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USAHS Conditions > Unit 2: Burn Injury > Flashcards

Unit 2: Burn Injury Flashcards

1
Q

Skin Anatomy Review

A

.

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2
Q

Functions of the Skin

A
  • Protection from infection & injury
  • Prevention of loss of fluid and maintains hydration
  • Regulation of body temperature
  • Sensory contact with the environment
  • Excretion/Secretion (oils from sebaceous glands)
  • Physical Appearance
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3
Q

Classification of Burns

A
  • Depth of Injury
  • Size of Injury (usually reflected in a percent of total body surface area (TBSA)
  • Mechanism of injury
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4
Q

Depth of Injury (Classification of Burns)

A

-Reflects how deep into the skin layers a burn extends and the duration of the hot contact.

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5
Q

Size of Injury (Classification of Burns)

A

Usually reflected in a percent of total body surface area (TBSA).

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6
Q

Mechanism (Classification of Burns)

A

Indicates the type of burn, for example, an electrical burn or a chemical burn

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7
Q

Classification of Burns: Depth

A
  • Superficial Burn (First Degree)
  • Partial Thickness (Second Degree) or Deep Partial Thickness
  • Full Thickness (Third Degree)
  • Deep Full Thickness (Fourth Degree)
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8
Q

Superficial Burn (First Degree)

A
  • Confined to the epithelial layer of skin (epidermis)
  • Often caused by flame flashes or brief scald
  • Painful
  • For example: superficial sunburn or brief contact with a curling iron.
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9
Q

Partial Thickness or Deep Partial Thickness (Second Degree)

A
  • Penetrates the dermis
  • May see blisters, thin eschar, and severe pain.
  • Deep 2nd degree can injury the hair follicles and sweat glands (moderate eschar, lack of blisters, less pain due to damage to superficial nerve endings)
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10
Q

Full Thickness (Third Degree)

A
  • Full thickness burn that destroys dermis (thick inelastic eschar, not painful).
  • Skin graft will be required.
  • Dry, leathery, white. Often painless.
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11
Q

Deep Full Thickness (Fourth Degree)

A
  • Most severe and life threatening burn.
  • Full thickness burn that results from prolonged thermal contact (often electrical).
  • Skin graft and possibly muscle flap will be needed for coverage
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12
Q

Classification of Burns: TBSA

A

Burn size is determined based on percentage of total body surface area (TBSA).
-Two common methods: “Rule of Nines” and Lund-Browder
TBSA percentage is used for the following:
-Calculating nutritional and fluid requirements
-Determining level of acuity to establish the level of medical treatment needed
-Classifying patients for use of standardized protocols

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13
Q

Estimating Percent Total Body Surface Area Affected by Burns

A

.

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14
Q

Classification of Burns: Type

A
  • Thermal
  • Flame
  • Scald
  • Flash
  • Inhalation Injuries
  • Electrical Burns
  • Chemical Burns
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15
Q

Medical Management of Burn Injury

A

-Respiratory support (when inhalation injury is present).
-Fluid Resuscitation
Administration of IV fluid to maintain intravascular volume and ensure adequate perfusion and oxygenation to all organs.
-Nutritional Support

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16
Q

Wound management

A
  • Debridement
  • Hydrotherapy
  • Burn Dressings
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17
Q

Debridement (Wound management)

A

Cleansing and removal of nonadherent and nonviable tissue
-Removal of Eschar (Dead tissue that sheds from health tissues & facilitates bacterial access- possibly leading to sepsis).

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18
Q

Hydrotherapy (Wound management)

A

Form of wound cleansing in which water is used as a means of decontamination of the burn site.

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19
Q

Burn Dressings (Wound. Management)

A

Act as a barrier to the environment to prevent against infection and can assist in the management of wound fluids.
-Encourage a moist (not wet or dry) environment to promote epithelization.

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20
Q

Skin Grafting

A

Non-viable tissue is removed from the wound and the medical team may decide the patient would benefit from a skin graft to aid in wound healing & closure.

21
Q

Types of Skin Grafts:

A
  • Autograft
  • Allograft
  • Xenograft
  • Synthetic skin grafts
22
Q

Autograft (Types of Skin Grafts)

A

Split thickness skin graft from an uninjured donor sit of the patient.

23
Q

Allograft (Types of Skin Grafts)

A

Donor skin taken from another living or deceased person

24
Q

Xenograft (Types of Skin Grafts)

A

Tissue graft or organ transplant from a donor of a different species from the recipient

25
Q

Burn Shock (Medical Complications)

A

Can occur within 48 to 72 hours after injury. Increased peripheral vascular resistance accompanied by decreased cardiac output.

26
Q

Hypermetabolism (Medical Complications)

A

Large burn injury triggers a significant prolonged stress response in the body and initiates the release of hormones that initiate a hypermetabolic state.
-Increased energy expenditure.

27
Q

Infection (Medical Complications)

A

The skin provides a barrier to the external environment. Offers metabolic and immunological support.
-Leading cause of death after burn injury

28
Q

Scars (Medical Complications)

A

Scars normally form as wounds close. If they are not managed properly they can form abnormally.

29
Q

Hypertrophic Scars (Medical Complications)

A

Uncontrolled production of fibroblasts and excess deposits of collagen tissues.

30
Q

Contractures (Medical Complications)

A

Abnormal shortening and tightening of the burn scar. 40% of burn patients will develop scar contractures.
Limit ROM and interfere with ADL engagement

31
Q

Impact on Occupational Performance

A
  • Impact on occupation can be influenced by the size, depth, and location of a burn.
  • Burn injury has the potential to impact every area of someone’s life, occupations, and roles.
  • Deep partial thickness or full thickness burns have the greatest potential to impact occupational performance due to scar formation and risk for contracture.
32
Q

Client factors commonly impacted by burn injury:

A
  • ROM, joint mobility and function
  • Edema
  • Scar development
  • Muscle power & endurance secondary to prolonged immobilization
  • Mental and emotional function after experiencing trauma
  • Mobility status
33
Q

Role of Occupational Therapy in Burn Rehabilitation

A
  • Orthotic management, wound care, positioning
  • ROM/joint mobility
  • Scar tissue management
  • Assist clients in improving function and fulfilling meaningful roles & occupations
  • Caregiver training
  • Pain management & advocacy
34
Q

Emergent Phase (Phases of Burn Management and Rehab)

A

(from injury to first 72 hours)

  • Medical management and stabilization
  • Dressings, infection control, preventing contractures/positioning
35
Q

Acute Phase (Phases of Burn Management and Rehab)

A

(post 72 hours until wound closure)

  • Medical management of skin grafts
  • Detailed initial evaluation, ROM/Function, ongoing contracture/positioning management, environmental modifications and adaptations, pain management, patient/family education
  • Psychosocial support, Team communication
36
Q

Rehabilitation Phase (Phases of Burn Management and Rehab)

A

(wound closure until scar management)

  • Scar management
  • ROM, Strength, Fine motor, gross motor
  • Increased activity tolerance
  • Sensory retraining
  • Functional task training (i.e. self care, home management)
37
Q

Anticontracture Positioning by Location of Burn

A

.

38
Q

The body is a complex system that strives for…

A

Homeostasis.
-When you have an injury or illness your body works tirelessly to try to heal itself.
There are stages of tissue healing that occur in a typical fashion unless impacted by other factors. Let’s take a look at some of the factors that influence the healing process:

39
Q

Factors that Influence the Healing Process

A
  • Age
  • The characteristics of the tissue damage
  • Infection
  • Chronic diseases
  • Poor nutrition and hydration
  • Edema
  • Repeated trauma
  • Patient behaviors
40
Q

Age (Factors that Influence the Healing Process)

A

People over the age of 60 may experience delayed healing due to typical age related physiological changes. Additionally, as we get older we tend to accumulate comorbidities which can change the healing process. Our body’s inflammatory response lessens, and our angiogenesis and epithelialization is slower. Scars form slower due to reduced collagen. All this results in less efficient healing as we get older.

41
Q

The characteristics of the tissue damage. (Factors that Influence the Healing Process)

A

Larger damage takes longer to heal. Damage that has been neglected and where necrotic tissue or foreign bodies are present also take longer to heal. There isn’t much you can do about the size of the damage that occurs but you can encourage and educate patients on proper hygiene and methods for taking care of themselves as they heal.

42
Q

Infection (Factors that Influence the Healing Process)

A

When an infection is present in the body the immune system will be working to get rid of the infection and divert the cells, fluids, and energy away from healing the existing damage to fight the infection.

43
Q

Chronic diseases (Factors that Influence the Healing Process)

A

Diabetes and diseases that impact the circulatory system may inhibit healing. Blood flow is necessary to heal tissue damage, when that is impaired the healing is slowed and may need additional external intervention to assist in the healing process.

44
Q

Poor nutrition and hydration (Factors that Influence the Healing Process)

A

When the body doesn’t have the energy from foods and the fluids for cellular migration, healing is delayed. People who are in the stages of healing actually need more food and hydration than those who are not healing because it takes the body so much energy and fluid to heal properly.

45
Q

Edema (Factors that Influence the Healing Process)

A

Inflammation is a natural and healthy part of healing. However, excessive inflammation can put stress on tissues and reduce blood flow to the area that needs to heal. Compression and elevation can help with reducing edema. Other manual techniques may be needed if it is severe or chronic.

46
Q

Repeated trauma (Factors that Influence the Healing Process)

A

Healing is delayed when the area being healed is disrupted in someway and the body needs to start the healing process over. Also, areas that have been injured more than once are more fragile and will not be as strong as they once were, making them more prone to future repeated injury.

47
Q

Patient behaviors (Factors that Influence the Healing Process)

A

Lifestyle choices including smoking, excessive drinking, poor sleep habits, being too sedentary, and not properly caring for the tissue hygienically can all lead to poorer healing. These are areas well within the control of the client and OTs can provide education on proper health and wellness to improve healing.

48
Q

(Factors that Influence the Healing Process)

A

USAHS Conditions (12 decks)

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