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Integ - PTH 703 - Unit 1 > Rehabilitation of Individuals with Burns > Flashcards

Rehabilitation of Individuals with Burns Flashcards

1
Q

Should you expect to achieve full ROM in burn cases

A

Yes, anything is possible.

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2
Q

Should you expect long-term hospital stays in burn cases?

A

No, stays can be short and independence can be achieved quickly

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3
Q

What is a first degree burn?

A

Superficial burn

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4
Q

What is a second degree burn?

A

superficial partial thickness or deep partial thickness (grafting sometimes indicated)

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5
Q

What is a third degree burn?

A

Full thickness (grafting)

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6
Q

What are the 4 PT/OT goals for those w/ burns?

A
  1. Prevent scar contractures, with full AROM at all joints and body parts
  2. Minimize hypertrophic scarring
  3. Return to baseline independence in ADLs, IADLs, and work, with pre-burn movement patterns
  4. Return strength and cardio-pulmonary endurance to baseline

*Predict wound healing to prevent future impairments. Rehab is time-sensitive

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7
Q

What are 3 things PTs and OTs need to do quickly?

A

Assess location/depth with team
Predict burn healing, scar potential, possible ROM losses
Assess patient and family social and emotional resources

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8
Q

What is a tool you can use to see if you’re competent enough to treat burns?

A

Burn Rehab Therapist Compentency Tool (BRTCT)

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9
Q

Where are burns most concerning when trying to prevent scar contractures/achieve full AROM?

A

Burns on or around joints

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10
Q

Intervention to attain full AROM?

A

AROM/PROM frequently throughout the day most effective in maintaining or attaining PROM and strength

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11
Q

How much stretching per day is needed in the Rehab phase?

A

Greater than one hour per day`

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12
Q

When is Immobilization Indicated? (4)

A

48+ hrs after skn substitutes placed, for good adherence, on partial thickness wounds
5 days or more after grafting over full-thickness wounds
When intubated, sedated, and frequent ROM not possible (including possible night time positioning)
To augment PT/PT (??) exercise

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13
Q

Where do you want immobilized joint positioned?

A

Positioned in optimal, functional stretch position

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14
Q

What are three ways to predict ROM losses and prevent ROM loss

A

Exercises
Activity (ADL, IADL, Work, Leisure)
Positioning

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15
Q

What tissue should you stretch?

A

Burn will shorten tissue. stretch to lengthen the burned area

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16
Q

Should you use an air mattress in an ICU?

A

Yes

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17
Q

What is a position to avoid in burn patients with burn over the hip?

A

Side lying on a flat bed on either side.

18
Q

What is a piece of furniture to avoid in patients with knee burn?

A

Recliner

19
Q

Burn on ant. ankle? What motion do you stretch?

A

Do PF. If it was posterior, you’d do DF

20
Q

What are 3 considerations in splinting hands and wrists?

A

Location of burn
Thumb, wrist, palm involvement
Extensor tendon involvement

21
Q

What are two types of splints for the hands/wrists?

A

Types of splints:

  • Instrinsic plus
  • Fist position (open and close to get fluid moving

(BioBrane is a good dressing to use, FYI)

22
Q

How do you want wrist positioned?

A

IPs and DIPs extended

23
Q

What are 4 other areas to consider?

A

Trunk (rotation, flex, ext, lat rot)
Mouth (microstomia orthosis)
Donor sites
Finger web spaces

24
Q

4 keys for positioning?

A

Develop positioning and splinting recommendations and schedules
Monitor skin tolerance (and fit)
Adjust as needed
Educate team

25
Q

Considerations for positioning? (6)

A

Edema management via elevation critical to TOM success, and is included in positioning suggestions - ELEVATE ABOVE LEVEL OF THE HEART
Progress to AAROM and AROM ASAP
Good outcomes associated with frequent repositioning of ROM throughout day and prolonged stretch
May combine positioning device at night and AROM during the day
AROM also achieved thru participation in ADL, work, leisure
Encouragement and extensive education needed to work through superficial skin tears or synthetic skin ‘adhesions’ with ROM
(use gonio and hand tracings)

26
Q

How long can burn scar take to heal?

A

12-15 months

27
Q

What length of time indicates hypertrophic scarring?

A

> 3 weeks

28
Q

What is essential for gaining compliance?

A

Family education

29
Q

What group of patients are least compliant with ROM and stretching, but most compliant with ADLs?

A

Pediatrics

30
Q

Should you use scare tactics?

A

Yes, they sometimes work

31
Q

What is an objective measure of scars?

A

Vancouver Scar Scale

32
Q

What four things does the Vancouver Scar Scale measure?

A

Vascularity
Pigmentation
Pliability
Height

(pigmentation refers to surface color)

33
Q

What are different pressure garments?

A

Temporary: tubigrip for limbs, Isotoner gloves hands, inserts where needed, face masks, etc.

Permanent: Custom pressure garments (ex. Jobst)

34
Q

What are 3 different inserts used?

A

50/50
Gel inserts
Ensel garment inserts

35
Q

How to do scar massage?

A

Circular, downward pressure

36
Q

Is there evidence to support scar massage?

A

No. There is no compelling evidence that it minimizes scarring. May be a psychological benefit though…

37
Q

What has best results in reducing scar thickness?

A

Combo of pressure therapy combined with silicone gel sheeting on hypertrophic scar

38
Q

Treatment strategies for those with an inhalation injury?

A 
Head of bed up
Incentive spirometer use
Therapeutic coughing
Moving, turning
Endurance and strength training
39
Q

How to maintain or attain strength and balance?

A

Transfer out of bed ASAP
Promote AROM over PROM
Combine strengthening and stretching ex prog to minimize complexity and time, to improve chances for follow through
Encourage gradual progression back to former activities

40
Q

How to enforce long-term skin protection?

A

Prevent sun exposure over burned areas, via long sleeved shirts, sun hats, and sun screen
Full thickness burned areas are without sweat glands; care in exercise if substantial burns
Burned skin can be more fragile than unburned; consider footwear, contact activities, even clothing early post-burn

Integ - PTH 703 - Unit 1 (9 decks)

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