Integ (burn questions) Flashcards
What are the 3 zones of a burn?
Zone of coagulation: Center; Cells are irreversibly injured (cell death)
Zone of of stasis: Cells are injured; may die without specialized treatment, usually within 24-48 hours
Zone of hyperemia; Minimal cell injury; cells should recover (reddened area of skin)
Describe the degrees of burns. (5 degrees)
Epidermal Burn (1st degree): Damage to epidermis only, no blistering, no scarring, heals on its own in 3-7 days
Superficial Partial Thickness Burn (2nd degree): Epidermis and upper dermis are damaged, has blisters, moderate edema. Spontaneous healing 7-21 days, minimal to no scarring
Deep Partial Thickness Burn (2nd degree): Severe damage to epidermis and dermis with injury to nerve endings, hair follicles, and sweat glands. Broken blisters, Sensitive to pressure but insensitive to light touch or soft pin prick. Healing is slow and occurs through scar formation. Excessive scarring without preventative treatment
Full-thickness burn: Complete destruction of epidermis, dermis, and subcutaneous tissues; may reach muscle. little pain; nerve endings are destroyed. Skin grafting is necessary.
Subdermal Burn: Complete destruction of everything. Electrical burns or from prolonged contact with flame. can cause V-fib, acute kidney damage, and spinal cord damage. Requires extensive surgery; amputation may be necessary
What are some complications of a burn injury?
- Infection (leading cause of death)
- Shock
- Pulmonary complications (smoke inhalation)
- Metabolic complications (increase metabolic activity)
- Cardiac and circulatory complications (fluid and plasma loss results in decrease in CO
- Integumentary scars and contractures
What are some topical agents that can be used following a burn as treatment?
Ointments: Bacitracin, Polymyxin B, and Neomycin
Silver sulfadiazine; common topical agent
Sulfamylon (mafenide acetate): Penetrates eschar
What types of dressings may be used following a burn?
Silver-impregnated, hydrogels, petroleum-impregnated, and cause dressings
What types of grafts are their for severe burns?
Allograft: Use of other human skin, temporary until autograft is available
Xenograft: Use of skin from other species (pigskin), also temporary
Biosynthetic Grafts: Combination of collagen and synthetics
Cultured skin: Lab grown from patient’s own skin
Split-Thickness Graft: contains epidermis and upper layers of dermis from donor site
Full-thickness Graft: Contains epidermis and dermis from donor site
What are the overall goals for rehab following a burn?
Limit ROM loss,
Reduce edema
Prevent predicable contractures through positioning and splinting
Prevent or reduce complications of immobilization
How do you prevent contractures in the anterior neck?
Deformity is flexion
Stress hyperextension; position with firm cervical orthosis
How do you prevent contractures with burns on the shoulder?
Common deformity: Adduction, IR
Stress abduction, flexion, and ER; Position with axillary splint (airplane splint)
How do you prevent contractures of the elbow?
Common deformity is flexion and pronation
Stress extension and supination; use posterior arm splint
How do you prevent contractures of the hand?
Common deformity is a claw hand
Stress wrist extension (15 degrees), MP flexion (70 degrees), PIP and DIP extension, thumb abduction; position in intrinsic plus position with resting hand splint
How do you prevent contractures of the hip?
Common deformity is flexion and adduction
Stress hip extension and abduction; position in extension, abduction, and neutral rotation
How do you prevent contractures of the ankle and knee?
Knee: common deformity is flexion, stress extension with posterior knee splint
Ankle: Common deformity is PF; stress DF with foot-ankle in neutral with splint or plastic AFO
How long after a graft do you want to discontinue exercise to allow for tissues to heal?
3-5 days
