Week 9 - OT Management of the Burn Patient Flashcards
traumatic injury to the skin or other organic tissue primarily caused by thermal trauma. it results when some or all of the cells in the skin or other tissue are destroyed by heat, cold, electricity, radiation, or caustic chemicals.
burn
T/F - the number of burn pts. per year has declined since the 1960s
true
how many burn injuries needing medical attention are there per year in US?
.5 million
what is the most prevalent cause of burn-related deaths every year?
residential fires
t/f - burn hospitalizations are decreasing
false - they are increasing (quicker response by 1st responders so burn victims are surviving and getting to medical care)
name 9 aspects of burn care.
- fluid administration
- antibiotics
- skin grafting
- physiotherapy
- splinting
- personalized exercise programs
- psychological eval and intervention
- respiratory therapy
- follow-up
in the burn unit, care is ___.
centralized
burn pts. must be ____ in the first hour following incident and require specialized ___ ___ and a sterile, warm environment bc they are highly susceptible to infection.
stabilized, wound care
for OTs planning a recovering program for a burn pt. starts when?
on admission
name 3 things that should be minimized during OT treatment of burn pts.
- scarring
- contractures
- loss of function
name 4 treatment modalities to maintain function, strength, and ROM in burn pts.
- splints
- pressure garments
- aerobic and resistive exercise
what is most time and effort spent on during OT treatment of burn pts.
-explaining, persuading, and motivating pts.
___ ___ ___ is essential to ensure optimal functional and aesthetic outcomes.
long term compliance
OTs must be able to understand which 4 aspects of burn care.
- functions of the skin
- results of surgery
- wound care techniques
- scar pathophysiology
OTs must be able to anticipate which 5 aspects of burn care.
- post-burn edema
- hand deformities
- loss of skin sensation
- PNIs
- HETEROTOPIC OSSIFICATION (HO) - formation of new bone, commonly in elbow
how long is the initial phase of burn care?
1-3 days
name 4 goals during the initial phase of burn care.
- wound healing
- scar suppression
- pain reduction
- prevention of complications
what is the second phase of burn care also called?
wound care phase
name 3 goals of the second phase of burn care.
- excision of non-viable tissue and wound closure
- pain control
- provide environment for wound healing
what is the third phase of burn care also called?
definitive wound closure
name 2 goals of the third phase of burn care.
- replace temporary wound coverings
- removal of burned skin and replace with skin grafts
what is the final phase of burn care also called?
rehabilitation, reconstruction & reintegration
name 3 goals of the final phase of burn care.
- rehab starts day 1 and may last for years
- multidisciplinary effort
- prepare pt. for social and psychological challenges
what is the role of the OT in the emergent stage of burn care?
splinting and positioning
name 7 roles of the OT in the acute stage of burn care.
- review chart
- continue splinting/positioning
- perioperative care
- exercise/activities
- pain management
- adaptations
- discharge planning
name 6 roles of the OT during the rehab stage of burn care.
- ROM
- strength
- activity tolerance
- self-care
- scar management
- pt. and caregivers education
what is the largest organ in the body?
skin
name 3 classifications of burns.
- depth of burn
- total body surface area
- location
- sunburn
- heals spontaneously
1st degree (superficial) burn
name the 3 depth of burn classifications.
- first degree burn
- second degree burn
- third degree burn
heals spontaneously in 5-21 days
2nd degree (superficial) burn
- 21-31 days to heal unless infection
- may convert to full thickness burn
2nd degree (deep) burn
- skin graft required to close/heal wound
- dead tissue needs to be removed
3rd degree (full thickness) burn
name the 2 charts used to classify burns by total body surface area.
- rule of 9’s
- lund and browder sheet
name the 2 classifications of burns by location.
- minor burns
- major burns
name 3 locations of major burns.
- hands
- face
- perineum
is age a classification of burns?
not a true classification but always plays a significant role
name 4 therapy management guidelines for burns.
- positioning: general and specific
- edema management
- anti-contracture positioning
- neuropathy prevention
name 4 roles of OTs during the acute care phase of burn case.
- control edema
- prevent loss of mobility
- promote self-care
- orientation activities and stimulation
skin grafting procedures and other surgeries influence the therapeutic goals of what 3 things?
- splints/orthoses and positioning
- adaptive devices for ADL
- exercise
name 5 potential hand deformities of burns.
- claw hand
- boutonniere
- mallet and swan neck
- palmar cupping
- scar band
edema following a full-thickness burn of the dorsum of the hand - imposed MCP extension and IP flexion.
claw hand
name 2 expected deformities of a burn of the palmar surface of hand.
- MCP flexion/IP extension
- thumb opposition
how should the hand be positioned following a palmar surface burn?
hand positioned with all fingers extended and the thumb web space on a slight stretch
how can you maintain proper hand position after a palmar surface burn of the hand?
- in acute palmar burn cases use dorsal splints
- when healing progresses use silicone pad to provide both positioning and pressure
name 3 expected deformities of a dorsal surface burn of hand.
- MCP hyperextension
- IP flexion
- thumb adduction
how should the hand be positioned following a dorsal surface burn?
-wrist extension, MCP flexion, IP extension, thumb palmar abduction or opposition
how can you maintain proper positioning after a dorsal surface burn of the hand?
- a gauze roll is wrapped into the palm extending into the thumb web space
- hand splint (volar)
what is the expected deformity following a circumferential burn of the hand?
contracture towards the most deeply burned side
how should the hand be positioned following a circumferential burn?
- wrist in functional position (from neutral to 30 degree extension)
- forearm supinated/neutral
how can you maintain proper positioning following a circumferential burn of the hand?
- wrist splint
- towel or gauze placed in the hand while forearm supinated.
describe the safe position of the hand.
- MCP - immobilized in flexion
- PIP - immobilized in extension
the safe position of the hand is also known as what?
intrinsic plus position
what is a microstomia brace/splint used for?
scar contracture of mouth
name 3 aspects of scar control in burn care.
- positioning
- stretch
- pressure
which positions should be avoided in burns of UE?
- flexion
- adduction
- internal rotation
which positions should be avoided in burns of LE?
- adduction
- plantar flexion
which positions should be avoided in burns of LE?
- adduction
- plantar flexion
which positions should be avoided in burns of the hand?
-claw position - MCP hyperextension with IP flexion
OTs must be able to ___ problems caused by scarring.
predict
which ADL do burn patients usually begin with?
eating
greater emphasis on ___ ___ if healing burn and/or surgery permits, rather than orthotics.
early movement
t/f - orthotics are always used in burn care.
false
name 3 components of a scar without treatment
- red
- raised
- restricts mobility
name 2 components of an optimal scar.
- faded color
- flat supple
an abnormal proliferation of scar tissue that forms at the site of cutaneous injury (ex: on the site of a surgical incision or trauma); it does not regress and grows beyond the original margins of the scar.
keloid
keloid grows beyond the ___ __ of the scar.
original margins
raised scars that do not grow beyond the boundaries of the original wound and may reduce over time.
hypertrophic scars
describe scar management methods regarding pressure.
garments are the ultimate goal.
describe 3 scar management methods regarding stretch.
- splints
- exercise
- inserts
describe scar management methods regarding positioning.
immediately post burn through rehab phase.
compression dressing used to provide pressure over healing burns
pressure garments
what is the most common amount of pressure in pressure garments used in practice?
15-25 mmHG
how long should pressure garments be worn for?
for a minimum of 23 hours a day for 6-12 months or until scar maturation.
when does pressure therapy begin?
2 to 3 weeks after healing
name 7 outcomes of burn pressure garments.
- to occlude capillaries - resulting in a lack of oxygen which accelerates the maturation of the scar
- to reduce scar thickness
- to increase scar elasticity
- to reduce scar bleeding
- to reduce edema
- to reduce the rate of collagen synthesis
- to prevent the formation of contractures over flexor joints
what is the first priority for all practitioners when burn pt. is recovery?
pt. education - wear splints, etc.
thickness in which joints is common in full thickness burns?
joints btwn radius and ulna
blood doesn’t get to muscles, leads to swelling
compartment syndrome
more ___ may be needed to increase ROM due to scarring.
surgeries
at nearby joints on same side of body, can restrict motion.
scar bands
generally, we don’t put ___ on splints right after surgery.
straps
how do pressure garments work regarding collagen?
helps collagen lay down flat as it should rather than all jumbled up (scarring)
holds skin in natural cup of hand on palmar hand burns
palmar cupping
how can we reduce thumb web contractures?
- pressure in web space
- in splint - plaster blocks
name 2 ways in which pressure can help scarring.
- changes the color
- helps it lay flat
- have to get rid of skin or else it’ll kill them
- treat it like a burn
necrotizing fascitis
when should AROM begin after a skin graft?
7-10 days
what is the contracture tendency of the neck following a burn?
flexion
what is the contracture tendency of the axilla following a burn?
adduction
what is the contracture tendency of the neck following a burn?
flexion
what is the contracture tendency of the dorsal wrist following a burn?
extension
what is the contracture tendency of the hand dorsal following a burn?
claw hand deformity
what is the contracture tendency of the hand volar following a burn?
palmar contracture cupping of hand
what is the contracture tendency of the hip-anterior following a burn?
flexion
what is the contracture tendency of the knee following a burn?
flexion
what is the contracture tendency of the foot following a burn?
foot drop
what is the anticontracture positioning and/or typical splint of the neck following a burn?
- remove pillows
- use half-mattress to extend the neck
- neck extension splint or collar
what is the anticontracture positioning and/or typical splint of the axilla following a burn?
- 120 degrees of abduction with slight external rotation
- axilla splint or positioning wedges
- watch for signs of brachial plexus strain
what is the anticontracture positioning and/or typical splint of the anterior elbow following a burn?
elbow extension splint in 5-10 degrees of flexion
what is the anticontracture positioning and/or typical splint of the dorsal wrist following a burn?
wrist support in neutral
what is the anticontracture positioning and/or typical splint of volar wrist following a burn?
wrist cock-up splint in 5-10 degrees of extension
what is the anticontracture positioning and/or typical splint of the hand dorsal following a burn?
functional hand splint with MP joint 70-90 degrees
- DIP joints fully extended
- first web open
- thumb in opposition (safe position)
what is the anticontracture positioning and/or typical splint of hand volar following a burn?
palm extension splint - MPs in slight hyperextension
what is the anticontracture positioning and/or typical splint of the hip anterior following a burn?
- prone positioning
- weights on thigh in supine
- knee immobilizers
what is the anticontracture positioning and/or typical splint of the knee following a burn?
- knee extension positioning and/or splints
- prevent external rotation, which may cause peroneal nerve compression
what is the anticontracture positioning and/or typical splint of the foot following a burn?
- ankle at 90 degrees with foot board or splint
- watch for signs of heel ulcer
