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Conditions II > Burns > Flashcards

Burns Flashcards

1
Q

What is skin?

A
  • The soft outer covering of vertebrates
    •The largest organ in the body
    •Skin is .5 cm to 4.0 cm thick
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2
Q

T or F: Women have thicker skin than men.

A

False; men have thicker skin

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3
Q

T or F: The young and elderly have thicker skin than adults.

A

False; the young and elderly have thinner skin than adults

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4
Q

T or F: Skin on various parts of the body varies in thickness and blood flow

A

True

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5
Q

The skin is made up of what three different layers?

A

Epidermis, dermis, hypodermis

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6
Q

What layer are melanocytes found in? What is the purpose of melanocytes?

A

Epidermis; melanocytes produce a protective skin-darkening pigment melanin

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7
Q

What layer are langerhans cells found in? What are their purpose?

A

Epidermis; they protect your skin from infection and produce allergic reactions

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8
Q

What layer are merkel cells found in? what are their functions?

A

Epidermis; it is a touch receptor

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9
Q

What is the outermost layer of the skin called?

A

epidermis

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10
Q

which layer of skin contains blood capillaries, hair follicles glands, nerve endings and receptors?

A

dermis

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11
Q

What layer of the skin is subcutaneous and contains fat and blood vessels?

A

Hypodermis

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12
Q

What are the functions of the skin?

A
  1. Temperature regulation
  2. Protection
  3. Sensation
  4. Excretion
  5. Immunity
  6. Blood reservoir
  7. Vitamin D synthesis
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13
Q

How do you classify a burn?

A

By level of cellular injury
•Use of Laser Doppler Flowmetry (LDF), MRI, and thermography
•Most often clinical observation is the techniques used

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14
Q

T or F: Superficial burn is known as a second degree burn.

A

False; superficial is formally known as a first degree burn

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15
Q

T or F: Partial thickness is formally known as a first degree burn.

A

False; partial thickness is formally known as a second degree burn

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16
Q

T or F: Full thickness is formally known as a second degree burn.

A

False; full thickness is formally known as a third degree burn

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17
Q

What are the characteristics of a superficial burn?

A
  • Damage to cells on the epidermis only
  • Red painful intact skin
  • Heals spontaneously within 1-7 days
  • No scarring
  • “Think sun burn”
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18
Q

What are characteristics of a superficial partial thickness?

A
  • Damage to epidermis parts of the dermis
  • Red, wet, edematous, painful, blisters
  • Reepithelialize in 7-21 days
  • Minimal to no scarring
  • Hair may be spared/ grow back
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19
Q

What are characteristics of deep partial thickness?

A
  • Severe damage to dermal layer
  • Blotchy and white
  • Healing 3- 5 weeks (sluggish)
  • Grafted to expedite healing
  • Infection can lead to full thickness easily
  • Scaring
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20
Q

What are characteristics of full thickness?

A 
•Destruction of the epidermis, dermis and sometimes muscle/bone
•Apears:
–White/ gray
–leathery
–insensate
–contracted
•5-14 days via skin graft
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21
Q

What is the incidence and prevalence of burns?

A

•Burn Injuries Receiving Medical Treatment: 450,000
•Fire and Burn Deaths Per Year: 3,400
•Hospitalizations Related to Burn Injury: 40,000, including 30,000 at hospital burn centers
•Stats:
–Survival Rate: 96.1%
–Gender:
•69% male
•31% female
–Ethnicity:
•59% Caucasian, 19% African-American, 15% Hispanic, 7% Other
–Admission Cause:
•44% fire/flame, 33% scald, 9% contact, 4% electrical, 3% chemical, 7% other
–Place of Occurrence:
•69% home, 9% occupational, 7% street/highway, 5% Recreational/Sport, 10% Other

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22
Q

What are the types of burns?

A
  • Thermal Burns
  • Electrical Burns
  • Chemical Burns
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23
Q

How are thermal burns usually caused?

A

– flame
– scald
– flash
– contact with a hot surface

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24
Q

T or F: Thermal burns are most common in teenagers.

A

False; Most common in children and older adults

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25
Q

What are the most common mechanisms for thermal burns?

A

Hot drinks and hot bathwater

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26
Q

T or F: Thermal burns vary in depth secondary to length of exposure to heat source

A

True

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27
Q

What type of thermal burns tend to be superficial or partial thickness burns?

A

Scald burns tend to be superficial or partial thickness burns

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28
Q

What type of thermal burns tend to be partial and full thickness?

A

Flame burns are usually partial and full thickness; contact burns can be partial to full thickness

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29
Q

What two types of thermal burns are considered “dirty wounds”?

A

Flame and scald; because debris from the fire or hot liquid can
contaminate the wound

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30
Q

T or F: If the skin barrier is broken there is a greater

chance for infection

A

True; This may then change treatment option; such

as dressing choice

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31
Q

T or F: Electrical burns require special consideration because where the electrical current enters the body and exists

A

True

32
Q

What type of burn typically has an entrance wound and an exit wound?

A

Electrical burn

33
Q

Do electrical burns require cardiac monitoring?

A

Yes

34
Q

What type of burns are caused by high voltage, low voltage or lightning?

A

Electrical burns

35
Q

What type of burns are a result of reduction, oxidation, corrosion or the desecration of body tissue?

A

Chemical burns

36
Q

T or F: Chemical burns alter pH and metabolism.

A

True

37
Q

What setting do chemical burns usually occur in?

A

Industrial settings

38
Q

What kind of burn can occur with misuse of household cleaners?

A

Chemical burns

39
Q

T or F: Chemical burns tend to be shallow.

A

False; chemical burns tend to be deep

40
Q

T or F: Chemical agents have to be neutralized.

A

True

41
Q

T or F: Frostbite is a type of burn.

A

False; it is not a burn

42
Q

T or F: Frostbite is treated at burn centers because it involves the skin and underlying structures

A

True

43
Q

T or F: The severity of a frostbite depends on length of exposure to cold.

A

True

44
Q

T or F: In the pre-thaw base, the area should be padded and warmed in a water bath about 100-103 F.

A

False; it should be in a water bath about 104-107.6 F

45
Q

What should you do in the post thawing phase?

A

Minimize inflammation process

46
Q

How many degrees can frostbite be classified in?

A

Classified into 1st, 2nd, 3rd, 4th degree

47
Q

T or F: Injured tissues die immediately.

A

False; it may not die immediately. Wound “declared”

48
Q

What does TBSA stand for?

A

Total body surface area

49
Q

Who is part of the burn team?

A
  • Burn or plastic surgeon
  • Nurse
  • Burn therapist (occupational therapist, physical therapist)
  • Nutritionist
  • Pharmacist
  • Case manager
50
Q

What are the phases of burn management?

A

Emergent, acute, rehab

51
Q

What phase is from 72 hours until wound is closed by healing or graft?

A

Acute

52
Q

What phase is from the date of injury to 72 hours?

A

Emergent

53
Q

What phase occurs until scar maturation can take place 6 months to years?

A

Rehab

54
Q

What is part of the emergent medical treatment?

A 
•Clean wound
–2 to 3 x’s daily
•Fluid resuscitation
–Constant hydration
•Establishment of tissues perfusion
–Blood back to area
•Cardiopulmonary stability
•Eschar- Burned tissue
–Greek for scab
•Maintain airway
–Escharotomy and Fasciotomy
•Debridement
–Remove eschar and necrotic tissue
•Dressing for debridement
•Infection prevention/control
•Significant contracture risk
55
Q

What do you do in the emergent phase OT treatment?

A

•Starts 0-72 hours post burn
•Prevention contracture via splinting and positioning
•Apply splints over burn dressing
-Splint as soon as possible to stabilize joints
•Anti-deformity positioning
–Positions that are opposite to the deformity

56
Q

What are positions that are opposites to the deformity called?

A

Anti-deformity positioning

57
Q

How long can the acute phase medical treatment last?

A

Days to several months

58
Q

What is part of the acute phase medical treatment?

A
  • Skin grafting is completed if reepithelilzation has not occurred within 14 days or is not expected
  • Nutrition
  • Pain management
59
Q

What do you do for management of burn wounds?

A 
•Dressings
–After the TBSA is calculated the burn is cleansed
–Antibiotic applied
–Silver-impregnated dressing
•Hydrotherapy
–Whirlpool loosens necrotic tissue
–Increase circulation
•Vacuum-Assisted closure
•Surgery
–Full thickness burns or burn not expected to heal in 3 wks
•Temporary and Permanent wound covering
60
Q

What are the types of grafts?

A 
•Autografts skin from unburned area is used
–Solid
–Meshed
•Temporary
–Xenographs (bovine skin)
–Allographs (cadaver skin)
–Biological dressing
61
Q

What happens in the acute phase OT assessment?

A 
•Detailed IE
–Age
–burn mechanism
–areas burned
–% burned (TBSA)
–Depth
–Joints involved
–Procedure (s) preformed
•ADL’s & IADL’s
•Psychosocial status and support systems
•Behavior and Communication
•Cognitive and perceptual status
•Neuromuscular status (ROM and Strength)
•Activity tolerance
•Burn Scar Index (Vancouver Scar Scale) VSS
–1-13 score on Vascularity, height/thickness, pliability, and pigmentation
62
Q

What happens in the acute phase OT treatment?

A
  • ROM and Strength
  • Splinting-Check daily fit
  • Positioning
  • Exercise
  • Environmental Modifications
  • Alternative Communication systems
  • Clients treatment tolerance may limited
  • Post-op splinting must be immobile 5-10 days
  • Anti-deformity positions (table 40-1)
  • Pain management
  • Client and family education
  • Discharge planning
  • Support and psychosocial adjustment
63
Q

What happens in the rehab phase?

A

•Continues from Acute phase and continues till scar maturation
–Can last up to 6 months
–Scar become pale and decreased rate of collagen production
•OT Role varies
–Inpatient
•Hands on need not able to return home safely yet
–Outpatient
•Hand therapy/ Upper quarter rehab

64
Q

In what phase does the scar become pale and there is a decreased rate of collagen?

A

Rehab phase

65
Q

What happens in the rehab phase OT assessment?

A 
•Assess capacities and abilities
•Homemaking
•Work functioning
•Performance components
–Scar management
–ROM
–Strength
–Activity tolerance
–Sensation
–Coordination
66
Q

What happens in rehab phase OT treatment?

A
  • Goal = return to previous level of function
  • ROM
  • Strength
  • Activity tolerance
  • Sensation
  • Coordination
  • Scar management
  • Self care- ADL’s may have need for assistive devices
  • Home management skills
  • Patient and family education
  • Psychosocial skills
  • Return to work
67
Q

What is part of scar management?

A 
•Massage
•Pressure garments
–Coban
–Tubigrip
–Isotoner gloves
–Elsatomere
–Closed cell foam
68
Q

T or F: A scar massage aides desensitization.

A

True

69
Q

T or F: A scar massage can only be done by an OT

A

False; Done several times daily by OT initially and then by patient and family
–‘Desensitize’ the family to the scar

70
Q

T or F: Scar massages help maintain suppleness.

A

True

71
Q

How should you give a scar massage?

A

Massage to blanch, hold for a few seconds-client should report tension and not pain- feel pressure

72
Q

What does hypertrophic scarring look like?

A
  • Red
  • Raised
  • Inelastic
  • Increased fibroblasts
  • Nodular collagen which can limit function
73
Q

What are some complications of burns?

A
  • Prutitis-persistent itching
  • Microstomia-oral commisure contracture
  • Heterotrophic ossification
  • Myositis ossificans ( about 13% of all patients with burns)
  • Heat intolerance
74
Q

What are some surgical options for burns?

A 
•Debridement
•Grafts
•Reconstructive surgery
–OT can recommend this in contracture limits occupational performance
–Corrects deformities
–Z-plasty-elongates soft tissue
75
Q

T or F: Hand burns can lead to web space contractures and some precautions would be extensor tendon injuries.

A

True

76
Q

What are some psychosocial and mental health factors with burn clients?

A
  • Body image
  • Depression
  • Posttraumatic stress disorder (PSTD)
  • Decreased sleep

Conditions II (7 decks)

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