Burns and Wounds

Question 1

What are the 5 stages of wound healing?

Answer 1

1. Hemostasis - immediate skin response
2. Vasoconstriction - blood vessels clump together, blood clot form, fibrin crosslink
3. Inflammation - sends signal to fight pathogen, macrophages eat bacteria through phagocytosis, produce GF for healing
4. Vasodilation, expansion of constricted BV to allow WBC to travel to site.
5. Proliferative - 2-3 days after fibroblast enter wound, process of collagen deposition

Question 2

What is a pressure injury?

Answer 2

Localized damage to skin and underlying soft tissue over bony prominence, by prolonged pressure and shear.

Question 3

What is the Braden Scale?

Answer 3

Scale to measure elements of risk contributing to high intensity and duration of pressure. Low is risk.

Question 4

Why is the ear important for pressure wounds?

Answer 4

Requiring oxygen for tubes over ears - higher likelihood of skin breakdown.

Question 5

What are the 3 parts of the skin?

Answer 5

Epidermis - barrier

Dermis - tough CT, hair follicles, sweats glands, nerves

Hypodermis - fat, CT, BVs

Question 6

What are the 4 stages of pressure ulcers?

Answer 6

Non-blanchable erythema, Partial thickness skin loss with exposed dermis, full thickness of skin loss, full thickness skin and tissue loss.

Question 7

What is a non-blanchable erythema?

Answer 7

Intact skin, erythema (redness of skin), localized redness, painful, firm, soft, warmer, cooler.

NOT purple or maroon.

Question 8

What is partial thickness skin loss with exposed dermis?

Answer 8

Shallow open ulcer, pink wound bed, moist, intact or ruptured blister, adipose/ deep tissue is NOT visible.

Question 9

What are the 4 types of skin wound not classified in stage 2?

Answer 9

Incontinence related dermatitis, maceration, scratches, skin tear

Question 10

What is full thickness skin loss?

Answer 10

Adipose fat visible, eschar, slough present. Epibole present. Undermining and tunneling occurs.

Question 11

What is undermining and tunneling?

Answer 11

Undermining - wider area of tissue, one or more direction

Tunneling - channels from wound, one direction

Question 12

What is epibole?

Answer 12

Rolling of tissue around the wound. Indicate its chronic.

Question 13

What is full thickness skin and tissue loss?

Answer 13

Exposed bone, tendon, muscle present.

Question 14

What is unstageable or unclassified?

Answer 14

Obscured full thickness of what the wound is, by slough or eschar.

Question 15

What is suspected deep tissue injury?

Answer 15

Deep purple and maroon discoloration, pain/temperature changes precedes skin color changes. Results from pressure at bone-muscle interface.

Question 16

What are the 4 sources of burns?

Answer 16

Thermal, chemical, electrical, radiation.

Question 17

What is 1st degree burn? How to treat it?

Answer 17

Superficial, only epidermis, red, dry, no blisters.

Soak area in cool water, wrap with dry bandage, painkillers.

Question 18

What is 2nd degree burn? How to treat it?

Answer 18

Partial thickness, from epidermis to dermis, red, moist with blisters, swollen.

Soak in water for several minutes, no support for topical antibiotics.

Question 19

What is 3rd degree burn? How to treat it?

Answer 19

Beyond dermis into hypodermis, patchy white or brown, dry leathery, little to no pain.

Immediate medical care, elevate burn above heart level.

Question 20

What is 4th degree burn?

Answer 20

Beyond hypodermis into muscle or bones, brown, dry, charred. Painless.

Question 21

How long for skin replacement to heal?

Answer 21

7-10 days to heal and graft site, dressing is left on for 2-5 days to keep new skin in place before changed.

Question 22

What is a hypertrophic scarring?

Answer 22

Lots of tension around wound, 3 Rs (red, raised, rigid). Imbalance in collagen at wound site, longer wound healing, more likely to develop. Dry, itchy, sensitive.

Question 23

What is a keloid scar?

Answer 23

Infiltrate surrounding tissue, firm tender tumor with hyperpigmentation. Does not regress.

Keloid composed of type 1 and 3 collagen irregularly branched, without nodules, excess myofibroblasts.

Question 24

What is a contracture? How to treat contracture?

Answer 24

Tightening of skin after 2-3rd degree burn, loss of ROM.

Scar massages, stretches, silicone gel, splints, can help prevention.