Burns: Healing, Management, PT Goals Flashcards by Katherine Nadelberg

Epidermal healing:

Retention of ____ cells allows for epithelialization to occur

Viable

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Epidermal healing:

Epithelial cells grow and proliferate, migrate to cover the ____

Wound

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Epidermal healing:

Protection of _____ cells is critical

Epithelial

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Epidermal healing: Loss of _____ glands can result in drying and cracking of wound; protection with moisturizing creams is important

Sebaceous

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Dermal healing: Results in ____ formation (injured tissue is replaced by ___ ____)
Scars are initially ___ or ____, later become white

Scar
CT
Red, purple

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Phases of healing: Inflamm phase: characterized by what 5 things? Lasts how many days?

Red, edema, warm, pain, dec ROM

3-10 days

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Phases of healing: Proliferative, granulation, fibroblastic phase: lasts how many days?

Next 10-14 after inflamm

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Phases of healing: Proliferative, granulation, fibroblastic phase:
What are the 4 primary events?

Angiogenesis
Granulation formation
Wound contraction
Epithelialization

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Phases of healing: Proliferative, granulation, fibroblastic phase:
Fibroblasts synthesize collagen, GAGs and elastin. Type ___ collagen is initially deposited and later replace with type __ collagen and scar tissues

III

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Phases of healing: Proliferative, granulation, fibroblastic phase:
________ are responsible for wound contraction in dermal tissues

Myofibroblasts

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Phases of healing: Maturation phase:

Tissue remodeling lasts up to ____ years

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Phases of healing: Maturation phase:
Normal mature scar is soft, _____, and ____
Takes over a _____ to occur

White, flat

Year

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Phases of healing: Maturation phase:

At _____ weeks, scar is immature (bright pink)

6-12

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Phases of healing: Maturation phase:

Hypertrophic scar may result: raised scar that stays within the boundaries of the burn wound and is ___, _____, ___

Red
Raised
Firm

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Phases of healing: Maturation phase:
Keloid scar may result: raised scar that extends _____ boundaries of the original burn wound and is ___, ____, ____. More common in young ____ and those with ____ skin

Beyond
Red, raised, firm
Women, dark

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Phases of healing: Maturation phase:

Hypotrophic scar: ____ and _______ below the surrounding skin

Flat and depressed

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Burn Management:
Emergency care: Immersion in ____ water. If less than half the body is burn and injury is immediate, _____ ______ may also be used

Cold

Cold compress

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Burn Management:
Emergency care:
Cover burn with _____ bandage or ____ ____
NO _____ or _____

Sterile
Clean cloth
Ointments or creams

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Burn Management: Medical Management:
Asepsis and wound care
1. Remove ______ clothing
2. Wound _______
3. Topical medications (_______ agents): reapplied __ to ___ times daily
Ointments: Bacitracin, Polymyxin B, and Neomycin
Silver sulfadiazine: common topical agent. Avoid at _____ pregnancy, on infants less than ____ months and those with sulfa drug allergies
Sulfamylon: penetrates through _____. Avoid with sulfa drug allergies

Charred
Cleansing
Antibacterial, 1-3 times
Term pregnancy, less than 2 months
Eschar

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Burn Management: Medical Management:
Asepsis and wound care: Dressings
Prevent ______ contamination, prevents ____ loss, and protects the wound
May additionally limit _____
Dressings include silver-impregnated, hydrogen’s, petroleum impregnated, and gauze dressings

Bacterial, fluid

ROM

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Burn Management: Medical Management:

Establish and maintain _____, adequate ____, and resp function

A/W

Oxygenation

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Burn Management: Medical Management:
Monitor: ____, serum _____ _____, ____ output, ___
___ function: provide nutritional support

ABGs, electrolyte levels, urinary, VS

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Burn Management: Medical Management:
Pain relief (\_\_\_\_\_)

Morphine

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Burn Management: Medical Management:
Prevention and control of infection:
______ and ______
____ pxns

Tetanus prophylaxis and antibiotics

STANDARD

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Burn Management: Medical Management: Fluid replacement therapy: Prevention and control of _______ _____ fluid and _____ replacement

Shock Post shock Fluid

Burn Management: Medical Management: Surgery: Primary excision: escharotomies, fasciotomies may be required to prevent _____ effects. As the patient is stabilized, surgical removal of _____ begins

Tourniquet | Eschar

Burn Management: Medical Management: Surgery: ______: closure of the wound Allograft (homograft): temporary for large burns, used until ______ available

Grafts | Autograft

Burn Management: Medical Management: Grafts: Xenograft (heterograft): Use of skin from _____ _____ A ______ graft

``` Other species (pigskin) Temporary ```

Burn Management: Medical Management: Grafts: Biosynthetic grafts: combo of ____ and _____

Collagen and synthetics

Burn Management: Medical Management: Grafts: Cultured skin: _____ grown from patient’s own skin

Lab

Burn Management: Medical Management: Grafts: Autograft: use of ____ own skin

Pt’s

Burn Management: Medical Management: Grafts: Split-thickness: contains ____ and ____ layers of ____ from donor site

UPPER EPI DERM

Burn Management: Medical Management: Grafts: Full thickness graft: Contains ____ and _____ from donor site

EPI and DERM

Burn Management: Medical Management: | Escharotomy and fasciotomy with circumferential burns of the extremities and compression due to increased tissue ______

Edema

Burn Management: Medical Management: | Surgical resection of scar contracture (examples?)

Z-plasty: surgical incision in the form of the letter Z used to lengthen a burn scar

Burn Management: Burn Wound Healing: | Factors that affect healing including: what 4 things?

Nutrition Infection Associated illness (DM, CA, vascular insufficiency) Cytotoxic treatments — aka people with life threatening lupus!

Burn Management: Burn Wound Healing: | Significant burn injury more likely in very _____ or the _____ who have thin skin

Young | Elderly

PT Goals, Outcomes, Interventions: Burn Wound Cleaning/Debridement: Use _____ control techniques at all times

Infection

PT Goals, Outcomes, Interventions: Burn Wound Cleaning/Debridement: Maintain _____ of burn wound by warming cleansing solutions, maintaining ambient temp and avoiding lengthy exposure of wet wound surfaces

Temp

PT Goals, Outcomes, Interventions: Burn Wound Cleaning/Debridement: Cleansing with ____ soap and ____ water Some wounds or dressings benefit from ______, wet removal of dressings Excess immersion is _________ Risks include auto contamination and electrolyte imbalance

Disinfectant Warm Soaking CONTRAINDICATED

PT Goals, Outcomes, Interventions: Burn Wound Cleaning/Debridement: _____ _________: removal of loose, charred, dead skin

Wound debridement

PT Goals, Outcomes, Interventions: Debridement: Autolytic dressings: use of _____ dressings such as _____ or ______ to help remove eschar

Moist | Hydrogel or hydrocolloids

PT Goals, Outcomes, Interventions: Debridement: Surgical or sharp: excision of eschar using _____ surgical instruments

STERILE

PT Goals, Outcomes, Interventions: Debridement: Enzymatic: example?

Fibrinolysins

PT Goals, Outcomes, Interventions: Debridement: Mechanical: ___ to ___ dressings, pulsed lavage, gentle _____

Wet to dry | Washing

PT Goals, Outcomes, Interventions: Rehab: Overall goals: limit loss of ____, reduce ____, prevent predictable ______ through positioning and splinting, and prevent or reduce complications of ________

ROM Edema Contractures Immobilization

PT Goals, Outcomes, Interventions: Rehab: Typically includes ______ daily therapy sessions times with planned ____ meds

Twice | Pain

PT Goals, Outcomes, Interventions: Rehab: Exercises to promote ____ ____ and chest _____

Deep breathing and chest expansion

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Starts from day ___ and continues for many months

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Anterior Neck: Common deformity? Stress what? Position with?

FLEXION Stress HYPEREXTENSION Position with firm (plastic) cervical orthosis

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Shoulder: Common deformity? Stress what? Position with?

ADDUCTION and IR Stress ABD and ER and FLEX Position with an axillary splint (airplane splint)

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Elbow: Common deformity? Stress what? Position with?

FLEXION and PRONATION Stress EXT and SUPINATION Position in EXT with posterior arm splint

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Hand: Common deformity? Stress what? Position with?

Common deformity is claw hand (intrinsic minus position) Stress wrist ext (15*), MP flex (70*), PIP and DIP extension, thumb abduction (intrinsic plus position) Position in intrinsic plus position with resting hand splint

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Hip: Common deformity? Stress what? Position with?

FLEXION and ADDUCTION Stress EXT and ABD Position in extension, abd, neutral rotation

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Knee: Common deformity? Stress what? Position with?

FLEXION Stress EXT Posterior knee splint

PT Goals, Outcomes, Interventions: Rehab: Anti contracture positioning and splinting: Ankle: Common deformity? Stress what? Position with?

PF Stress DF Position with foot ankle in neutral with splint or plastic AFO

PT Goals, Outcomes, Interventions: Rehab: Edema control: ______ of extremities, active ROM

Elevation

PT Goals, Outcomes, Interventions: Rehab: Stretching and early mobs, taking all joints through full ____

PROM

PT Goals, Outcomes, Interventions: Rehab: Red Flag: Schedule therapy to coincide with optimal pain med (______ minutes before session) and dressing changes/wound cleansing Postgrafting: Discontinue exercise for ____ days to allow grafts to heal

30-45 min | 3-5 days

PT Goals, Outcomes, Interventions: Rehab (post-acute): Continued _____, increasing _____ Progressive ______ to correct loss of muscle mass and strength Minimize _____: Elastic supports to control ______

PROM, AROM Strengthening Edema, edema

PT Goals, Outcomes, Interventions: Rehab (post-acute): Scar management: Massage and application of _______ Regular massage and touching of scars to ______ hypersensitive scars Pressure garments to help prevent ______ scarring or _____ formation

Moisturizer Desensitization Hypertrophic, keloid

PT Goals, Outcomes, Interventions: Rehab (post-acute): Progressive ambulation to improve ___ endurance and activity tolerance

``` PT Goals, Outcomes, Interventions: Rehab (post-acute): Preparation for home, work, play, school. Management of _____ pain Provide education and emotional support ```

Chronic