Burns and Wounds

Question 1

Depth of Burns

Answer 1

Superficial, superficial partial thickness, deep partial thickness, full thickness, subdermal

Question 2

Superficial burn

Answer 2

1st degree, 3-7 day healing, epidermis, mild pain, no blisters

Question 3

Superficial partial thickness burn

Answer 3

2nd degree, 1-3 week healing, epidermis + dermis, significant pain, blisters

Question 4

Deep partial thickness burn

Answer 4

2nd degree, 3-5 week healing, epidermis + dermis + hair follicles + sweat glans, severe pain, potential for sensory loss and hypertrophic scar

Question 5

Full thickness burn

Answer 5

3rd degree, epidermis + dermis + hair follicles + sweat gland + nerve endings, pain free/no sensation, high potentail for hypertrophic scar, REQUIRE graft

Question 6

Subdermal burn

Answer 6

damage to underlying tissues including muscle, fat, bone, REQUIRE surgical intervention

Question 7

Phases of Burn Therapy

Answer 7

Emergent, acute, rehabilitative

Question 8

Emergent Phase Burns

Answer 8

0-3 days
Assess location and prior function
Splinting in anti-deformity positions

Question 9

Acute Phase Burns

Answer 9

3 days or until wound closure
Assess ADL, ROM, MMT, cog, psychsoc
Splinting in anti-deformity positions
Edema mgmt
Early ADL with AE
ROM as tolerated
Education

Question 10

Neck anti-deformity

Answer 10

Slight extension

Question 11

Chest and abdomen anti-deformity

Answer 11

Trunk extension with shoulder retraction

Question 12

Axilla anti-deformity

Answer 12

Shoulder AB 100 with ER

Question 13

Elbow anti-deformity

Answer 13

Extension

Question 14

Wrist anti-deformity

Answer 14

Neutral to 30 extension

Question 15

Hand anti-deformity

Answer 15

Intrinsic plus MP 70 flexion, IP extension, thumb AB

Question 16

Knee anti-deformity

Answer 16

Extension (slight flexion for anterior burn)

Question 17

Ankle anti-deformity

Answer 17

Neutral to 5 dorsiflexion

Question 18

Rehabilitation phase

Answer 18

Post wound closure
Skin conditioning, scar mgmt, edema, therapeutic activity, splinting, increased ROM/strengthening

Question 19

Immobilization period post graft

Answer 19

3-10 days or until graft adherence confirmed

Question 20

No walking period for LE burns post graft period

Answer 20

5-7 days post-op

Question 21

Post graft intervention

Answer 21

Anti-deformity splinting
Movement of uninvolved extremities and other joints if possible and able to prevent graft tension (after 3-10 days gentle AROM)

Question 22

Cause of contracture

Answer 22

prolonged immobilization, hypertrophic scar, tight scar band

Question 23

Best practice for hypertrophic scar

Answer 23

Early compression (gel pads with inserts)

Question 24

Heterotrophic ossification

Answer 24

Formation of bone in abnormal areas common in elbow, knee, shoulder, hip that cause rapid ROM loss, localized pain and hard end feel with PROM

Post dx NO passive stretch or dynamic splint

AROM within pain free range to preserve joint mobility

Question 25

Dorsal hand burns precautions

Answer 25

Avoid composite flexion until extensor hood integrity is confirmed - mobilize 1 joint at a time to decrease possibility of rupture

Question 26

Boutonniere deformity

Answer 26

PIP flexion DIP hyperextension

Question 27

When is there sensory loss with burns

Answer 27

Deeper than partial thickness`

Question 28

How to provide vascular support for LE burns

Answer 28

Wrap with elastic bandage wrap to decrease blood pooling and pain

Question 29

General rule for burn ROM

Answer 29

Start gentle AROM/PROM as early as possible ( before 3 days) with exception of post graft operation requiring 3-10 days of immobilization followed by gentle AROM

Question 30

How to measure burn size

Answer 30

Rule of 9s to calculate total body surface area of burn LLE: 18 RLE: 18 RUE: 9 LUE: 9 Torso: 36 Head: 9

Question 31

How to desensitize hypersensitive graft site or burn scar

Answer 31

Skin massage

Question 32

Best method for scar and edema management

Answer 32

Compression therapy

Question 33

Appropriate temporary pressure bandages

Answer 33

- Elastic bandage - Coban - Elasticated tubular support bandage - TED stockings - Spandex bicycle pants - Isotonic gloves with impression silicone or pad inserts

Question 34

Custom made pressure garment

Answer 34

- Used for scars that take more than 2 weeks to heal spontaneously - Provide gradient pressure - Wear 24 hours a day except during bathing or massage - Conform to body contours and prominences - Additional flexible inserts added under garment to distribute pressure more evenly

Question 35

What should patient due before exercise and activity

Answer 35

Skin lubrication and massage

Question 36

How long does it take for scar maturation

Answer 36

1-2 years

Question 37

Hypertrophic scar timeline

Answer 37

Most apparent 6-8 weeks after wound closure Most active in initial 4-6 months

Question 38

What causes hypertrophic scarring

Answer 38

Increased vascularity causes scar to become firmer and thicker allowing it to rise above the original surface level of skin

Question 39

Pruritis

Answer 39

Persistent itching that can lead to skin maceration and reopening due to scratching

Question 40

How to relieve pruitis

Answer 40

Compression garment Skin lubrication Cold pack Anti-histamine medications

Question 41

Goal of compression glove for scar mgmt.

Answer 41

1. Decrease scar tissue 2. Improve appearance of scar

Question 42

Hydrogel dressing

Answer 42

- Used for dry and shallow wounds - Look like jelly sheet - Decrease pain and pressure -Retain fluid well

Question 43

Film dressing

Answer 43

- Used for minimal exudate and depth - Transparent to visually assess wound - Allow air to get through but no water or bacterial

Question 44

Foam dressing

Answer 44

- Used for moderate depth and exudate - Absorbs moisture well

Question 45

Hyrocolloid dressing

Answer 45

- Used for deeper wounds with more exudate - Decrease risk of infection

Question 46

Alginated

Answer 46

- Used for very deep with max exudate - Really good for infection

Question 47

What type of dressing should be used for infected wound

Answer 47

Gauze - use the least occlusive dressing possible

Question 48

What type of dressing should be used for wound with a lot of exudate

Answer 48

Alginate