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822: Integumentary > Burns > Flashcards

Burns Flashcards

1
Q

What are the 3 types of burn injuries?

A
  • Thermal
  • Chemical
  • Electrical
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2
Q

What do thermal burn injuries result from?

A

direct/indirect contact with flame, hot liquid, or steam

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3
Q

Thermal burn injury severity is influenced by what 3 things?

A
  • Contact time
  • Temperature
  • Type of insult
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4
Q

Only 1 second of exposure to temperatures above ___ degrees can cause a full-thickness burn

A

158

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5
Q

What 4 things can cause a chemical burn injury?

A
  • acids
  • bases
  • industrial accidents
  • assaults
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6
Q

Chemical burns are ____ likely to cause full-thickness damage

A

more

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7
Q

What is the severity of a chemical burn injury related to?

A

the contact time with the skin, as well as the type, concentration, and amount of chemical

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8
Q

Are acidic or alkali burns more severe?

A

alkali

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9
Q

Because chemical burns continue to burn until the substance is removed or diluted, what is suggested?

A

thoroughly irrigate for 20-30 minutes

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10
Q

What are the 2 types of electrical burns?

A

low and high voltage

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11
Q

How do electrical burns typically present?

A

a depressed or charred entrance wound and a larger, explosive-appearing exit wound

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12
Q

Describe what happens to deeper tissues affected by an electrical burn

A

They are often times damaged even if the skin does not appear to be due to differences in resistance

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13
Q

The severity of an electrical injury depends on what 3 things?

A
  • type of current
  • duration of contact
  • voltage
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14
Q

Does an alternating or direct current penetrate the skin more readily and produce 3 times the amount of tissue damage?

A

alternating

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15
Q

High voltage injuries result from currents greater than ____ volts

A

1000

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16
Q

What are the 2 ways in which burn injuries are classified?

A
  • depth of injury

- burn size

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17
Q

Clinicians should be cautious with their assessment of burn depth immediately after chemical exposure because it takes up to __-__ hours for a chemical burn to fully develop

A

24-72

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18
Q

What are the 5 burn classifications according to depth? (from most superficial to deepest)

A
  • superficial
  • superficial partial-thickness
  • deep partial thickness
  • full-thickness
  • subdermal
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19
Q

What layers of the skin are involved in a superficial burn?

A

the epidermis only

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20
Q

Superficial burns fit into what Integumentary practice pattern?

A

B

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21
Q

Describe the characteristics of a superficial burn

A

Dry, bright red, or pink skin that blanches under pressure

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22
Q

Superficial burns resolve within - days without scarring

A

3-5

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23
Q

What are 2 examples of superficial burns?

A
  • sunburn

- minor flash burn

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24
Q

What layers of the skin are involved in a superficial partial-thickness burn?

A

epidermis and part of the dermis

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25
Q

Superficial partial-thickness burns fit into what Integumentary practice pattern?

A

C

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26
Q

Describe the characteristics of a superficial partial-thickness burn

A

Painful, moist, weeping, blistered skin with local erythema and edema that blanches to pressure with immediate capillary refill

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27
Q

Superficial partial-thickness burns resolve within __-__ days with minimal or no scarring

A

10-14

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28
Q

What are 4 examples of superficial partial-thickness burns?

A
  • severe sunburns
  • brief contact burns
  • flash burns
  • brief contact with dilute chemicals
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29
Q

What layers of the skin are involved in a deep partial-thickness burn?

A

epidermis and part of the dermis

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30
Q

Deep partial-thickness burns fit into what Integumentary practice pattern?

A

C

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31
Q

Describe the physical characteristics of a deep partial-thickness burn

A

Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity or be painful that blanches to pressure with immediate capillary refill

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32
Q

Deep partial-thickness burns may take _ or more weeks to heal and are often characterized by scarring, pigment changes, and contractures

A

3

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33
Q

What are 3 examples of deep partial-thickness burns?

A
  • severe sunburns
  • scald
  • flash burns
  • brief contact with dilute chemicals
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34
Q

Other than the physical appearance how can the clinician determine whether or not a burn is superficial or deep partial-thickness?

A

Both blanch to pressure, however superficial burns demonstrate immediate capillary refill, whereas deep demonstrates slow capillary refill

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35
Q

What layers of the skin are involved in a full-thickness burn?

A

epidermis and the entire dermis

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36
Q

Full-thickness burns fit into what Integumentary practice pattern?

A

D

37
Q

Describe the physical characteristics of a full-thickness burn

A

Initially look red then become mottled white/black, dry, leathery eschar, very painful

38
Q

What is typically required of full-thickness wounds?

A

surgical debridement and grafting

39
Q

What are 4 ways in which full-thickness burns may result?

A
  • immersion scald injury
  • prolonged contact with a flame or steam
  • contact with electrical currents
  • exposure to chemicals
40
Q

Describe why a patient with a full-thickness burn feels pain even if though this type of burn is insensate to light touch

A

Less severely damaged areas surrounding the FT burn are likely to be excruciatingly painful

41
Q

What layers of the skin are involved in a subdermal burn?

A

Epidermis, dermis, and beyond into fat, muscle, tendon and/or bone

42
Q

Subdermal burns fit into what Integumentary practice pattern?

A

E

43
Q

Describe the physical characteristics of a subdermal burn

A

Charred, mummified appearance in which deep tissues are exposed

44
Q

What is required of subdermal wounds?

A

surgery (fasciotomy, escharotomy, grafting) and possible amputation

45
Q

What are 4 ways in which subdermal burns may result?

A
  • electrical injury
  • prolonged thermal contact
  • exposure to strong chemicals
46
Q

What are the 3 methods in which burn size is estimated?

A
  • Rule of Nines
  • Lund-Browder Classification
  • Palmar Method
47
Q

What is the problem with the rule of nines?

A

It consistently overestimates the size of the burn injury

48
Q

What does the Lund-Browder Classification take into account?

A

The variation of body proportion from child to adult

49
Q

Burn Severity Treatment Guidelines:

Minor Burn: _____
Moderate Burn: _____
Major Burn: _____

A

treat as out-patient

treat as in-patient

treat in specialized burn unit

50
Q

For an adult a burn is classified as minor if the percentage of TBSA that is a FT burn injury is less than _% or if the percentage of TBSA that is a PT burn injury is less than __%

A

2

10

51
Q

For a child a burn is classified as minor if the percentage of TBSA that is a FT burn injury is less than _% or if the percentage of TBSA that is a PT burn injury is less than _%

A

1

5

52
Q

For an adult a burn is classified as moderate if the percentage of TBSA that is a FT burn injury is somewhere between -% or if the percentage of TBSA that is a PT burn injury is between __-__%

A

2-5

10-20

53
Q

For a child a burn is classified as moderate if the percentage of TBSA that is a FT burn injury is somewhere between -% or if the percentage of TBSA that is a PT burn injury is between __-__%

A

1-5

5-10

54
Q

For an adult a burn is classified as major if the percentage of TBSA that is a FT burn injury is greater than _% or if the percentage of TBSA that is a PT burn injury is greater than __%

A

5

20

55
Q

For a child a burn is classified as major if the percentage of TBSA that is a FT burn injury is greater than _% or if the percentage of TBSA that is a PT burn injury is greater than __%

A

5

10

56
Q

Integumentary damage due to burn injuries is divided into 3 concentric circles known as the zones of what?

A
  • Zone of coagulation
  • Zone of stasis
  • Zone of hyperemia
57
Q

What is the zone of coagulation?

A

The central portion of the burn that has suffered irreparable damage and is characterized by coagulation, ischemia, and necrosis

58
Q

What is the zone of stasis?

A

The area the surrounds the central necrotic region and represents an area of cellular injury and compromised tissue perfusion

59
Q

Within the zone of stasis RBCs and platelets aggregate and may form microemboli which results in what?

A

further impeding of local circulation

60
Q

What is the process of widening and deepening of the original area of necrosis called?

A

Conversion

61
Q

What is the zone of hyperemia?

A

The outer edges of tissue that are affected by the burn and sustain only minimal cellular damage

62
Q

What is the zone of hyperemia characterized by?

A

erythema due to vasodilation

63
Q

The zone of hyperemia typically recovers within _-__ days of injury

A

7-10

64
Q

What are 3 things PTs should be cautious to further impede the already precarious circulation in the zone of stasis?

A
  • Bandages that are too tight
  • Undue pressure from splints
  • Improper patient positioning
65
Q

What is burn shock?

A

a complex clinical syndrome in which there is a massive fluid shift from the vasculature to the interstitium

66
Q

What does this massive fluid shift result in?

A
  • hypovolemia (a decreased volume of circulating blood in the body)
  • edema
67
Q

What does burn shock result in?

A
  • tissue necrosis
  • organ failure
  • possible death
68
Q

Patients with greater than __% TBSA burns at high risk for burn shock

A

15

69
Q

Although PTs do not manage burn shock directly, what are 4 things they should be cautious of?

A
  • Fluid resuscitation
  • Decreases in BP
  • Increased resting HR (100-120 in adults; 120-170 in children)
  • Edema management
70
Q

What 2 things account for half of all deaths that occur after the first 12 hours of a burn injury?

A
  • CO poisoning

- smoke inhalation

71
Q

Inhalation injuries cause up to __% of burn deaths

A

20

72
Q

What are 3 pulmonary symptoms that PTs should be cautious of?

A
  • breathing difficulties
  • oxygen saturation
  • encourage aggressive pulmonary hygiene
73
Q

A patients BMR may increase by how much with severe burn injuries?

A

2-3 times

74
Q

What 3 things cause an increase in resting BMR?

A
  • increased body temperature
  • increase in resting O2 consumption due to increased fat catabolism
  • decrease in body mass due to hyperglycemia
75
Q

The hypermetabolic response peaks _-__ days following a major burn injury

A

7-17

76
Q

It is estimated that up to __% of burn deaths may be due to infection

A

75

77
Q

What is the number one recommendation for patients with severe burns that have resulted in complications?

A

early, controlled mobility

78
Q

What are 3 precautions for patients with burn injuries?

A
  • screen for domestic violence
  • anticipate/prevent complications when possible
  • ensure adequate pain control
79
Q

What are the 4 keys to local burn wound care?

A
  • Debridement
  • Infection Control
  • Dressings
  • Scar Management
80
Q

What is the most common dressing type for burns?

A

Topical antimicrobial covered with nonadherent impregnated gauze and a short-stretch compression wrap to decrease edema and scarring

81
Q

If a burn wound is going to take longer than 2-3 weeks to heal what is required?

A

Compression

82
Q

Do lighter or darker skinned individuals have a greater incidence of hypertrophic or keloid scars?

A

darker

83
Q

The Vancouver scar scale rates 4 scar waulities, what are they?

A
  • Vascularity
  • Pliability
  • Pigmentation
  • Height
84
Q

The Vancouver scar scale scores range from _-__ with lower scores indicating ____ severe scar tissue

A

less

85
Q

What are the 5 areas in which contracture risk is highest?

A
  • Anterior neck
  • Axilla/shoulders
  • Cubital fossa
  • Ankle
  • Posterior knee
86
Q

When performing aerobic exercise with a burn patient it is suggested that target HR should be between __-__% of max predicted HR

A

50-70

87
Q

Define Escharotomy

A

Incision through eschar and subcutaneous tissue to release tissue constricting circulation

88
Q

Define Fasciotomy

A

Incision through fascia to release pressure/improve distal circulation

822: Integumentary (16 decks)

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