PTA Acute Care - Burns Flashcards
What comprises the Integumentary System?
- skin
- hair
- hair shafts
- nails
- sebaceous glands
- sweat glands
What are the 2 layers of skin?
- epidermis
- dermis
What connects the skin to muscles and bones?
- subcutaneous tissue
- fat
What are the functions of the Integumentary System?
- temperature regulation
- protection
- sensation
- excretion
- immunity
- blood reservoir
- vitamin-D synthesis
how does the integumentary system regulate Temperature?
- sweat production
- superficial blood flow
from what does the integumentary system Protect the body?
- micro organisms
- UV
- abrasion
- chemicals
- dehydration
what 3 Sensations does the integumentary system detect?
- pain
- temperature
- touch
what does the integumentary system Excrete?
- heat
- sweat
- water
how does the integumentary system provide Immunity?
- shedding of epidermis removes micro organisms
how does the integumentary system act as a Blood Reservoir?
- dermis contains blood vessels
- can shunt volumes of blood to muscles or organs as needed
how does the integumentary system Synthesize Vitamin D?
uses UV radiation
what is a Burn?
the tissue damage that results from skin and body destruction from absorption of heat energy
what are the 3 burn Zones?
- zone of coagulation
- zone of stasis
- zone of hyperemia
what is the Zone of Coagulation?
- center of the burn
- area of greatest damage
- area of eschar
- is area of non-viable tissue
what is the Zone of Stasis?
- the area surrounding the zone of coagulation
- contains marginally viable tissue
what is the Zone of Hyperemia?
- the outermost area
- area of least damage
- area that heals the most quickly
what are 7 Complications of Burns?
- infection
- respiratory
- metabolic complications
- decreased cardiac function
- heterotropic ossification
- neuropathy
- pathological scars
which burn complication is the leading cause of death?
infection
along with organ system failure
what kind of Respiratory complications might arise?
- CO poisoning
- tracheal damage
- upper airway obstruction
- pulmonary edema
- pneumonia
what is the progression of the Metabolic Complications?
> increase in metabolic activity
decreased weight
decreased nitrogen balance
decreased energy stored
why is the burn patient’s room kept warm?
because of the heat loss due to missing skin
why is the burn patient weak and atrophied?
because he is using his muscle for energy
how is Cardiac Function compromised in the burn patient?
fluid volumes are decreased
cardiac volumes are decreased
where does Heterotopic Ossification usually occur in the burn patient?
in the elbows
- but also at hips and shoulders
ROM will be decreased
What causes Neuropathy in the burn patient?
Local
- compression bandages
- poorly fitting splints
- bad positioning
Poly
- idiopathic
what is important to consider regarding Pathological Scars on the burn patient?
loss of ROM when scars cause contractures or are keloid
- watch positioning
what are the 4 types of burns?
- thermal - flame, explosion, contact with hot metal or liquid
- electrical - lightning, electrical waves
- chemical - acids and alkalids
- UV radiation - sunburn
which thermal burn do children aged 1-5 sustain?
hot water
how do you recognize an Electrical Burn?
entrance wound
exit wound
how do you treat the Chemical Burn?
neutralize it
usually water
What is a 1st degree burn?
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
What is a 2nd degree burn?
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
What is a 3rd degree burn?
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)
What is a 4th degree burn?
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
What is the Rule of Nines?
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
What is the Initial Treatment of the burn?
- removal of heat source
- establish adequate airway (CPR as needed)
- if chemical, flush with water
What is the Emergency Room Treatment of the burn?
- Maintain airway (ventilator)
- Prevent cyanosis; shock; hemorrhage
- Establish extent and depth of burn injury
- Prevent/reduce fluid loss -> IV solutions
- Insert catheter
- Clean wounds -> escharotomy for circumferential burns of extremities or chest to prevent compression and constriction of blood flow
- Assess injury
- Prevent pulmonary and cardiac complications
What is the Ongoing Treatment (ie Treatment of the Burn Wound) of the burn?
- 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
What did Lund and Browder do?
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
what would be included in a comprehensive Physical Therapy Care Plan for the burn patient?
- wound care
- positioning
- splinting
- exercise
- gait training (functional training)
- fitting of post-burn compression garments
- scar management
- HEP and positioning/splinting program
How does PT do wound care for the burn?
- 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
Why is the PTA careful to position and/or splint the burn patient?
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
How would the PTA position and/or splint the burn patient?
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
In what kinds of exercises would the PTA instruct the burn patient?
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
What functional training would the PTA do for the burn patient?
Gait Training
- at the earliest stage possible
Why does the PTA apply compression garments to the burn patient?
to prevent hypertrophic scarring
How does the PTA perform Scar Management for the burn patient?
- applies compression garment to prevent hypertrophic scarring
- massage scars to soften the areas
name 4 major causes of death in burn patients
- Infection - #1
- Respiratory b/c of inhalation injury (CO poisoning)
- Metabolic complication (patient’s body cannot keep up)
- Cardiac function (decreased CO)
