnormal
wound

Question 24

With the exception of the post–graft operation immobilization period, gentle ______ and
_____ to the client’s tolerance should be implemented as early as possible.
B. After post–graft operation immobilization, begin with ______ initially, and resume
PROM after graft adherence has been confirmed.

Answer 24

AROM
PROM
AROM

Question 25

With dorsal hand burns, take care to maintain Boutonniére precaution and avoid
having the client form active or passive composite _______ of the fingers during
evaluation and intervention.
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.

Answer 25

flexion

Question 26

With any burn deeper than a deep partial-thickness burn, _______ impairment may
occur. Sensory testing for _________ nerve damage should be performed as soon as the
wounds are closed.

Answer 26

sensory

peripheral

Question 27

For electrical burns, a gross ________ screening should be performed on the involved
limb to identify the extent of the peripheral sensory nerve involvement.

Answer 27

sensory