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Burns 09/16/2019
Midterm 09/16/2019
| Question | Answer |
|---|---|
| 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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