FINAL Burns Flashcards
How many burns injuries occur yearly in the US?
How many related deaths occur each year?
0.5 million
4000
What is skin function?
Protection, thermoregulation, neurosensory and cosmesis
Epidermis is?
Non-vascular
Rapid regeneration
Protects from sun
Dermis is?
Vascular
Fibrous connective tissue made up of collagen and elastin
Lymph spaces, sweat glands, hair follicles
Subcutaneous tissue is?
Fatty tissue, fibrous CT
What are burn wounds classification?
Superficial 1st degree Superficial partial-thickness (Superficial 2nd degree) Deep partial-thickness (Deep 2nd degree) Full-thickness (3rd degree) Subdermal (4th degree)
How does superficial burn 1st degree present as?
Epidermis only Pink/red Erythema due to vasodilation Painful Scarless (heals within 7 days)
How does superficial partial-thickness 2nd degree present as?
Epidermis, superficial dermis Pink/red Blistering Wet, weepy very painful soft, blanchable little scarring.
How does deep-partial thickness burn (deep 2nd degree) present as?
Most of dermis Red with overlaying eschar Insensate Potential for pressure Delayed healing Scarring
How does full thickness burn (3rd degree) present as ?
White, brown, black, tan or red Dry leathery Firm, non-blachable Insensate No potential for healing Significant scarring Grafting.
How does Subdermal (4th degree) burn present as?
Electrical burns, long duration burns Charring of invisible surface, exposed fat Wounds on tendons, muscles Loss of subdermal tissue and PN damage Surgical intervention Amputation
The extend of burns is classified by?
% of total body surface area (%TBSA)
True or False. Deep partial and full-thickness burns >30% TBSA require prolonged period to close and intensive rehab?
Tues
What is the rule of nine?
Divides body surface into areas consisting of 9% or multiple of 9.
Body surface vary depending on children and age.
What is Lund and Browder Chart and where is it used?
More accurate and used in burn centers and provided %TBSA to body segments adjusted to age.`
What are the phases of wound healing?
Inflammatory phase
Proliferation phase
maturation phase
How long does inflammatory phase last, and how is it characterized by?
3-10 days
the wound is painful, warm, red and edema develops
Characterized by vascular and cellular response
How long does the proliferation phase last, and how is it characterized by?
begins around day 3 and lasts until the wound heals
Revascularization/re-epithelialization
COntracture of the burn wound
The wound remains red, raised, a rigid scar may develop
The tensile strength of the new scar is poor.
How long does the maturation phase last, and how is it characterized by?
begins around 3rd weeks of healing lasting up to 2 years.
Fibroblast leave and collagen remodeling occurs
Redness fades, scar softens and flattens
The tensile strength of scar increases only reaching about 80% of its original strength.
What are hypertrophic scars?
thick, rigid, red scars (6-8 wks after wound closure)
True/False. Deeper wounds that take over 2 wks to heal have an increased risk of hypertrophic scarring?
Ture
Can scare lead to loss of motion and joint contracture?
Yes
Scare can be influenced by proper positioning, exercise, splinting, and compression?
Yes
What are burning rehabilitation goals, STG, and LTG?
STG; provide support, preparing for self-care tasks, AROM, education
LTG; established with the patient, family, and rehab team.
In the acute care phase of recovery, what is the focus?
Psychosocial support edema prevent contractures and loss of ROM strength Activity Tolerance Promote occupational performance and I with self-care Education
In the Postop Phase of recovery, what is the focus on?
Protect/preserve graft and donor sites (splints, positioning)
Prevent atrophy and DVT (exercise as appropriate)
I with self-care
AE
Educate
IN the Rehab phase of recovery, what is the focus on?
Begins when the wound closes.
Scar mgt program
Compression therapy
Improve jt mobility and prevent contracutres
Restore ROM, MMT, Coordination and endurance
ADL, IADL retraining, post dc planning (school, work)
What are OT interventions in burns?
Preventive positioning Splinting ADL's Therapeutic exercise Scare management Compression therapy Edema management
Preventive Positioning is focusing on?
Reducing edema
Maintaining antideformity position
Position of comfort is usually the position of contracture
Position of contracture include?
UE - shoulder add and flexion
LE - flexion of the hip, knees with plantar flexion of the ankles, toes pulled dorsally
Hand - MP ext, IP flexion, thumb add (claw hand)
Splitting should be in what position?
Antideformity position
What splint should be provided for acute phase?
Static splint
Volar hand splint should be in?
Wrist ext 15-30%, MP flex 50-70, IP ext th abd/ext
Elbows and knees should be in?
5 degrees of flexion
Splints should be?
check for pressure
assessment daily
secure with a figure of 8 wrap
(ear protection splint).
Important to remember after surgery is to?
avoid shearing after graft placement
assess surrounding tissue for graft integrity
doner sites are treated similarly to burn sites.
How do ADLs look like in the acute phase?
can be very limited
self suctioning of oral cavity possible if facial burns have not occurred.
After extubation oral care is attempted
Self-feeding when cleared by MD
AE for ADL’s
Select tasks with high probability of success
What are the examples of therapeutic exercises/activity tolerance?
Sitting tolerance transfers ambulation activities A/AA/PROM exercises Preserve ROM Decreased edema Build cardiopulmonary endurance Graded exercise as appropriate
Scare Massage /skin conditioning is meant to?
Help improve scar integrity and durability
Used on any burned area taking over 2 wks to heal
Lubrication and massage with water-based cream performed 3-4 x per day.
Help desensitize, soften scar bands
Massage in a circular motion
True or false? Scar maturation takes 12-18 mo after injury
Ture
Compression therapy should be initiated when?
Early usually 5-7 days after removal of dressings
The goals are to decrease hypersensitivity, edema control, and scar compression
A patient has sustained a circumferential burn of his entire R UE. Using the rule of 9’s how would you calculate his injury?
9%
A full thickness burn includes?
Dermis and epidermis
A pt arrives in your clinic with a thumb that is red and blistered from a burn. How would you classify this injury?
Superficial partial-thickness
It is important for an Occupational therapist to complete their eval?
within 48 hrs
Tx intervention for scar mgt often used by OTs include?
all of these answers
An OT practitioner is treating a client who sustained second and third degree burns on the dorsal forearm and hand. Which splint would be appropriate for this client?
intrinsic plus splint
An OTR is evaluating a pt with 3rd degree burns on his neck. The anti-deformity position to educate the pt caregiver on for the neck is?
Neutral
Which of the following is considered a medical emergency?
compartment syndrome
A burn on the dorsal hand with exposed tendon and bone is best treated with which of the following procedures?
A local flap
Which of the following is an advantage of a split thickness skin graft?
Can be stretched to large area and allows drainage
