PT and Burns - Class 5 Flashcards
PT initial evals
chart review
objective eval
assessment
plan
chart review should include
MOI/extent
%total body surface area, location, inhalation injury?
hospital course
PMH, PSH
meds, allergies
social history
precautions
referring MD
social history
married or single
w/ or w/o family
occupation
house or apartment/stairs, elevator
ETOH
prior to admission
prior to admission
level of fxn
ADs
hand dominance
objective eval
vital signs
mental status
AROM
PROM
burns
muscle strength
motor fxn/muscle tone
sensation
vital signs
from nursing flow sheets if necessary
burns
depth
location
size = %TBSA
appearance –> red, blood base v necrotic areas
wound treatment
muscle strength
specific muscle testing is indicated in nerve distribution areas
important and helpful w/ electrical injury involvement
what should we take into consideration –> objective
pt is heavily medicated and sometimes sedated
during the initial eval we should try and find out
when the pt is going to be tanked or when they receive their dressing change
%TBSA can be found
on the chart
how do we check if a burn is circumferential
lift pt’s extremities
look anterior and posterior
how long do burns take to show themselves/demarcate
2-3 days
initially they might look more superficial than they really are and vice versa
assessment
includes PT assessment
candidate for therapy, to ambulate independently or be sent home w/ or w/o care
plan
consists of PT tx
5-6 days/week
for A/PROM techniques
transfers
strengthening and ambulation
first couple days post burn goals of medical team
fluid resuscitation
critical care techniques
PT intervention –> couple days post burn
CPT/percussion
PROM technique
positioning can be included
–> as long as nursing and OT are aware and in agreement
what is important
consistency!
tx must be
aggressive and regimented
should be seen 2x a day
when should we review the chart
daily for changes
note surgeries, donor sites and grafts
what should we look for
signs of infection
staples left intact
when performing P/AAROM to elbows and knees
be sure it is GENTLE
what can aggressive PROM at the knees and elbows cause
heterotrophic ossification
who should we notify with problems
the proper HCP
as the pt begins to heal
some scar bands may begin to develop around or near joints
what may occur when the pt performs thier exercise program
the skin may blanch
occasionally the pt or PT may cause
an auto release of their scar band or skin contracture and bleed
notify MD
outpatient
use of modalities such as
paraffin
heat and ice
can be beneficial depending on sitatuation and sxs
paraffin
an excellent modality to soften hard tight skin
paraffin –> where should it be used
exposed area
make sure the area is healed w/o opened areas
to use paraffin we should
stretch joint until it is blanched
set up of paraffin
take 4x4 gauze and dip it into the paraffin several times –> until impregnated with it
let paraffin drop over paraffin bin until it stops dripping
place gauze on joint –> approx 1-2 min
use w/ prolonged stretch 1-3 min
what should we remember –> paraffin
grafted skin usually has decreased sensation and decreased ability to dissipate heat
always check every 20-30 s
tx planning objectives
prevent the loss of ROM and fxn
restore lost motion and fxn
return to preburn fxnal status (PTA) or educate pt to fxn w/ disability
disability doesnt mean
handicap
tx planning –> tx interventions
proper positioning, splinting and exercise
compliment one another along continuum of interventions
tx concept
tx location
time of day
frequency of txs
tx concept
to impart stress in a controlled manner to cause scar tissue to remodel
what time of the day is the worst
mornings
but there is benefit in achieving ROM early for use throughout the day
when should we schedule tx sessions
to coincide w/ administration of pain meds
by later afternoon pt may be
fatiguede w/ the day’s activities
can benefit ROM
frequency of tx
continuous
1-6x per day
formal tx is
therapist guided
informal
self ROM
nurse or family supervised
ROM is used as a
guide
positioning objectives
control edema
prevent tissue destruction
maintain soft tissues in an elongated state
control edema
elevate extremities when lying or sitting
UE when ambulating
when is it most critical –> edema
first 72 hours
when sitting –> edema
pts arms at the level of their heart
preventing tissue destruction
pressure areas
preventing tissue destruction includes
turning schedule
alternate positions
dermal pads for head and heels
maintain heels off bed
use for specialty beds
maintain soft tissue in an elongated state–> how should the pt be positioned
position opposite the location of the burn wound
what should we extend –> elongated state
flexor surfaces
there are –> elongated state
positioning techniques for specific body areas
heterotopic ossification pathogenesis
unknown
suspected etiologies –> HO
calcium mobilization
what is calcium mobilization from –> HO
immobilization
high protein intake
microtrauma
> 20% of total body burn
incidence of HO
0.1-3.3% in retrospective studies
13/14-23% in prospective studies
burn program exercise objectives
reduce edema and promote circulation
prevent scar tissue contractures and deformity
prevent deconditioning
preserve muscle strength and joint mobility
maximize lung fxn
promote maximum fxnal independence
