Burns - Patho, Complications, Healing, Classification Flashcards
What are the 3 zones of a burn wound?
Zone of coagulation
Zone of stasis
Zone of hyperemia
In which zone are cells irreversibly injured?
Zone of coagulation
In which zone is there minimal cell injury, with good chance of recovery?
Zone of hyperemia
In which zone are cells injured?
Zone of stasis
How soon should cells in the zone of stasis be treated to prevent cell death?
Within 24 - 48 hours.
What is the rule of nines for estimating burn area?
- Head and neck 9 %
- Anterior trunk 18 %
- Posterior trunk 18 %
- Arms 9 % each
- Legs 18 % each
- Perineum 1 % each
What percent of burn area would a Pt with burns along both arms and posterior trunk cover?
36 %
What percent of burn area would a Pt with burns along one leg, posterior trunk, and head and neck cover?
45 %
What percent of burn area would a Pt with burns along one arm, head and neck, both legs, and perineum cover?
55 %
What can change the rule of nines?
Pt age.
What are the classifications of burns by body area?
Crticial: 10 % of body with 3rd degree, 30 % or more with 2nd degree
Moderate:
What classification by body area would a Pt with 3rd degree burns on head and neck, and 2nd degree burns on both arms be?
Moderate
What classification by body area would a Pt with no 3rd degree burns, but 2nd degree burns along anterior and posterior trunk be?
Critical
What tissue is damaged in an 1st degree burn?
Epidermis only
What tissue is damaged in a 1st degree burn?
Epidermis only
What is the appearance of a 1st degree burn?
Pink or red with no blistering, minimal edema.
How much pain associated with a 1st degree burn?
Tenderness with delayed pain
How long does it take for a 1st degree burn to heal?
3 - 7 days.
How much scarring occurs with a 1st degree burn?
None
What tissue is affected in a 2nd degree superficial partial-thickness burn?
Epidermis, and upper layers of dermis.
What is the appearance of a 2nd degree superficial partial-thickness burn?
- Bright pink or red
- Blanching with quick capillary refill
- Blisters, moist surface, weeping
- Moderate edema
How much pain is present in a 2nd degree superficial partial-thickness burn?
Painful, sensitive to touch and temperature changes.
How long does it take for a 2nd degree superficial partial-thickness burn to heal?
7 - 21 days.
How much scarring occurs with a 2nd degree superficial partial-thickness burn?
Minimal to no scarring or discoloration.
What tissue is affected in a 2nd degree deep partial-thickness burn?
- Epidermis
- Dermis
- Nerve endings
- Sweat glands
- Hair follicles
What is the appearance of a 2nd degree deep partial-thickness burn?
- Mixed red or waxy white appearance
- Blanching with slow capillary refill
- Broken blisters, wet surface
- Marked edema
How much pain is associated with a 2nd degree deep partial-thickness burn?
Sensitive to pressure, but insensitive to light touch or soft pin prick.
How long does it take for a 2nd degree deep partial-thickness burn?
- Healing is slow
How does a 2nd degree deep partial-thickness burn heal?
- Scar formation and re-epithiliazation
What will occur without preventative treatment of 2nd degree deep partial-thickness burn?
Excessive scarring.
What tissue is affected in a 3rd degree burn?
- Epidermis
- Dermis
- Subcutaneous tissue
- Possibly muscle
What tissue is affected in a 3rd degree burn?
- Epidermis
- Dermis
- Subcutaneous tissue
- Possibly muscle
What is the appearance of a 3rd degree burn?
- White (ischemic)
- Charred
- Tan
- Black
- No blanching, poor circulation distally
How much pain is associated with a 3rd degree burn?
Little pain because nerve endings are destroyed.
How does a 3rd degree burn heal?
- Removal of eschar and skin grafting necessary
What are 3 potential complications of a 3rd degree burn that can be reduced with preventative treatment?
- Infection
- Hypertrophic scarring
- Wound contracture
What tissue is affected in a 4th degree burn?
- Epidermis
- Dermis
- Subcutaneous tissue and muscle
- Possibly vascular system
What is the appearance of a 4th degree burn?
- Charred
Why may further necrosis develop as a result of a 4th degree burn?
- Compromised vascular system
How do 4th degree burns develop?
- Electrical burns
- Prolonged exposure to flame
What are 3 additional possible complications with an electrical burn?
- Ventricular fibrillation
- Acute kidney damage
- Spinal cord damage
How does a 4th degree burn heal?
- Skin grafting
- Scarring
- Extensive surgery
What may be necessary following a 4th degree burn surgically?
Amputation
What are 6 complications following burns?
- Infection
- Shock
- Pulmonary complications
- Metabolic complications
- Cardiac and circulatory complications
- Integumentary scars
What is the leading cause of death following burns?
- Infection/ gangrene
How do pulmonary complications develop following burns?
- Inhalation of hot smoke
- Smoke poisoning
- Pulmonary edema results with airway obstruction
- Restrictive lung disease from burns to trunk
- Pneumonia
What should be a sign of potential smoke inhalation?
- Singed nose hairs
- Burns of the face
What metabolic complications arise form burns?
- Increased metabolic/ catabolic activity
- Leads to weight loss
- Nitrogen balance becomes negative
- Energy decreases
How are cardiac and circulatory systems affected following burns?
- Fluid and blood plasma loss leads to decreased cardiac output
How do epithelial cells heal?
- Cells that are still viable are retained
- Epithelial cells grow and proliferate over wound - epithelialization
What is essential in the treatment of epithelial burns?
- Protect epithelial cells
- Prevent wound drying and cracking 2o to loss of sebaceous glands with moisturing creams
What is essential in the treatment of epithelial burns?
- Protect epithelial cells
- Prevent wound drying and cracking 2o to loss of sebaceous glands with moisturing creams
How do dermal wounds heal?
- Scar formation - replacement of injured cells with connective tissue
What color are scars?
- Initially red or purple
- Later white
What are the 3 phases of burn healing?
- Inflammatory
- Proliferative
- Maturation
How long is each phase of burn healing?
- Inflammatory: 3 - 5 days
- Proliferative/ maturation: Up to 2 years
What are the 4 primary events of the proliferative phase?
- Angiogenesis
- Granulation formation
- Wound contraction
- Epithelialization
What types of collagen are used in the proliferative phase of burn healing?
- Type III initially
- Type I/ scar tissue later
What cells synthesize collagen, glycoaminoglyicans, and elastin?
Fibroblasts
What cells cause wound contraction in dermal wounds?
Myofibroblasts.
When does a scar become immature?
6 - 12 weeks
What color is an immature scare?
Bright pink
What is the appearance of a mature scar?
Soft, white, flat
How long does it take for a scar to mature?
> 1 year
What is a hypertrophic scar?
Raise scar within boundaries of burn
What is the appearance of a hypertrophic scar?
- Red
- Raised
- Firm
What is a Keloid scar?
Raised scar that extends beyond boundaries of original burn
What is the appearance of a Keloid scar?
- Red
- Raised
- Firm
In whom are keloid scars more likely to develop?
- Young women
- Individuals with darker skin
What is the appearance of a hypothrophic scar?
- Flat
- Depressed below surrounding skin
