Burns Flashcards
What type of burn does this describe? erythema, dry, no blisters, short-term moderate pain - usually takes 3-7 days; No potential for hypertrophic scar or contractors; Common causes: sunburn, brief flash burns, brief exposure to hot liquids or chemicals
Superficial
What type of burn does this describe? erythema, wet, blisters, significant pain - usually takes less than 2 weeks to heal; Minimal potential for hypertrophy or contractures if healing is not delayed by secondary infection or further trauma; Common causes: severe sunburn or radiation burn, prolonged exposure to hot liquids, brief contact with hot metal objects
Superficial Partial Thickness
What type of burn does this describe? erythema, larger, usually broken blisters on skin with hair, on glabrous skin of the palms and soles of the feet; large, possibly intact blisters over beefy red dermis; severe pain to even light tough - typically heals in longer than 2 weeks, may convert to full thickness with onset of infection; High potential for hypertrophic scarring and contractures across joints, web spaces, and facial contours; high risk for boutonniere deformities if the dorsal surface of fingers involved; Common causes: flames, firm or prolonged contact with hot metal objects; prolonged contact with hot, viscous liquids
Deep partial thickness
What type of burn does this describe? pale, nonblanching, dry, coagulated capillaries possible; no sensation to light touch except at deep partial-thickness borders - surgical intervention required for wound closure in larger areas; possible for smaller areas to heal inward from borders over extended period; Extremely high potential for hypertrophic scarring or contractures, depending on the method used for wound closure; Common causes: extreme heat or prolonged exposure to heat, hot objects, or chemicals for extended periods
Full thickness
What type of burn does this describe? possible charring of nonviable surface or, with exposed fat, possible presence of small external wounds on tendons, muscles; with electrical injuries, possibility for small external wounds with significant secondary loss of subdermal tissue and peripheral nerve damage - requires surgical intervention for wound closure; may require amputation or significant reconstruction; Similar to full-thickness burns except when amputation removes the burn site; Common causes: electrical burns and severe long-duration burns (e.g. house fires, entrapment in or under a burning motor vehicle or hot exhaust system, smoking in bed or alcohol-related burns)
Subdermal
What are the seven primary objectives of OT on a burn unit?
Pt and family education Edema management ROM Positioning and Splinting Therapeutic Exercise Scar management Compression Therapy
What are the 12 goals of OT on a burn unit?
Acute care:
provide cognitive reorientation and psychological support
reduce edema
prevent loss of joint and skin mobility
prevent loss of strength and activity tolerance
promote occupational performance, such as independence with self-care skills
provide patient and caregiver education
Surgical/Postoperative Phase:
promote cognitive awareness by providing orientation activities when necessary, and continue psychological support
protect and preserve graft and donor sites by fabricating splints and establishing positioning techniques that support the surgeon’s postop care orders
prevent muscular atrophy and loss of activity tolerance and reduce thrombophlebitis risk by providing exercise for areas that are not immobilized
increase self-care independence by teaching alternative techniques and providing adaptive equipment as needed
educate and reassure the pt and family members regarding this phase of recovery
Rehabilitation Phase:
continue to provide psychological support as the pt progresses toward physical and emotional independence
improve joint mobility and reduce contractures by using correct positioning, sustained passive stretching exercises, splinting as needed
restore m. strength, coordination, and activity tolerance
initiate a compression therapy and scar management program using vascular support garments, custom scar compression garments, and pressure adapters to minimize scar hypertrophy, contractures, and disfigurement
promote independent self-care skills, including appropriate positioning, exercise, and skin care. Provide instruction and opportunities to practice IADLs, including vocational and home care activities
continue to provide instruction regarding scar development, including potential sensory and cosmetic changes, scar management techniques, and related safety precautions
guide the implementation of a post-discharge plan that supports resumption of school, work, social, and leisure occupations.
In burn therapy, what is meant by the phrase “position of comfort is position of contracture”?
Typical position of comfort (think semi fetal position): adduction and flexion of the UEs, flexion of the hips and knees, and plantar flexion of the ankles. Toes are typically pulled dorsally. Burned hands often in “claw hand” position (wrist flexion, MP ext, IP flexion and thumb adduction). This position can lead to severe dysfunction if it is not prevented during active scar formation
Need to use preventive positioning to reduce edema and maintain extremities in antideformity position.
How can you help a burn patient manage pain during ROM activities?
- can be done around time of hydrotherapy since the pt receives analgesics for that tx
- coordinating with scheduled pain meds
- teach progressive relaxation, breathing techniques, guided imagery, coping strategies
- use aromatherapy, music therapy
- predetermined length of treatment and stick to this to foster trust
What are some ways to address edema to the extremities in a burn patient?
Acute: positioning/elevation & AROM exercises
Rehabilitation Phase: elevation, progressive compression and activity
At what stage of burn rehabilitation should a client be fitted with custom-made compression garments? How long should they be worn each day? How many weeks does a patient typically wear them?
Clients should be fitted with custom-made compression garments no later than 3 weeks after wound healing; otherwise, wearing of interim garments is continued until custom garments can be applied (may need to order garments in pieces since different areas of body may be ready for compression treatment at different points in time). The compression garments should be worn 23 hours a day, and removed only for bathing, massage, skin care, or sexual activity. Face masks and gloves can be removed for meals. Compression therapy should be applied to the burned area for 12-18 months or until scar maturation is complete. Each patient should have at least 2 sets of garments so one can be washed while the other is worn.
An airplane splint is used to address the risk of contracture to what parts of the body?
Axilla: antideformity position; shoulder abduction 90-100 degrees
List seven strategies for managing burn scars
ROM/splinting Excision of scar with integra then grafting Scar massage Compression garment Silicone Kenalog (steroid) injections Laser surgery
How do silicon and pressure garments help burn patients?
Keeps in lost body heat
Deep massage breaks down the matrix stretching the scar
Prevents contractures
Can stimulate fibroblasts so combine with compression may reduce scar development
Protect fragile skin
Promote better circulation of damaged tissues
Decrease extremity pain through vascular support
Decrease itching
Help keep moisturizers on, thereby lubricating the damaged skin
Reduce bulky, thick, hard scars
Increase skin length by putting pressure on maturing contracture bands that force the skin to lengthen
What is the role of hydrotherapy on a burn unit?
can be performed at least 1x/day when pt condition is stable to remove loose debris and “stale” topical antibiotics
provides a thorough cleansing of both the wound and uninvolved areas
