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NPTE Integumentary PT > Burns > Flashcards

Burns Flashcards

1
Q

Burn injury results from

A

thermal, chemical, electrical, or radioactive agents

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2
Q

Burn wound - zones

A

Zone of coagulation
Zone of stasis
Zone of hyperemia

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3
Q

Burn wound - zone of coagulation

A

cells are irreversibly injured, cell death occurs

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4
Q

Burn wound - zone of stasis

A

cells are injured, may die without specialized tx, usually within 24-48 hours

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5
Q

Burn wounds - zone of hyperemia

A

minimal cell injury, cells should recover

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6
Q

Degree of burn - first degree

A

epidermal burn
damage is to epidermis only
no blistering, minimal edema

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7
Q

Degree of burn - second degree - superficial partial thickness burn

A

Epidermis and upper layer of dermis are damaged
Blanching with brisk capillary refill
Blisters, moist surface, weeping
Moderate edema, painful, sensitive to touch and temp changes

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8
Q

Degree of burn - second degree - deep partial thickness burn

A

Severe damage to epidermis and dermis with injury to nerve endings, hair follicles and sweat glands
mixed red or waxy white appearance
Blanching with slow capillary refill
Broken blisters, wet surface
Marked edema
Sensitive to pressure but insensitive to light touch or soft pin prick

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9
Q

Degree of burn - third degree

A

Full thickness burn
Complete destruction of epidermis, dermis, and subcutenous tissues - might extend into muscle
White, charred, tan, or black appearance
No blanching - poor circulation
Dry leathery surface, depressed area
Little pain - nerve endings destroyed

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10
Q

Degree of burn - fourth degree

A

Subdermal burn
Complete destruction of epidermis, dermis, with involvement of subcutaneous tissues and mm
Charred appearance
Destruction of vascular system
Additional complications if electrical burn

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11
Q

Extent of burned area - rule of

A 
Nines for estimating burn area 
Head and neck 9%
Anterior trunk 18%
Posterior trunk 18%
Arms 9% each
Legs 18% each
Perineum 1%
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12
Q

Classification by % of body area burned - Critical

A

10% of body with 3rd degree burns and 30% or more with 2nd degree
Complications are common

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13
Q

Classification by % of body area burned - moderate

A

less than 10% with 3rd degree and 15-30% with 2nd degree

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14
Q

Classification by % of body area burned - minor

A

less than 2% with 3rd degree and 15% with 2nd degree

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15
Q

Complications of burn injury

A 
Infection
Shock
Pulmonary complications
Metabolic complications
Cardiac and circulatory complications
Integumentary scars
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16
Q

Complications of burn injury - Pulmonary complications

A

Smoke inhalation - pulmonary edema, airway obstruction
Restrictive lung disease if burns to trunk
Pneumonia

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17
Q

Complications of burn injury - Metabolic

A

Inc metabolic and catabolic activity results in weight loss, negative nitrogen balance and dec energy

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18
Q

Complications of burn injury - Cardiac and circulatory

A

fluid and plasma loss results in dec CO

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19
Q

Burn healing - Epidermal healing

A

Retention of viable cells allows for epithelialization to occur
Protection of epithelial cells is critical
Loss of sebaceous glands can result in drying and cracking of wound

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20
Q

Burn healing - dermal healing

A

results in scar formation

scars are initially red or purple, later become white

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21
Q

Burn healing - phases

A

Inflammatory phase
Proliferative phase
Maturation phase

22
Q

Burn healing - Inflammatory phase

A

characterized by redness, edema, warmth, pain, decreased ROM, lasts 3 to 5 days

23
Q

Burn healing - Proliferative phase

A

Granulation or fibroblastic phase

Four primary events - Angiogenesis, granulation formation, wound contraction, epithelialization

24
Q

Burn healing - proliferative phase - fibroblasts…

A

synthesize collagen, glycoaminoglycans, and elastin
Type III collagen is initially deposited and replaced later with Type I collagen
Myofibroblasts are responsible for wound contraction in dermal wounds

25
Q

Burn healing - maturation phase

A

Tissue remodeling - lasts up to 2 years
Normal mature scar is soft, white, and flat (takes about 1 yr to occur)
At 6 to 12 wks scar is immature and bright pink

26
Q

Burn healing - maturation phase - hypertrophic scar

A

a raised scar that stays within the boundaries of the burn wound and is characteristically red, raised, firm

27
Q

Burn healing - maturation phase - keloid scar

A

a raised scar that extends beyond the boudnaries of the original burn wound and is red, raised, and firm
more common in young women and those with darker skin

28
Q

Burn healing - maturation phase - hypotrophic scar

A

flat and depressed below the surrounding skin

29
Q

Burn management - Emergency care

A

Immersion in cold water
if less than half body and injury is immediate - cold compresses can be used
Cover burn with sterile bandage or clean cloth - NO ointments of creams

30
Q

Burn management - Medical management - topical meds

A

applied 1 to 3 x day
Ointments
Silver sulfadiazine
Sulfamylon

31
Q

Burn management - surgery - Primary excision

A

Escharotomies and fasciotomies

Might be required to prevent tourniquet effects

32
Q

Burn management - surgery - grafts

A

Closure of the wound

33
Q

Burn management - surgery - grafts - allograft

A

Use of other human skin (cadaver)

Temporary grafts for large burns, used until autograft is available

34
Q

Burn management - surgery - grafts - Xenograft

A

use of skin from another species

Temporary graft

35
Q

Burn management - surgery - grafts - Biosynthetic graft

A

combination of collagen and synthetics

36
Q

Burn management - surgery - grafts - Cultured skin

A

lab grown from pt own skin

37
Q

Burn management - surgery - grafts - Autograft

A

use of pt own skin

38
Q

Burn management - surgery - grafts - Split thickness graft

A

contains epidermis and upper layers of dermis from donor site

39
Q

Burn management - surgery - grafts - full thickness graft

A

contains epidermis and dermis from donor site

40
Q

Burn wound healing - factors that impact it

A

nutrition, infection, associated illnesses, cytotoxic tx

41
Q

PT - wound debridement - autolytic dressings

A

use of moist dressings such as hydrogels or hydrocolloids to help remove eschar

42
Q

PT - wound debridement - Surgical or sharp debridement

A

excision of eschar using sterilized surgical instruments

43
Q

PT - Rehab - overall goals

A

limit loss in ROM, reduce edema, prevent predictable contractures through positioning and splinting

44
Q

PT - rehab typically includes what freq

A

2x daily with planned pain meds

45
Q

PT - rehab - anti contracture positioning and splinting starts day one and continues for months - anterior neck common deformity is

A

flexion
So stress hyperextension
position with firm (plastic) cervical orthosis

46
Q

PT - rehab - anti contracture positioning and splinting - Shoulder common deformity is

A

adduction and IR
So stress abduction and ER
position with axillary splint (airplane splint)

47
Q

PT - rehab - anti contracture positioning and splinting - Elbow common deformity is

A

flexion and pronation
So stress extension and supination
Position in extension with post arm splint

48
Q

PT - rehab - anti contracture positioning and splinting - Hand common deformity is

A

claw hand
Stress wrist ext (15) and MP flex (70) with PIP and DIP ext, thumb abd
Position in intrinsic plus position with resting hand splint

49
Q

PT - rehab - anti contracture positioning and splinting - Hip common deformity is

A

flexion and adduction
Stress ext and abduction
Position in ext, abd, and neutral rotation

50
Q

PT - rehab - anti contracture positioning and splinting - knee common deformity is

A

flexion
stress ext
position in ext with posterior knee splint

51
Q

PT - rehab - anti contracture positioning and splinting - ankle common deformity is

A

PF
stress DF
position in foot ankle neutral with splint or plastic AFO

52
Q

PT - postgrafting

A

postpone/discontinue exercise for 3 to 5 days to let graft to heal

NPTE Integumentary PT (5 decks)

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