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PTA - Intro to Rehab > PTA Acute Care - Burns > Flashcards

PTA Acute Care - Burns Flashcards

1
Q

What comprises the Integumentary System?

A
  • skin
  • hair
  • hair shafts
  • nails
  • sebaceous glands
  • sweat glands
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2
Q

What are the 2 layers of skin?

A
  • epidermis

- dermis

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3
Q

What connects the skin to muscles and bones?

A
  • subcutaneous tissue

- fat

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4
Q

What are the functions of the Integumentary System?

A
  • temperature regulation
  • protection
  • sensation
  • excretion
  • immunity
  • blood reservoir
  • vitamin-D synthesis
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5
Q

how does the integumentary system regulate Temperature?

A
  • sweat production

- superficial blood flow

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6
Q

from what does the integumentary system Protect the body?

A
  • micro organisms
  • UV
  • abrasion
  • chemicals
  • dehydration
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7
Q

what 3 Sensations does the integumentary system detect?

A
  • pain
  • temperature
  • touch
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8
Q

what does the integumentary system Excrete?

A
  • heat
  • sweat
  • water
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9
Q

how does the integumentary system provide Immunity?

A
  • shedding of epidermis removes micro organisms
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10
Q

how does the integumentary system act as a Blood Reservoir?

A
  • dermis contains blood vessels

- can shunt volumes of blood to muscles or organs as needed

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11
Q

how does the integumentary system Synthesize Vitamin D?

A

uses UV radiation

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12
Q

what is a Burn?

A

the tissue damage that results from skin and body destruction from absorption of heat energy

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13
Q

what are the 3 burn Zones?

A
  • zone of coagulation
  • zone of stasis
  • zone of hyperemia
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14
Q

what is the Zone of Coagulation?

A
  • center of the burn
  • area of greatest damage
  • area of eschar
  • is area of non-viable tissue
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15
Q

what is the Zone of Stasis?

A
  • the area surrounding the zone of coagulation

- contains marginally viable tissue

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16
Q

what is the Zone of Hyperemia?

A
  • the outermost area
  • area of least damage
  • area that heals the most quickly
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17
Q

what are 7 Complications of Burns?

A
  • infection
  • respiratory
  • metabolic complications
  • decreased cardiac function
  • heterotropic ossification
  • neuropathy
  • pathological scars
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18
Q

which burn complication is the leading cause of death?

A

infection

along with organ system failure

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19
Q

what kind of Respiratory complications might arise?

A
  • CO poisoning
  • tracheal damage
  • upper airway obstruction
  • pulmonary edema
  • pneumonia
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20
Q

what is the progression of the Metabolic Complications?

A

> increase in metabolic activity
decreased weight
decreased nitrogen balance
decreased energy stored

21
Q

why is the burn patient’s room kept warm?

A

because of the heat loss due to missing skin

22
Q

why is the burn patient weak and atrophied?

A

because he is using his muscle for energy

23
Q

how is Cardiac Function compromised in the burn patient?

A

fluid volumes are decreased

cardiac volumes are decreased

24
Q

where does Heterotopic Ossification usually occur in the burn patient?

A

in the elbows
- but also at hips and shoulders

ROM will be decreased

25
Q

What causes Neuropathy in the burn patient?

A

Local

  • compression bandages
  • poorly fitting splints
  • bad positioning

Poly
- idiopathic

26
Q

what is important to consider regarding Pathological Scars on the burn patient?

A

loss of ROM when scars cause contractures or are keloid

- watch positioning

27
Q

what are the 4 types of burns?

A
  • thermal - flame, explosion, contact with hot metal or liquid
  • electrical - lightning, electrical waves
  • chemical - acids and alkalids
  • UV radiation - sunburn
28
Q

which thermal burn do children aged 1-5 sustain?

A

hot water

29
Q

how do you recognize an Electrical Burn?

A

entrance wound

exit wound

30
Q

how do you treat the Chemical Burn?

A

neutralize it

usually water

31
Q

What is a 1st degree burn?

A

classification of depth

  • Superficial
  • damage only to epidermis
  • (sunburn)
  • painful - nerve ending on epidermis
  • heals on its own
  • no scar
  • treatment is cover and manage pain
32
Q

What is a 2nd degree burn?

A

classification of depth

  • Partial Thickness Burn
  • Superficial partial-thickness burn
    • Damage through epidermis and into the papillary layer of dermis
    • Moist skin and blister that need to be evacuated because they may delay healing
    • Heal in 7-10 days with minimal scarring
    • Extremely painful due to exposed nerve endings
  • Deep partial-thickness burn
    • Damage of dermis down into the reticular layer
    • Appears as mixed red or waxy white color. The deeper the injury the more white it will appear
    • Marked edema and large amt of evaporative water loss
    • Heals in 3-5 weeks if doesn’t get infected
    • Development of hypertrophic and keloid scars frequent
33
Q

What is a 3rd degree burn?

A

classification of depth

  • Full Thickness Burn
    • All epidermal and dermal layers are destroyed completely; subcutaneous fat layer may also be destroyed
    • Skin deadly white to dark; charred brown
    • Characterized by hard, parchment-like eschar
    • Peripheral vascular system damaged
    • Surgery often required to remove eschar
    • Grafting necessary
    • No pain (not as much as 1st and 2nd anyway)
34
Q

What is a 4th degree burn?

A

classification of depth

  • Subdermal
    • Destruction of all tissue from the epidermis down to and through the subcutaneous tissue. Fascia, muscle, and bone may be damaged
    • Often due to electrical burn
    • Extensive surgical and therapeutic management is required
35
Q

What is the Rule of Nines?

A

how to calculate the extent of the body surface involved in the burn

  • Allows a rapid estimate of extent of body burned
  • Divides body surface into areas of 9% or multiples of 9% of total body surface
  • UEs and head 4.5% front and back each
  • LEs 9% each front and back
  • Trunk 18% front; 18% back
36
Q

What is the Initial Treatment of the burn?

A
  1. removal of heat source
  2. establish adequate airway (CPR as needed)
  3. if chemical, flush with water
37
Q

What is the Emergency Room Treatment of the burn?

A
  1. Maintain airway (ventilator)
  2. Prevent cyanosis; shock; hemorrhage
  3. Establish extent and depth of burn injury
  4. Prevent/reduce fluid loss -> IV solutions
  5. Insert catheter
  6. Clean wounds -> escharotomy for circumferential burns of extremities or chest to prevent compression and constriction of blood flow
  7. Assess injury
  8. Prevent pulmonary and cardiac complications
38
Q

What is the Ongoing Treatment (ie Treatment of the Burn Wound) of the burn?

A
  • Prevent infection: isolation and sterile techniques; use of silver medications
  • Clean wound: possible whirlpool
  • Open or closed (bandaging) treatment
  • Debridement
    • Surgical debridement: excision of eschar
    • Sharp debridement: using forceps and surgical scissors
    • Enzymatic debridement: application of proteolytic enzyme ointment that digests necrotic tissue
  • Increased caloric intake
  • Warm room
39
Q

What did Lund and Browder do?

A

made the Rules of Nines more accurate.

  • modified the Rule of Nines to account for a continuum of age and to accomodate for growth of different body segments
  • they have a fancy chart
40
Q

what would be included in a comprehensive Physical Therapy Care Plan for the burn patient?

A
  • wound care
  • positioning
  • splinting
  • exercise
  • gait training (functional training)
  • fitting of post-burn compression garments
  • scar management
  • HEP and positioning/splinting program
41
Q

How does PT do wound care for the burn?

A
  • Clean wound: possible whirlpool
  • Open or closed (bandaging) treatment
  • Debridement
    • Surgical debridement: excision of eschar
    • Sharp debridement: using forceps and surgical scissors
    • Enzymatic debridement: application of proteolytic enzyme ointment that digests necrotic tissue
42
Q

Why is the PTA careful to position and/or splint the burn patient?

A

In such a way as to:

  • Minimize edema
  • Prevent tissue destruction
  • Maintain soft tissues in elongated state
  • Splint to assist with preventing contractures or ROM
43
Q

How would the PTA position and/or splint the burn patient?

A

Because they are mostly burned on the front

  • Neck: extension and no rotation
  • Shoulder: abduction (90 degrees); external rotation; horizontal flexion (10 degrees)
  • Elbow and forearm: extension with supination
  • Wrist: neutral or slight extension
  • Hand: finger and thumb extension (palmar burn)
  • Trunk: straight postural alignment
  • Hip: neutral extension/flexion; neutral rotation; slight abduction (perpendicular to that ASIS line)
  • Knee: extension
  • Ankle: neutral or slight dorsiflexion; no inversion; neutral toe extension/flexion
44
Q

In what kinds of exercises would the PTA instruct the burn patient?

A

ROM exercises

  • Active or active assistive if possible; passive and stretching occasionally
    • Difficult with pain level but must be persistent; time sessions with pain meds
    • Must avoid exercise to grafted areas for at least 3-5 days or until okay by surgeon
    • Not performed on areas of exposed tendons

Strengthening

  • Exercises in rehab stage
    • Monitor vital signs closely and gradually progress to aerobic exercise
45
Q

What functional training would the PTA do for the burn patient?

A

Gait Training

- at the earliest stage possible

46
Q

Why does the PTA apply compression garments to the burn patient?

A

to prevent hypertrophic scarring

47
Q

How does the PTA perform Scar Management for the burn patient?

A
  • applies compression garment to prevent hypertrophic scarring
  • massage scars to soften the areas
48
Q

name 4 major causes of death in burn patients

A
  • Infection - #1
  • Respiratory b/c of inhalation injury (CO poisoning)
  • Metabolic complication (patient’s body cannot keep up)
  • Cardiac function (decreased CO)

PTA - Intro to Rehab (12 decks)

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