Burns and Skin Conditions Flashcards
Functions of the skin
> Prevention of loss of body fluid or absorption of fluid from the environment.
Protection of the network of blood and vessels and nerves in the dermis.
Protection from ultraviolet radiation.
Defense against bacteria.
Control of body temperature.
Production of VitD.
Sensation for protection from external noxious stimuli.
PT precautions for pt’s with burns
- Use standard/universal precautions at all times when the wound is exposed to protect the pt from infection and contamination.
- Check the pt’s chart daily for changes in physician orders.
- When removing wound dressings, soak the dressing and area to make the dressing easier to remove and reduce damage to the wound to a min.
- Do not provide high agitation whirlpool to a recently grafted area, it may loosen the graft.
- Be careful when changing wound dressings not to damage sensitive granulating tissue.
- Provide the pt with stretching and strengthening ex’s and FROM of joints.
- Ensure the pt is positioned to place the affected area on a stretch when at rest to prevent contractures.
- Provide the pt with a HEP and educate the family or care providers in positioning and home management techniques.
Arterial, Ischemic, and Diabetic Ulcers
- Perform a complete evaluation of the wound to include location, depth, extent, size, odor, drainage type and amount, tissue damage, infection, appearance, and sensation of surrounding skin.
- Debride the wound if this hasn’t been performed surgically by the physician. Debridement of necrotic tissue has shown to reduce the possibility of infection in the wound because necrotic tissue contains bacteria.
- US may be used at nonthermal doses to change the permeability of the cell membranes, and ES may also be used to wound healing.
- The wound dressings applied must help the dry wound to become a moist environment conducive to wound healing.
- Advice the pt to avoid elevating the leg above the level of the heart.
- Avoid pressure dressings as the arterial circulation is unable to cope with the extra stress of pressure bandages.
- Do not use heat to the area, and advise pt to avoid heat, as it could result in a burn. It may be applied to proximal areas to improve circulation.
- Provide instructions on dressing changes.
- Provide instructions in non-weight-bearing ambulation for the unaffected limb.
- Give advise on prevention of further ulcers.
Venous Stasis Ulcers
Everything the same as in Arterial Ulcers but:
- Advice pt to elevate the leg above the level of the heart to assist venous return to the heart, especially when sleeping. Blocks of wood under the foot of the bed can be used to assist with this process.
- Use of compression dressings can be effective when applied over a dressing for a venous ulcer. Pressure assists venous return and promotes healing of the wound.
- Pt’s should be encouraged to exercise the involved leg to include ankle pump ex’s, quad sets, and HS work to encourage the venous return.
- Provide HEP to encourage venous return and help to prevent future problems.
Pressure Ulcers (Decubitus)
If compression lasts for ≥2h, irreversible damage to the tissues may occur.
Areas of body most susceptible to pressure ulcers are the sacrum, ischial tuberosities, lateral malleoli, calcaneal area of the heel, greater trochanters, scapulae, and ribs.
Pressue Ulcers: Classification
> Stage I: area of reddened or purple colored skin. May be warm or cool to touch and be painful or itchy.
> Stage II: partial-thickness skin loss. May be a blister or a small ulcerated area.
> Stage III: full-thickness skin loss with subcutaneous tissue necrosis.
> Stage IV: full-thickness skin loss with subcutaneous tissue necrosis and damage to muscle, tendons, ligaments, and bone.
> Closed pressure ulcer: these ulcers look small on the surface, or the skin may be intact, but the underlying tissue damage is extensive and may extend to bone.
Pressure Ulcers: PT intervention
May include:
- Debridement.
- Ice massage around the perimeter of the wound to stimulate deep circulation.
- Whirlpool if the ulcer is on the LL or UP, or a full-body whirlpool tank for trunk areas if necessary.
- Occlusive or semi-occlusive dressings to maintain a moist environment optimal for healing for a dry wound.
- Absorbent dressings, such as alginate dressings, for heavily draining wounds to maintain a moist, but not wet, environment conducive to healing.
- Packing of areas with sinus formation, tunnelling, or undermining with dressings of suitable material to encourage healing from the wound surface and not across the surface of the skin which would leave a cavity.
- Wound irrigation using a syringe or pulsatile lavage unit.
- ES to the wound bed to stimulate the healing process.
- Vacuum device, with a sponge fitted into the wound cavity to remove copious exudate.