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Burns 09/16/2019

Midterm 09/16/2019

Lymphadenopathy Swollen lymph glands
Kaposi’s Sarcoma A type of cancer that forms in the lining of blood and lymph vessels (only with hiv/aids patients)
The Pizzi Assessment Productive Living (PAPL) For adults with HIV disease provides other areas that need to be assessed
Psychosocial Assessment Neuropsychiatric and coping
Function of The Skin 1. Sensory input 2. Help control temperature 3. Protection from infection 4. Part of identity 5. Waterproof 6. Prevent fluid loss
What is a burn? A burn is a permanent destruction of tissue caused by released of energy from external agent
Most common burn? The hand is the most common thermal burns and may result in long-term loss of function
Epidermis (top layer) is where the skin growth cells (germinal keratinocytes)
Germinal Keratinocytes Cells for skin growth
Where are the melanocytes found? The melanocytes are found at the dermo-epidermal junction
Dermis (bottom layer)
What’s in the dermis? • Collagen • Blood vessels • Elastic fibers • Glycosaminoglycans
Glycosaminoglycans Glue-like substance on ground surface
Mechanism of Injury 1. Thermal: (most common) dry heat (fire) and most heat (steam, hot liquid) 2. Chemical 3. Electrical 4. Friction 5. Radiation
Superficial Burn (first degree burn) 1. Involves epidermis (top layer of the skin) 2. Heals by itself in 1 to 5 days 3. Therapist rarely consulted
Superficial Dermis (superficial partial thickness) 1. 14 days for spontaneous healing 2. Possible pigment 3. Coordinate txs with adequate pain medication
Deep Partial-Thickness Burn (deep reticular dermis) 1. 21 days for spontaneous healing 2. 14 days with grafted healing 3. Sensory scarring 4. Sweating changes 5. Edema 6. Vascular support garments 7. Elevated positioning and/or splints
Full Thickness Burn (subcutaneous tissue) 1. Variable healing time 2. Graft needed 3. Nerve ending damaged 4. Possible loss of fingers or toe nails 5. Initiate exercise despite pain 6. Vibration for itching 7. Support/pressure garments 8. ADLs/community re-entry 9. Support groups
4th Degree Burn 1. Variable healing time 2. Amputation or reconstructive surgery needed 3. All layers destroyed including nerve endings 4. Possible work retraining
Treatment goal for burns? 1. Goal is to prevent deformity where burns have occurred and restore Parts where damaged or lost
Greatest concern for burns? Loss of skin and joint mobility in areas of wrist and digits
Proper splinting is used to prevent what? Deformity and maintain function.
Skin resurfacing is used for what? Achieve joint motion and tendon gliding
DO NOT IF OPEN WOUND PRESENT • Excessive heat on burn wound • Serial casting • Overstretching or vigorous exercise • No splinting straps (use gauze) • No ROM to exposed tendons • No ROM if pt. complains of deep joint pain
Phase of Recovery 1. Acute Care (first 72 hours) 2. Surgical/Post Op 3. Rehabilitation
Acute Care • 72 hours • Therapist focuses o bn edema management and splinting • ROM and exercises initiated • ADL independence
Surgical/Post Op Therapist promotes skin graft adherence and body parts usually immobilized in extension 1 to 2 days.
Rehabilitation • Wound healing • Scar management • Contracture management • Exercise • Stretching • Achieving ADLS and functional abilities • Edema management • Splinting • D/c planning
Partial Thickness Burn • First 48 hours keep had elevated • Gentle AROM and PROM to tolerance • Splint if needed • Control pain • After 48 hours, full mobility
Deep Partial Thickness (if not grafted) • Up to 72 hours post op keep hand elevated • Splint at night and during rest only • Once edema goes down, being PROM • Use hand for light activity • Gradual strengthening
Full Thickness Burn (grafting) • After 5 to 7 days take off splint to exercise with gentle AROM • Some light ADLs • After 7 days, begin PROM to tolerance; use hand for all self-care • Once tissue heals, begin friction massage and edema massage; use scar control methods
Skin Graft Are used to replace skin in areas where adequate circulation is available and underlying structures are protected by adequate subcutaneous tissue.
Meshing Allows draining of exudate/blood if needed or if there is a donor site shortage allows expansion of graft.
Split thickness skin graft (STSG) • Takes more readily • Less prone to infection • offers a large supply of donor sites
Full thickness skin graft (FTSG) location? Taken from hypothenar eminence, medial aspect of arm, or groin
Split thickness skin graft (STSG) location? Taken from thigh, buttock, abdomen -more suitable for large and contaminated wounds
Full thickness skin graft (FTSG) • Increased durability • Better protection • Better sensibility • More epidermal attachments -contracts less than STSG • Increased cosmesis and color match -More suitable for small clean wounds
ORDER FOR GRAFT TO TAKE 1. Recipient bed must have good vascularity 2. Free from increased levels of bacteria 3. Optimal bed muscle and fascia 4. Bone and tendon are not optimal for take
Hydrotherapy Tank/Whirlpool Use for wound cleaning, prevention of infection, and promotes revascularization
Sharp Debridement Surgical removal of loose eschar (dead skin)
Rule of Nines Quick assessment of total body surface area burned. More accurate for adults
Lund and Browder Chart More accurate assesment for children younger than 1
Hypertrophic Scarring First and superficial second degree burns usually don not scar Deep second- and third-degree burns scar the most Early healing/grafting decrease scarring Made up of collagen and a rich blood supply
Hypertrophic Scarring Tx: Pressure application: apply when wounds are healed, continued 23 hours a day for one year, effective as long as the scar is immature (red, warm, elevated)
Methods of Pressure Application: • Jobst pressure garments -ace bandages • Tubigrip • Isotoner gloves • Splints, -pressure inserts
Position of Comfort = Position of Contracture
Goals of positioning? • Prevent contractures -prevent edema • Prevent decubiti • Wrist/hand: wrist extension 30 degrees, thumb abd./extended, MCP flexion 50-70 degrees, IP extension
Created by: Genevadarcius
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