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815 > Ch. 40 Minor Burns, Sunburns, and Wounds > Flashcards

Ch. 40 Minor Burns, Sunburns, and Wounds Flashcards

1
Q

Minor Burns, Sunburns, and Wounds (MBSW)

A
  • Can speed up healing of cuts, burns, and wounds with proper drug selection
  • ~450,000/year need medical treatment for burns
  • Proper antiseptic and antibiotic use can help healing, minimize scar formation, and prevent secondary infection
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2
Q

MBSW Pathophysiology

A
  • Acute wounds - burns, abrasions, puncture wounds, and lacerations
  • Usually from trauma and heal within 1 month
  • Chronic wound - any wound that doesn’t heal through normal stages of wound healing
  • Require triage and more intense medical care
  • Can self treat wounds that don’t extend beyond dermis
  • Homeostasis must return quickly after the wound to allow proper healing
  • Then healing phases occur (overlap): inflammatory, proliferative, and maturation (remodeling)
  • Local healing factors: Tissue perfusion, oxygenation, infection, wound characteristics
  • Systemic healing factors: Poor vascularization, bacterial contamination, inadequate nutrition, medical conditions, and medications
  • Elderly: delayed healing but equal quality
  • Obese: poor perfusion and delayed healing
  • Diabetes (uncontrolled) - decreased collagen synthesis, impaired wound contraction, delayed epidermal migration, and decreased chemotaxis/phagocytosis, SHOULD SEE PCP
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3
Q

Burns

A

Wounds from thermal, electrical, chemical, or UV exposure

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4
Q

Thermal Burns

A

Skin contact with flames, scalding liquids, hot objects, or from inhaling smoke or hot vapors

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5
Q

Chemical Burns

A
  • Secondary exposure to corrosive or reactive chemicals that cause tissue damage, ulceration, and sloughing
  • Necrotic tissue can then act as a reservoir for the chemical and can cause prolonged cutaneous damage
  • Remove chemical exposed clothing
  • Report to ER for evaluation
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6
Q

Sunburns

A
  • Too much UVA and UVB light exposure from sunlight or tanning beds
  • Similar to photosensitive reactions causes from drugs, similar clinical presentations
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7
Q

Abrasions

A

Rubbing/friction injury to epidermis that extends to uppermost portion of dermis

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8
Q

Punctures

A

Sharp object that pierces epidermis and can reach into dermis or deeper tissues

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9
Q

Lacerations

A

Sharp object cutting through the various layers of skin

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10
Q

Inflammatory Stage

A
  • First healing stage
  • Body’s immediate response to injury
  • Lasts 3-4 days and includes inflammation and hemostasis
  • Hemostasis: release of thromboplastin from injured cells that creates a clot to stop the bleeding
  • Inflammation: debris and bacteria removed from wound bed, collagen formed, first layer of epithelial cells go cover wound
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11
Q

Proliferative Stage

A
  • Second stage of healing
  • Filled with connective tissue and covered by new epithelium
  • Starts ~ day 3 and can last 3 weeks
  • Forms granulation tissue including connective tissue, capillaries, inflammatory cells
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12
Q

Maturation/Remodeling Stage

A
  • Last stage of healing
  • Longest phase starting at about week 3 and peaking at about 60 days post injury
  • Continual collagen synthesis/breakdown process where weak collagen is replaced with high strength collagen
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13
Q

Poor Vascularization

A
  • Delays healing
  • Results in poor oxygenation and therefore impaired leukocyte activity, decreased collagen, decreased epithelialization, and decreased resistance to infection
  • Conditions that decrease perfusion include diabetes, severe anemia, hypotension, peripheral vascular disease, and CHF
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14
Q

Wound Infection

A
  • Deposition/multiplication of organism that cause a host reaction
  • Most caused by bacteria like Strep, Staph, and Enterococcus
  • Delays collagen synthesis and epithelialization
  • Prolongs inflammation and causes tissue destruction
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15
Q

Adequate Nutrition

A
  • Needed for wound repair
  • Proteins, carbs, vitamins, and trace elements are all needed for collagen production/energy
  • Vitamins commonly used for healing
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16
Q

Vitamin C

A
  • Many roles in healing
  • Deficiencies effect many aspect of tissue repair
  • Decrease collagen synthesis, decrease fibroblasts, decrease angiogenesis, and increase capillary fragility
  • Impaired immunity can also occur from its deficiency
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17
Q

Vitamin E

A
  • Anti-inflammatory
  • Reduces scarring
  • Widely used for healing
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18
Q

MBSW Clinical Presentation

A
  • Determined by the depth of damage

- 4 stages of wounds

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19
Q

Stage I

A
  • Only epidermis involved
  • No skin layer loss
  • Redness, nonblanching, unbroken, nonblistering skin
  • Minor sunburn: superficial, erythema, slight edema due to increased blood flow to affected skin
  • Starts 4 hours post exposure and peaks between 12-24 hours
  • Treatment: Avoid additional injury, symptomatic pain/fever relief, mostly self-treated and heal in 3-6 hours
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20
Q

Stage II

A
  • Blistering, involves all epidermis and some of dermis
  • Involves skin breakage, pain, edema, erythema, and possible drainage from the wound
  • Severe sunburn: blisters, peeling skin, pain, edema, skin tenderness, possible chance of bacterial infection
  • Systemic symptoms: vomiting, low grade fever, chills, weakness, shock when larger body portions involved
  • Leaves skin more sensitive to sunburns for weeks
  • Painful, sensitive to temperature and air, large blisters, blanching (loss of blood vessels), and more intense pain to no sensation occurs
  • More prone to infection which can cause worse severity, depth, or both. Increases likelihood of delayed healing and scarring
  • Only self treat when on an adult and cover 1-2% BSA
  • Seek medical attention if it hasn’t healed or worsened in 2-3 weeks
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21
Q

Stage III

A
  • Loss of entire epidermis, dermis, and dermal appendages, possibly even subcutaneous tissue
  • Causes death of full skin thickness in the area
  • Results in dry, leathery area that is painless and insensate
  • Painful, bleeds profusely, needs hospitalization
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22
Q

Stage IV

A
  • Extension of stage II
  • Involves subcutaneous tissue and underlying muscle, tendon, and bone
  • SEE DOCTOR/ER
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23
Q

MBSW Treatment Goals

A
  1. Relieve symptoms
  2. Promote healing by protecting from further trauma
  3. Minimize scarring
    - Should be stepwise and include cleaning the area, using antiseptics and antibiotics, and closing or covering with appropriate dressing
24
Q

MBSW General Approach

A
  • Assess stage of wound at the start and after 24-48 hours
  • Don’t treat if burn is 2%+ of BSA
  • Stage III and IV need medical attention
  • Stage I and II need basic, supportive treatments like irrigating the area and keeping it moist
  • Use non-Rx topical antiseptics and antibiotics to help prevent secondary infections
25
Q

MBSW Nonpharmacologic

A
  • First aid to relieve pain, prevent contamination, and promote healing
  • Remove from exposure, stop bleeding/weeping, cool a burn, pain relief, decrease infection risk, and protect from further trauma
  • Wound irrigation is often necessary to clean dirt and debris from wound, use water or simple saline
  • Tetanus prophylaxis if necessary
  • Punctures should be cleared of debris, cleaned with water or saline, left open and soaked with soap water for 30 minutes 4x a day, then cover with dressing
  • Remove source of heal and cool area for a burn with tap water for at least 10 minutes to help decrease heat, reduce pain, and reduce edema. Can continue soaking for pain relief as needed
  • Irrigate chemical burns with lots of water
  • No ice packs, can cause vasoconstriction and tissue damage
  • Use nonadherent, hypoallergenic wound dressings
  • Don’t pull or peel off loose/burned skin
  • Remove chemically exposed clothes and wash for at least 15 minutes, ,don’t delay ER visit
  • If eye is involved, pull back eyelid and wash with water from nose to outer corner for 15-30 minutes
  • Call poison control and see doctor
26
Q

MBSW Dressing

A
  • Need a moist wound environment to decrease protein, electrolyte, and fluid loss and decrease pain and infection
  • Can use gauze with semi-occlusive dressing when would debridement is needed and for stage 1 wounds when tissue loss isn’t a concern
27
Q

Selection Criteria for Dressings

A
  • Need appropriate type and amount of moisture to wound to promote healing
  • Moist healing environment stimulates cell proliferation and encourages epithelial cells to migrate
  • Also act as a barrier and absorb wound fluid to make healing opportune
  • Can be cost-effective, decrease pain, reduce dressing changes, and provide autolytic debridement
  • Wound dressings may change with different phases
28
Q

Gauze

A
  • Generally used for minor wounds and burns that are draining or require debridement
  • Can be woven or nonwoven and can have nonadherent, antiseptic, or antimicrobial products impregnated in it
  • Advantages: many sizes, many forms, affordable, combined with other topicals
  • Disadvantages: must be held in place by secondary agent, fibers may stick to wound, change often to prevent drying out, don’t use alone for moist wound
29
Q

Antimicrobial Dressings

A
  • Contain products like silver and iodine to manage colonized or infected wound
  • Decrease bacterial load within wound bed
30
Q

Specialty Dressings

A
  • Provide moisture or absorb excess
  • Dressings that Absorb Moisture: beneficial in inflammatory phase, “too wet” wounds, moderate to high draining wounds. Medically absorbent dressings require less changes than nonabsorbent
  • Maintain moisture: preferred for proliferative, maintain in natural moisture, commonly hypercolloid and transparent film dressings
  • Provide Moisture: dry wound covered with dead tissue, softens and remove dead tissue to facilitate migration of new epithelial tissue. Must contain water, hydrogels - 80-99% H20, varying absorptive properties
31
Q

Adhesive Bandages

A
  • Good for superficial wounds
  • More hydrocolloid bandaids have been developed to promote healing
  • Can also use liquid bandage for small cuts and abrasions, good for cosmetic or difficult to bandage areas
  • Preferred by patients since they are waterproof, no needles, have antimicrobials
32
Q

Surgical Tape

A
  • Mainly hold bandages covering a wound or surgical incision
  • Needs to be adhesive AND easy to remove
  • No latex, should be hypoallergenic
  • Most adherent/irritating is clear, surgical tape, use only for minimal dressing changes
33
Q

MBSW Pharmacologic

A
  • Various products
  • Some clean, relieve pain swelling, or reduce inflammation (combinations of these too)
  • Can also protect area or aid in healing
34
Q

MBSW Systemic Analgesics

A
  • Short-term, preferably anti-inflammatory, for minor skin injuries
  • NSAIDs can decrease erythema and edema, especially good for mild sunburns but only for the first 24 hours
  • APAP is a good alternative is intolerant to NSAIDs, but little to no help with inflammation
35
Q

MBSW Skin Protectants

A
  • FDA approved for temporary protection of minor burns and abrasions
  • Make damaged area less painful, protect from mechanical irritation (friction), and prevent drying of stratum corneum
  • Apply as needed, but seek medical attention if it hasn’t improved or persists 7 or more days
36
Q

MBSW Topical Anesthetics

A
  • Can help alleviate pain but inhibiting pain signals, short lived, only 10-15 minutes
  • Benzocaine and lidocaine are the most used
  • Dibucaine, tetracaine, butamben, and pramoxine also available options
  • Higher concentrations are good for intact skin and lower concentrations are better for broken
  • Only apply to 1-2% of BSA to minimize systemic toxicity
  • Max 3-4x per day, continuous application can’t be achieved, multiple applications increase the risk of hypersensitivity and systemic toxicity
  • Benzocaine has more hypersensitivity but less systemic toxicity while lidocaine provides the opposite
  • Lidocaine systemic toxicity are rare when on intact skin, local areas, and for short periods
37
Q

MBSW First Aid Antiseptic

A
  • Designed to be applied to intact skin up to area of damage for disinfection
  • Helps decrease infection rate
  • Should effect all microorganisms without causing tissue damage
  • Don’t use on broken skin, can dry it out and cause increase pain/cell damage
38
Q

Hydrogen Peroxide

A
  • First aid antiseptic
  • 3% topical solution used widely
  • Causes enzymatic release of oxygen that causes efferent, mechanical cleansing
  • Use when gas can escape, not on abscesses, don’t use with bandage until completely dried
  • Limited bactericidal effect and increased tissue toxicity risk, limited benefits over soapy water
39
Q

Ethyl Alcohol

A
  • First aid antiseptic
  • 20-70%, good bactericidal
  • Use caution and apply to intact skin around wound only, tissue irritation can occur on broken skin
  • Use 1-3x per day and cover wound once dried
40
Q

Isopropyl Alcohol

A
  • First aid antiseptic
  • 70%, stronger bactericidal activity and decreased surface tension compared to ethyl alcohol
  • Generally used for cleansing and antiseptic effects on intact skin
  • Don’t use on open wounds due to cytotoxic effects and increased infection rates
  • Also increased risk of skin drying due to lipid solvent effects (more than ethyl)
  • Flammable
41
Q

Iodine

A
  • First aid antiseptic
  • 2% and 2.5% sodium iodine, antiseptic for superficial skin injuries
  • Aqueous solutions are preferred
  • Don’t use strong solution as antiseptic
  • Avoid bandaging after applications
  • Stained skin, irritations, allergic reactions can occur
  • Preferred for chlorhexidine allergies
42
Q

Providone/Iodine

A
  • First aid antiseptic
  • Water soluble complex
  • 9-12% iodine, rapid bactericidal activity
  • Nonirritating to skin and mucus membranes
  • When used as irrigator it is systemically absorbed
  • Excess iodine absorption can cause transient thyroid dysfunction, clinical hyperthyroidism, and thyroid hyperplasia
43
Q

Camphorated Phenol

A
  • First aid antiseptic
  • Oily solutions of phenol and camphor
  • High concentration of phenol, use with caution
  • If ointment are applied to moist areas, partitions into water and causes caustic concentrations on the skin
  • Only apply to dry, intact skin
  • Don’t bandage skin since increased moisture can cause damage
44
Q

First Aid Antibiotics

A
  • Non-Rx antibiotics have different ingredients
  • Help prevent infection in minor cuts, wounds, scrapes, and burns
  • Good for wound with debris and foreign matter
  • Wounds free of contamination and with low infection rates don’t need antibiotics
  • Use after cleaning and before dressing
  • Extensive use can increase systemic absorption and prolonged use can increase resistance and secondary fungal infections
  • If improvement isn’t seen within 7 days, see doctor
45
Q

Bacitracin

A
  • First aid antibiotic
  • Polypeptide bactericidal antibiotic that inhibits cell wall synthesis in gram negative bacteria
  • Resistance development is rare
  • Minimal absorption as a topical
  • 2% rate of ACD
  • Apply 1-3x per day, contain 400-500 U/g of ointment
46
Q

Neomycin

A
  • First aid antibiotic
  • Aminoglycoside antibiotic
  • Irreversibly binds to 30s ribosomal unit to inhibit protein synthesis in gram negative bacteria
  • Decrease severity of infections after 48 hours in tape-stripped wounds
  • Resistance may develop
  • 3.5-6% allergic reactions (relatively high)
  • Not absorbed on intact skin and can cause systemic toxicity on open skin
  • Mostly used in combination with other antibiotics
  • Apply 1-3x per day
47
Q

Polymyxin B Sulfate

A
  • Polypeptide antibiotics for gram negative organisms
  • Alters bacteria cell wall permeability
  • Solution or ointment
  • Apply 1-3x per day
48
Q

MBSW Product Selection Guidelines

A
  • Recommend most appropriate form of anesthetic
  • Ointment provide a protective film to impede water evaporation from wound area, impermeable on broken skin, don’t use on moist wounds since it traps bacteria, best for intact, minor burns/wounds
  • Creams are best for broken skin since they allow some fluid to pass through, easier to apply/remove than ointments
  • With either form, apply to clean or gloved hand THEN to the injured area
  • Lotions spread easily and good for large area burns, leave a powdery area so don’t use on wound since it can dry the area, can be difficult to remove, and provides a medium for bacterial growth
  • Aerosol and pump sprays are more expensive but you don’t have to directly touch the area which causes less pain with application. Hold 6’ from area and spray for 1-3 seconds, not protective since propellant can have water or alcohol which can irritate or dehydrate the wound
  • Normal saline is preferred for wound irrigation
  • Best antiseptic is still debated, but most choose product based on tissue toxicity and cost
  • Antibiotic applied 1-3x a day to area best helps healing when combined with wound cleaning and proper dressings
49
Q

MBSW Complementary Therapies

A

-Honey, Calendula officinalis, aloe vera, garcinia morellary, and Datura melol are said to have healing properties

50
Q

Aloe Vera

A
  • Complementary therapy for MBSW
  • Major ingredient in various skin and wound products
  • Has vitamins A, B, C, and E, enzymes, polysaccharides, amino acids, sugars, and minerals
  • Variable results in wound area management
51
Q

Calendula Officinalis

A
  • Complementary therapy for MBSW
  • Used in homeopathic medicines for many diseases
  • Thought to have increased wound healing via anti-inflammatory and antibacterial properties
  • Shown to have increased antioxidant deference mechanism and decrease burn injuries
52
Q

Honey

A
  • Complementary therapy for MBSW
  • Contains sugars and water, amino acids, antioxidants, vitamins, minerals, etc.
  • Viscous and develops a moist wound environment
  • Also absorbs exudates from wound
  • Antibacterial, anti-inflammatory, and antifungal properties
  • Showed to have better efficacy than SSD cream for superficial burns
53
Q

MBSW Assessment

A
  • Determine burn severity by depth of injury and percent of BSA
  • Can use rule of nine for estimation of BSA, back of band is 1%
  • Minor wounds need to have type, depth, location, and contamination assessed, usually visually
  • Assess for infection, drainage, increased pain, swelling, or red surrounding areas
  • Determine health states and medication use
  • Suggest antimicrobials when secondary infection is present or may occur
54
Q

MBSW Counseling

A
  • Advise how to protect injury from infection and scarring
  • 24-48 hour follow up to determine continuing self treatment or to see doctor
  • Let them know how long burns can take to heal and signs/symptoms to see doctor
  • Avoid sun exposure and use sunscreen for several weeks afterwards
  • Only self-treat minor cuts and abrasions
  • Irrigate with normal saline or soapy water, change dressing when it is dirty or not intact
  • See PCP if not healed after 7 days
55
Q

MBSW Evaluation

A
  • Reassess burned after 24-48 hours
  • If worsened or progressed see PCP
  • Minor wounds should decrease in redness with healing
  • Increased redness, swelling, pain, beyond the boundaries of the original wound are reasons to see a doctor
  • If no improvement after 7 days or worsening with drug treatment should be medically referred

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