SPECONLEC_S1_L2 - 73-109 Flashcards by Andre Neri Valencia

Long Term Goal of medical mx for burns is:

To restore skin integrity, function and appearance

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immediate goal is restore skin integrity t or f

f, this is the long term goal

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Immediate Goal (Post Resucitation) of medical mx for burns:

a. Prevent infection
b. Decrease pain
c. Prepare wounds for grafting
d. Prevent contracture and scarring
e. Maintain strength and function
f. all

f. all

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acute or initial medical mx of burns

transport
fluid replacement
determining the extent and depth of injury
wound cleansing
Topical Antibacterial Agents
Proper positioning for optimal joint placement
wound coverage
grafting

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t or f goal of wound debridement is To remove dead tissue, prevent
infection, and promote
revascularization/reepithelialization

f, this is the goal of wound cleansing

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what acute medical mx would help reduce the number of bacteria

Topical Antibacterial Agents

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Topical antibacterial agent; effective against gram-negative or
gram-positive organisms; diffuses easily to eschar

Mafenide acetate (sulfamylon)

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Most commonly used
anti-bacterial agent; effective against
Pseudomonas infections

Silver Sulfadiazine

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Topical solution with antimicrobial function against gram-positive
and gram negative organisms.

Mafenide acetate solution (sulfamylon 5% solution) silver nitrate

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t or f using mafenide acetate is effective against
Pseudomonas infections

f, using silver sulfadiazine

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Maintains moist environment

Mafenide acetate solution (sulfamylon 5% solution) silver nitrate

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Antiseptic germicide and astringent;
will penetrate only 1-2mm of eschar; useful for surface bacteria;
stains black

Mafenide acetate solution (sulfamylon 5% solution) silver nitrate

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mafenide acetate soultion (sulfamylon 5% solution) silver nitrate will
penetrate only how many mm of what

1-2 mm of eschar

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Bland ointment; effective against gram-positive organisms

Bicitracin/ Polysporin

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Enzymatic debriding agent selectively
debrides necrotic tissue; no antibacterial action

Collagenase, accuzyme

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_ applied with sterile glove_ directly to wound or impregnated into _ IN
silver sulfadiazine

white cream, 2-4 mm, fine mesh gauze

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White cream applied __ to wound with thin _ layer how many times daily;
may be left undressed or covered with _ in mafenize acetate

directly, 1-2 mm, 2 times, thin layer of gauze

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White cream applied with sterile glove 2-4mm directly to wound or
impregnated into fine mesh gauze in what topical medication

Silver Sulfadiazine

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50-gram packet of white powder that is mixed with either 1000mL
sterile water or 0.9% sodium chloride soaked gauze in what topical
medication

Mafenide acetate solution (sulfamylon 5% solution) silver nitrate

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Dressings or soaks used every __ hours; also available as _ to _ small
open areas in what topica ointment

2 hrs, small sticks, to cauterize, Mafenide acetate solution (sulfamylon 5% solution) silver nitrate

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how many grams of packet of _that is mixed with either _
or _ soaked gauze in Mafenide acetate solution
(sulfamylon 5% solution) silver nitrate

50 gram, white powder, 1000 mL sterile water or 0.9% sodium chloride

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t or f bicitracin is a thin layer of ointment
applied directly to wound and left closed

f, left open

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Ointment applies to eschar and covered with
moist occlusive dressing with or without an antimicrobial agent.

Collagenase, accuzyme

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thin layer of ointment applied directly to wound and left open

Bicitracin/ Polysporin

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collagenzase is applied to __ and covered with __ with or wihtout an antimicrobial agent

eschar, moist occlusive dressing

WOUND CLEANSING (2):

Debridement Review methods in wound management

Removal of eschar is callled

Debridement

Removal of necrotic tissue is also called debirdement t or f

debridement would help in preventing bacterial proliferation t or f

dressing is done to prevent wound _

contamination

debreidement keeps microorganism at bay t or f

f, dressing

wound cleansing Prevent further injuries t or f

f, dressing

Apply pressure to control the hemorrhage in wound dressing t or f

t or f wound dressing Absorb wound drainage and Assist in wound healing

two techniques of wound coverage (dressing)

open technique closed technique

Applying a topical cream or ointment with or without dressings (usually without)

OPEN TECHNIQUE

Applying dressings over a topical agent: what technique

Closed Technique

Allows for ongoing inspection of the wound and examination of the healing process

OPEN TECHNIQUE

purpose of closed technique:

Hold topical antimicrobial agents on the wound Reduce fluid loss Protect the wound

The topical medication must be reapplied throughout the week for open technique

f, throughout the day

for closed technique, how many times should you change in a day

Change once to twice a day

Layers of closed technique:

1st - Non-adherent 2nd - Cotton padding 3rd - Gauze or elastic bandage 4th - Roller gauze 5th - Elastic wrap

Patient's own skin, taken from an unburned area

autograft

autograft is temporary coverage t or f

f, permanent

Taken from cadaver of own species: what kind of grafting

Homograft/Allograft

what kind of grafting is taken from non human like pigs

Heterografts/Xenografts

ARE A LIFE-SAVING TECHNOLOGY FOR LARGE, FULL- THICKNESS, TOTAL BODY SURFACE AREA (TBSA) BURNS

CULTURED EPITHELIAL AUTOGRAFTS (CEAS)

CULTURED EPITHELIAL AUTOGRAFTS (CEAS) is used for __

LARGE, FULL- THICKNESS, TOTAL BODY SURFACE AREA (TBSA) BURNS.

CEAs are composed of

AUTOLOGOUS KERATINOCYTES

CEAs ARE CULTURED UNDER CONDITIONS THAT GENERATE __SUITABLE FOR GRAFTING.

EPITHELIAL SHEETS

what to put in subjective:

Patient's background Chief complaints HPI PMHx Lifestyle Social and Physical Environment Patient's goal

Preesisting limitations or previous injuries: what subj part

PMHx

part of subj where the pt will told you the first aid administered

HPI

MOI is what part of subj

HPI

Objective

VS OI ROM MMT/FMT Sensory testing wound assessment cardiopulmonary assessment antrhopometric measurement PA, FA, GA

what to put in OI

Attachments Splints Site of wounds etc

what to put in wound assessment

% TBSA Classification Burn type and depth Wound dressings Presence of grafting, graft sites

omts for Burn Outcome Measures

Burn Specific Health Scale -Brief (BSHS-B) Burns Scar Index (Vancouver Scar Scale)

PTDx: what to put

Classification of burn injury % TBSA Severity of burn

determinants of prognosticating factors (5)

Severity of burns Current health status Age Physical Condition Mental condition

RISK FACTORS TO RETURN TO WORK AFTER MAJOR BURN INJURY (6)

● Preburn psychiatric history ● Extremity burns ● Electric etiology ● Longer stay at hospital ● Inpatient rehabilitation ● Burn injury occurred at work

BARRIERS TO RETURN TO WORK AFTER MAJOR BURN INJURY (5)

● Wound issues ● Neurologic problems ● Physical abilities, impaired mobility ● Working conditions (temperature, humidity, and safety) ● Psychosocial factors

Psychosocial factors in barriers include: (6)

○ Drug and alcohol dependence ○ Insomnia ○ Depression ○ Post Traumatic stress (nightmares, flashbacks) ○ Anxiety ○ Appearance issues and concerns over body image

Suggested goals and outcomes for the physical therapy plan of care for the patient with burns include: (12)

○ Wound and soft tissue healing is enhanced. ○ Risk of infection and complication is reduced ○ Risk of secondary impairments is reduced. ○ Maximal range of motion is achieved ○ Pre-injury level of cardiovascular endurance is restored ○ Good to normal strength is achieved ○ Independent ambulation is achieved ○ Independent function in ADL and IADL is increased ○ Scar formation is minimized ○ Patient, family, and caregiver’s understanding of expectations and goals and outcomes is increased ○ Aerobic capacity is increased ○ Self-management of symptoms is improved

PT INTERVENTION (2)

positioning splinting

what PT intervention prevent contracture formation

positioning and splinting

Splinting uses

Facilitate proper positioning Prevention of joint contracture Protecting skin grafts or fragile wounds Assisting desired motions

to maintain hand at a functional position, what do u use

Hand splints

to avoid neck flexion (position of comfort); to maintain at neutral or slight extension

neck brace

neck brace avoid _

neck flexion

to help reduce scarring/ maintain or decrease appearance of scars

Compression garments

to maintain patency of mouth, what do pts wear

face splints

to maintain foot at neutral position, what do pts wear

dorsiflexion brace

t or f Compression garments help maintain or decrease appearance of scars which is why they are worn throughout the body or burned area

positioning strategy: ANTERIOR NECK common deformity

Flexion

positioning strategy: shoulder - axilla common deformity

Adduction and internal rotation

positioning strategy: elbow common deformity

Flexion and pronation

positioning strategy: hand common deformity

Claw hand (also called intrinsic minus position)

positioning strategy: hip and groin common deformity

Flexion and adduction

positioning strategy: knee common deformity

Flexion

positioning strategy: ankle common deformity

Plantarflexion

positioning strategy: anterior neck motions to be stresssed

Hyperextension

positioning strategy: shoulder axilla motions to be stressed

Abduction, flexion, and external rotation

positioning strategy: elbow motions to be stressed

Extension and supination

positioning strategy: hand motions to be stressed

Wrist extension; MCP flexion, proximal IP and distal IP extension; thumb abduction

positioning strategy: hip and groin motion to be stressed

All motions, especially hip extension and abduction

positioning strategy: knee motion to be stressed

Extension

positioning strategy: ankle motion to be stressed

All motions (especially dorsiflexion)

positioning strategy: anterior neck suggested approaches

Use double mattress; position neck in extension; with healing use rigid cervical orthosis

positioning strategy: shoulder axilla suggested approaches

Position with shoulder flexed and abducted (airplane splint)

positioning strategy: elbow suggested aproaches

Splint in extension

positioning strategy: hand suggested approaches

Wrap fingers separately. Elevate to decrease edema. Position in intrinsic plus position, wrist in extension, MBP in flexion, proximal IP and distal IP in extension, thumb in abduction with large web space

positioning strategy: hip and groin suggested approaches

Hip neutral (zero degrees of flexion/extension), with slight abduction

positioning strategy: knee suggested apporaches

Posterior knee splint

positioning strategy: ankle suggested approaches

Plastic ankle-foot orthosis with cutout at Achilles tendon and ankle positioned in neutral

The common deformity of the hand after burn injuries is in the claw hand position or intrinsic plus. t or f

Significant factors involving mortality involvement of the head, upper extremity, and the perineum. t or f

The free nerve endings that are found only in the dermis, convey the sensation of pain and itch to the brain. t or f

Inhalation injuries are the most devastating type of burns. t or f

In electrical burns, PNS and CNS problems may occur immediately after injury. t or f

In chemical burns, acidic products usually cause more damage compared to alkali products.

Complete healing of superficial thickness burns occurs in 7 to 10 days. t or f

The most common cause of burns in children 1 to 5 years of age is scalding from hot liquids t or f

The tissue with the least resistance to electricity is the blood as it is made up of water. t or f

Inhalation injuries are called carbon monoxide poisoning, heat injuries, or smoke inhalation injuries. t or f