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burns

QuestionAnswer
Superficial burn (first degree) epidermis only minimal pain and edema, no blistering heal 3-7 days
Superficial partial thickness (2nd degree) epidermis and upper dermis red, blistering, wet heal 7-21 days
Deep partial thickness (2nd degree) epidermis and deep portion of dermis red, white, elastic, potential for hypertophic scar is high sensation may be impaired potential to convert to full thickness due to infection heal 21-35 days
Full thickness (3rd degree) epidermis, dermis, hair follicles, sweat glands, nerve endings white, waxy, leathery, non elastic sensation absent, pain free, requires skin graft hypertrophic scar healing can take months
Subdermal (4th degree) fat, muscle and bone charring present peripheral nerve damage significant Wound closure and amputation
Emergent phase intervention splinting in antiderformity positions
Antideformity positions: hands, neck, elbow, knees, shoulder, hip, LE hands: intrinsic plus neck, elbow, knee: extension shoulder: abduction hip: extension LE: anti frog leg and anti foot drop
Acute phase intervention splinting and positioning edema management early participation in ADL client and caregiver education
Precautions and contraindications no passive or active ROM with exposed tendons or recent grafts (wait 5-7 days) treat 30 mins after pain meds avoid pooling of fluid in LE while standing-- compression wrapping use of volumeter should be avoided
Surgical and postoperative between 3-10 days until graft adherence is confirmed of donor site: 2-3 days if no active bleeding walking: not resumed until 5-7 days after grafting in LE after immob, start with gentle AROM to avoid shearing of new graft exercise of unaffected ext.
Rehabilitation phase wound closure is stable skin lubrication several x per day skin massage for desensitization compression therapy: edema and scar compression
custom made compression garments indications all donor sites, grafted sites, and burn wounds that take more than 2 weeks to heal spontaneously
compression garments provide gradient pressure 24 hours a day excpet bathing, massage, and other skin care activity
Outpatient and community reintegration phase compression therapy, skin conditioning, splinting and positioning, exercise ROM and strength tolerance
For full thickness burns, rehabilitation 72 hours after: dressing changes, splint all times 5-7 days: AROM, light ADL >7 days: PROM as tolerated massage, compression garments, otoform/elastometer inserts, strength
hypertophic scar most apparent 6-8 weeks after wound closure apply compression therapy early and continue till scar matures 1-2 years
heterotopic ossification formation of bones in abnormal areas elbow, hip, knee, shoulder loss of ROM rapid, pain local and severe hard end feel during PROM D/C passive stretching (including dynamic splint) and begin AROM with pain free range
pruritis excessive itching compression garment, maintenance of skin lubrication, use of cold packs and antihistamine medications