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burns
| Question | Answer |
|---|---|
| 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 |
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