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PHTH 564 - ICU > Burns > Flashcards

Burns Flashcards

1
Q

1st degree burns involve the ______

A

epidermis

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2
Q

2nd degree burns involve top layer and part of second layer (______)

A

dermis

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3
Q

___ degree burns will be blistered, red and swollen

A

2nd

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4
Q

______ patches may be evident in 2nd degree burns

A

white

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5
Q

3rd degree burns = ____ thickness burns

A

full

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6
Q

____ degree burns will look white or charred and the dead skin forms an _____

A

3rd; eschar

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7
Q

3rd degree burn sites may be painless (T/F)

A

TRUE

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8
Q

Burn severity and classification is determined by _____ and _____ ____ involved

A

depth; SA

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9
Q

Most common chart used in burn units for assessment of burn SA?

A

Lund and Browder

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10
Q

What comprises total body surface area in burn wound determination?

A

2nd degree + indeterminate + 3rd degree

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11
Q

Flame injuries may be associated with ______ injury and tend to be deep ______ or full thickness

A

inhalation; dermal

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12
Q

For ____ injuries, object must be extremely hot or contact abnormally long

A

contact

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13
Q

Contact injuries tend to be _____ dermal or ____ _____

A

deep; full thickness

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14
Q

_____ injuries = most common cause of burn injury in children

A

scald

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15
Q

Scald injuries can range from _______ to _____, often mixed

A

superficial; deep

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16
Q

High volt electrical burn = >_____ V

A

1000

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17
Q

Low volt electrical burn = < ____ V

A

1000

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18
Q

Things that are unique for electrical burns?

A

always have and exit wound; may have injury from current arc

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19
Q

Hypothermia injury causes a decrease in what 4 things ?

A
  1. HR
  2. CO
  3. RR
  4. BP
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20
Q

______ = localized body part freezing, compromised circulation

A

frostbite

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21
Q

2 most common burn injury mechanisms for adults?

A
  1. fire / flame

2. scald

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22
Q

3 risk factor that increase mortality rate from burn?

A
  1. increased age
  2. increased burn size
  3. presence of inhalation injury
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23
Q

3 zones in a burn?

A
  1. zone of coagulation
  2. zone of stasis
  3. zone of hyperaemia
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24
Q

Zone of _____ = point of max damage; irreversible tissue loss due to coagulate of constituent proteins

A

coagulation

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25
Q

Zone of _____ = characterized by decreased tissue perfusion, potentially salvageable with good resuscitation

A

stasis

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26
Q

Zone of _____ = outermost zone, will recover unless there is severe sepsis of prolonged hypo perfusion

A

hyperaemia

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27
Q

There is an ____ in capillary permeability which leads to loss of ____ and _____ into interstitial compartments

A

increase; proteins; fluids

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28
Q

Increase in capillary permeability leads to edema and hypovolemia, which leads to _____ ______

A

peripheral vasoconstriction

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29
Q

Inadequate CO post burn leads to inadequate ______/______ perfusion

A

tissue/organ

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30
Q

Renal effects of burn = loss of fluids from _____ _____ cases renal vasoconstriction, decreased renal blood flow and _____

A

intravascular spaces; GFR

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31
Q

Basal metabolic rate increases up to ___x original rate due to burns

A

3

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32
Q

There is a ______ immune response due to burns

A

reduces

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33
Q

Resp effects of burns = inflammatory mediators cause ______

A

bronchoconstriction

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34
Q

Resp effects of burns : ______ ______ = decreased O2 carrying capacity

A

carbon monoxide

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35
Q

5 signs of inhalation injury ?

A
  1. singed eyebrows or nasal hairs
  2. black nasal or oral discharge
  3. grossly swollen lips
  4. facial burns
  5. hoarse voice
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36
Q

Inhalation injury: __-__ hrs = upper airway obstruction, pulmonary edema

A

0-24

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37
Q

Inhalation injury: __-__hrs = pulmonary edema

A

24-48

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38
Q

Inhalation injury: __ hrs = bronchiolitis, alveoli’s, pneumonia and ARDS

A

48

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39
Q

With 1mm edema, airway resistance increased __x in in infants and xSA decreases by __%

A

16;75

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40
Q

With 1mm edema, airway resistance increases by __x in adults and x sectional area decreases by __%

A

3;44

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41
Q

5 steps to manage burn pts?

A
  1. ax
  2. dx
  3. early mobilization
  4. airways clearance
  5. exercise program including ROM and positioning
42
Q

Therapy role in early wound management (first 2-3 weeks)?

A
  1. maintain max ROM
  2. mobility
  3. scar management
  4. ADL
  5. D/C planning
43
Q

3 aspects of maintaining max ROM in early wound management?

A
  1. AROM and PROM
  2. positioning
  3. edema management
44
Q

Scar management begins day ___

A

1

45
Q

Soft tissue time lines for joint loss of motion: 1-4 days

A

brun scar tissue contracture

46
Q

Soft tissue time lines for joint loss of motion: 5-21 days

A

tendons and sheaths

47
Q

Soft tissue time lines for joint loss of motion:2-3 weeks

A

adaptive muscle shortening

48
Q

Soft tissue time lines for joint loss of motion:1-3 months

A

ligament and joint capsule

49
Q

5 pain management techniques we can use?

A
  1. liaise w/ team re meds
  2. adequate compression support
  3. distraction/relaxation, breathing techniques
  4. TENS
  5. itch control
50
Q

For exercise prescription, focus on areas most likely to develop scar _____ _____, and ____ over joints

A

tissue contractures; elongation

51
Q

Precautions to exercise prescription ?

A
  1. pre-existing cardiac and pulmonary conditions
  2. joint disease
  3. excessive bone (HO; AROM allowed)
  4. IV lines and ventilation support
  5. exposed tendons
52
Q

CI’s to exercise prescription?

A
  1. exposed joint
  2. DVT/thrombophlebitis
  3. compartment syndrome
  4. new skin graft
53
Q

PROM for pain pt’s = slow prolonged stretch to point of _____, within pt’s pain tolerance, multiple _____

A

blanching; reps

54
Q

______ can be performed for skin graft adherence

A

AAROM

55
Q

When is AROM appropriate post skin graft?

A

after first week

56
Q

Follow ______ ____ ____ when ambulating post skin graft

A

progressive dependency protocol

57
Q

What are the 5 steps in the progressive dependent protocol?

A
  1. observe graft site
  2. figure 8 wrap over dressing
  3. place limb in dependent position (dangle)
  4. elevate limb
    5, remove wrap to reassess
58
Q

_____ = potentially antimicrobial, prevents colonization and kills infection causing miro-organisms, has anti-inflammatory properties and is non-toxic to human tissue

A

silver

59
Q

______ = bilayer silver ion delivery system, works for several days when wet

A

acticoat

60
Q

Change acticoat dressing every __-__ days

A

5-7

61
Q

5 considerations for sx decision making ?

A
  1. TBSA involved
  2. depth of burn
  3. location of burn
  4. time for wound to heal
  5. circumferential burn
62
Q

If the burn is circumferential, there is a need for _____-

A

escharotomy

63
Q

____ ____ skin graft = skin transplant that requires a vascularized wound for graft to take

A

split thickness (STSG)

64
Q

STSG is harvested using a ______

A

dermatome

65
Q

STSG is always meshed (T?F)

A

FALSE; may be meshed

66
Q

STSG = immobilized until _____ connections are made (approx __ days_

A

vasular; 5

67
Q

STSG donor sites are from the epidermal layer (T/F)

A

FALSE ; epidermal and dermal layer

68
Q

Most common site of STSG harvest?

A

anterior thigh

69
Q

Can reharvest area of STSG within __-__ days

A

10-14

70
Q

One advantage of STSG is decreased rate of _____ ______

A

primary contration

71
Q

4 disadvantages of STSG?

A
  1. cosmetic inferiority to FTG
  2. decreased durability
  3. hyperpiguentaion
  4. increased risk of secondary contracture
72
Q

Full thickness graft (FTG) involves more ____ layer

A

dermal

73
Q

Donor sites of FTG?

A

groin or abdomen

74
Q

____ often used for joint contracture revision sx

A

FTG

75
Q

2 advantages of FTG?

A
  1. decreased secondary contracture

2. improved cosmesis and durability

76
Q

Disadvantage of FTG?

A

limited donor sites

77
Q

CI for early management post skin grafting ?

A

NO ROM or mobilization for 5 days post grafting sx

78
Q

3 precautions for early management post skin grafting?

A
  1. shearing
  2. fluid accumulation under graft
  3. tension and movement
79
Q

Management of skin graft in acute phase (1-2 weeks?)

A
  1. elevate
  2. immobilize (cast or splint)
  3. wound care (recipient and donor)
  4. controlled ROM
  5. once healed, initiate regular moisturizing
  6. begin light compression
80
Q

Splint hand in _______ position

A

antideformity

81
Q

Management of skin graft in the late phase (2 weeks +)?

A
  1. progress ROM
  2. continue compression
  3. silicon inserts
  4. static and/or dynamic splinting to minimize contractures
  5. begin gentle scar message
  6. education re sun protection
  7. continue to progress mobility and ADL’s
82
Q

____ = collagen rich matrix deposited in all tissues (except ___) in response to tissue disruption

A

scar; bone

83
Q

Scar is both central and problematic to wound healing (T/F)

A

TRUE

84
Q

Good scar should not limit function, should be without ____, _____ or _____

A

adhesions; contratures; hypertorphy

85
Q

Scar may remain metabiologically active for months (T/F)

A

FALSE - for YEARS

86
Q

Stage __ of scar maturation = fibroblastic / proliferative, __- __ weeks, scar is soft, find and weak

A

1; __-__

87
Q

Stage __ of scar remodelling = early remodelling, __-__ weeks, scar contracts, becomes red, hard, thick and strong

A

2; 4-12

88
Q

Stage __ of late remodelling and maturation = __ - __ weeks, scar gradually becomes soft, supple, white and loose

A

3; 12-40

89
Q

Custom made pressure garments = __mmHg of pressure

A

25

90
Q

Custom made pressure garments assist in promoting ______ skin healing in deeper skin layers

A

organized

91
Q

____ scar = extends beyond confines of original wound

A

keloid

92
Q

Keloid scars are often resistant to treatment (T/F)

A

TRUE

93
Q

_______ scar = bulky scar, stays within confines of wound

A

hypertrophic

94
Q

Hypertrophic scars are often found in areas of _____

A

motion

95
Q

Hypertrophic scars may be associated with wound ____/____ of closure

A

tension/timing

96
Q

Wide spread scar occurs during _____ phase of wound healing when continued tension and mobility of the wound leads to a flat, widely spread or depressed scar

A

third

97
Q

Wide spread scars (are/are not) a problem of excessive collagen deposition

A

are NOT

98
Q

Therapeutic management of scar begins with ___ day of wound healing

A

first

99
Q

Therapeutic management of scar stimulates ______ response and control ______ deposition

A

collagen x2

100
Q

4 therapist goals with burn patient?

A
  1. educate pt and family
  2. maintain and/or restore active and passive ROM of involved structures
  3. prevent deformity through ROM exercises, positioning, and scar management techniques
  4. optimize functional capabilities including mobility and ADLS

PHTH 564 - ICU (15 decks)

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