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Medcon Rehab IV > Burns: PT Interventions > Flashcards

Burns: PT Interventions Flashcards

1
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

What is FIRST???

A
  • Wound Care*
    • Debridement
    • Cleansing
    • Topicals
    • dressing must allow for mobility*
    • *ADD charts to this lecture!!!
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2
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

In order:

A
  • Wound Care
    • Debridement, Cleansing, Topicals
  • Splinting
  • Pos’ing to reduce deformity
  • Mobility and breathing
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3
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

Wound Care First

Tx→ Debridement (Surgical)

A
  • Surgical→ OR under anasthesia
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4
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

Wound Care (first)

Tx→ Debridement (NON-sx)

A
  • Mechanical debridement (non-sx)
    • Selective:
      • Sharp Debridement: scalpel, scissors, tweezers
    • Non-Selective:
      • Whirlpool, Pulse lavage, Wet→dry dressings
  • Precautions:
    • Anticoagulation tx (Heparin, Coumadin, Lovenox)***
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5
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

Wound Care (first)

Tx→ Cleansing

A
  • Spray/non-submersion
  • Submersion/Immersion w/ or w/out agitation
  • Pulsed Lavage (w/ suction)
  • Local wound care
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6
Q

Topicals for Burn Injuries

3 to know:

A
  1. Silver Sulfadiazine Cream 1% (SSD, Silvadene, Thermazene)** KNOW THIS ONE!
  2. Povidone-Iodine (Betadine)
  3. Bacitracin
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7
Q

Topicals for Burn Injuries

Silver Sulfadiazine Cream 1%

(SSD, Silvadene, Thermazene)

Indication, Adv’s/Disadv’s

A
  • Indication→ burns and wounds of all sizes/depths
  • Adv:
    • wide antimicrobial spectrum, lasts 24h
  • Disadv:
    • does not penetrate eschar well
    • cannot use w/ sulfa allergy or pregnant pts
    • may be toxic to keratinocytes and fibroblasts
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8
Q

Topicals for Burn Injuries

Povidone-Iodine

(Betadine)

Indication, Advs/Disadvs

A
  • Indication: FDA-approved for intact skin disinfectant, commonly used for road rash, “dirty” burns and infected wounds
  • Advs:
    • broad spectrum antimicrobial
    • antifungal*
  • Disadvs:
    • cytotoxic, delays epithelialization (not for helping wound heal)
      • systemic toxicity
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9
Q

Topicals for Burn Injuries

Bacitracin

Indications, Advs/Disadvs

A
  • Indication: Common for use on burned faces, superficial burns
    • Petroleum based antibiotic ointment, for Gram + bacteria
  • Advs:
    • Low $$
    • used when pts have sulfa allergy
  • Disadvs:
    • yeast superinfx, hypersensitivity/rash, ineffective for Gram - bacteria*
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10
Q

Topicals for Burn Injuries

A
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11
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

Splinting

________ is MOST effective for scar tissue realignment w/ focus on sustained end range stretch (giveaway)

A

Proloooonged Stretch***

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12
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

Splinting

Purposes?

A
  1. Control edema
  2. Maint. soft tissues in elongated state
  3. Prevent deformity
  4. Support/restore function and INDEP.
  5. Main/INC avail. ROM
  6. Protect exposed tendons, fx’s, P. Nerve injuries
  7. Preserve skin graft integrity
    1. *IF graft crosses joint→ WILL req. splinting!!)
  8. Also prevents hypertrophic scarring*
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13
Q

Sequence of PT Interventions for Pts w/ Burns

Aka Priorities

Splinting Considerations

Indications and Wear Time

A
  • Indicated:
    • IF function or ROM is lost w/out splinting
    • to protect skin graft
  • Wear time dep’s on condition:
    • Usually→ 2-4hrs on, 2-4hrs off
    • Intubated or sedated, post-graft→ Splint stays on at all times except skin checks
    • Actively moving→ encourage ADLs and wear @ night only
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14
Q

Table 10-5: Therapeutic Pos’ing for Burn-Injured Client

A

see pics, be familiar

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15
Q

Deformities:

Post Burn Injury

Mouth Deformities: Microsomia→ contraction of oral commissure

A

Mouth Splinting Options

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16
Q

Deformities:

Post Burn Injury

Neck Deformities

Cervical flexion & Lateral flexion contractures

A

Neck splinting options

*Rule of Thumb: NO pillow!

17
Q

Deformities:

Post Burn Injury

UE Deformities

  • Thumb ADD and/or Flexion contractures
  • EXT or HyperEXT of MCPs
  • 5th finger ABD/Torsion deformity
  • PIP Flexion contracture/Boutonnière
  • Wrist flexion
A

Wrist and Hand Splinting Options

18
Q

Deformities:

Post Burn Injury

UE Deformities

  • Thumb ADD and/or Flexion contractures
  • EXT or HyperEXT of MCPs
  • 5th finger ABD/Torsion deformity
  • PIP Flexion contracture/Boutonnière
  • Wrist flexion
A

Splinting options for Hand & Fingers

19
Q

Deformities:

Post Burn Injury

Anterior Chest and Axilla Deforms

  • Lack of shoulder flexion
  • Shoulder ADD, usually IR
A

Axilla Splinting Options

  • Position: Shoulder ABD to 90* w/ 15-20* of Horiz. ADD to avoid stretching brachial plexus
  • NOTE: Airplane vs Foam wedge (both keeping shoulder @ 90* ABD)
20
Q

Deformities:

Post Burn Injury

Elbow Deformity

  • Flexion
  • Flexion w/ PRO
A

Elbow Splinting Options

21
Q

Deformities:

Post Burn Injury

LE Deformities

  • Knee flex contracture*
  • Ankle DF or PF contracture
  • MTP HyperEXT deforms
A

LE Splinting Options

22
Q

Ankle Splinting Options

A

see pics

23
Q

PT intervention for the Pt w/ Burns

In terms of Restrictive Lung Disease…

A

Treat the Restrictive Lung Disease (RLD=cannot get air IN) and mitigate effects of immobility*

24
Q

Pts w/ burns have MANY involved systems.

Be ready to treat ALL systems during EVERY PT session!!!

A

*********************

25
Q

COMMON WOUNDS OUTLINE

A

JUST KEEP LOOKING AT IT!!!!!

26
Q

UNIT 6 CPPT II Wound Care Charts

A

READ THEM EVERY TIME YOU SEE THIS CARD!!!!!!

YOU MUST KNOW THESE!!!!

Medcon Rehab IV (18 decks)

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