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211 exam 2
Burn Management
| Question | Answer |
|---|---|
| burns | Injury to the skin caused by excessive heat |
| what do burns cause | immediate cellular and tissue death and subsequent vascular destruction |
| causes of burns | Fire/flame (43%) Scald from hot liquid or steam (34%) Contact with hot metal, glass or other objects (9%) Electrical currents (4%) Chemicals- strong acids, paint thinner, gasoline (3%) Sunlight/ UV radiation, and radiation from X-rays (7%) |
| functions of the skin | protective barrier Prevents loss of moisture from the body Reduces harmful effects of UV radiation Acts as a sensory organ (senses touch/temperature/pain) Helps regulate body temperature Produces Vitamin D |
| layers of the skin | epidermis dermis hypodermis (subcutaneous fat/layer) |
| epidermis | outermost part of the skin |
| hypodermis | subcutaneous/ fat layer |
| 3 cell types in the epidermis | squamous cells, basal cells, melanocytes |
| squamous cells | the outermost layer, they are continuously shed~ called stratum corneum |
| dermis | where sweat glands, hair follicles etc, are located |
| basal cells | found just under squamous cells at the base |
| melanocytes | also found at the base of the epidermis and they make melanin that gives skin its color - deep burns will appear white, more superficial burns will be pigmented |
| what does the dermis contain | Blood vessels Lymph vessels Hair follicles Sweat glands Collagen bundles Fibroblast Nerves Sebaceous glands |
| what do hair follicles contain | mini organ, generates epithelial stem cells that migrate to the wound for healing |
| what makes up the hypodermis? | Consists of a network of collagen and fat cells |
| function of the hypodermis | Conserves the body’s heat and protects the body from injury~ acts as a shock absorber |
| 4 phases of wound and burn healing | 1. hemostasis 2. inflammatory 3. proliferation 4. remodeling |
| hemostasis phase | clotting factors prevent further blood loss |
| inflammatory phase | formation of granulation tissue |
| proliferation phase | characterized by wound contraction and epithelialization (stage in which grafts take in burns) |
| remodeling phase | the building of scar tissue. This phase can last for months to years, |
| surface area burned is referred to as | Total Body Surface Area~ TBSA |
| Knowing TBSA affected by a burn is important for estimating the patient’s____ and ____ requirements and assists with determining hospital admission criteria. | fluid and metabolic |
| what is wallace rule of 9's based on | chart that divides the body into sections that represent 9% of the body surface area |
| Rule of 9's | head: 9% anterior and posterior arm: 4.5% each anterior and posterior trunk: 18% each anterior and posterior legs: 9% each genitals: 1% |
| Rule of 5's | suggested for obese people with 5% for each arm, 20% for each leg, 50% for the trunk, and 2% for the head. |
| most accurate method to calculate TBSA affected by burns | Lund and Browder Chart requires use of chart to calculate - slide 16 separates partial thickness and full thickness |
| what does Lund and Browder chart consider when calculating TBSA? | depth of the burn as well as the percentage of the body affected |
| how does Lund and Browser chart subdivide body segments | % of TBSA. Different for adolescents based on age. With decreased BSA of the head and increased BSA of the legs as the child ages. |
| the rule of the palm | size of the palm of the person that is burned is about 1% of their TBSA. Use the person’s palm to measure the body surface area burned |
| classifications of burn depth | Superficial Superficial partial-thickness Deep partial-thickness Full-thickness |
| superficial burns | Involve only the epidermal layer of the skin They do not blister but are painful Blanchable with pressure |
| healing for superficial burns | By day 4 the injured eipithelium peels away from the newly healed epidermis. |
| common supeficial burn | sunburn |
| what layer of the skin is effected by superficial partial thickness burns | epidermis and the superficial aspect of the dermal layer of the skin |
| characteristics of superficial partial thickness burns | Blisters formed between the epidermis and the dermis within 24 hours. Painful, red, weeping and blanch with pressure. |
| healing for superficial partial thickness burns | heal without scarring but some pigment changes may occur. The the preservation of the dermis allows for epithelial regeneration without the need to build scar tissue to repair heal within 5-21 days |
| what layer of the skin is effected by deep partial thickness burns? | Extend into the deeper dermis Damage hair follicles and glandular tissue |
| characteristics of deep partial thickness burns | Almost always blister Wet or waxy dry, variable mottled colorization from patchy cheesy to white to red. |
| _____ thickness burns are Considered to be full thickness until accurate differentiation is possible which may take several days. | deep partial |
| healing for deep partial thickness burns | If infection is prevented, they will heal without grafting in 2-9 weeks. |
| When burns heal, the _____ phase is prolonged which is the cause of hypertrophic scarring~ if involves a joint, dysfunction is expected even with aggressive PT | remodeling |
| what layer of the skin is affected by full thickness burns | Extend through all the layers of the dermis and injures the underlying subcutaneous tissue |
| characteristics of full thickness burns | anesthetic or reduced pain/touch sensation (nerves destroyed) Skin white waxy or leathery grey, or charred and black Skin dry, inelastic does not blanch no Vesicles/ blisters no hair as the hair follicles are destroyed. |
| treatment for full thickness burns | typically require grafting |
| healing for full thickness burns | severe scarring, joint contractures common |
| burn severity grading chart | slide 23 |
| criteria for admittance to a burn center | Percentage of TBSA>10% Full thickness burns in any age group Selective body parts involved: hands, feet, face, perineum, genitalia, over major joints burns along with inhalation electrical or chemical burn pre-existing conditions |
| goal of wound care treatment of burns | control infection, assist with debridement, maintain a moist environment, promote burn healing, and control pain |
| what agent typically needs to be used on a burn | prescription strength antimicrobial that is changed more often than with normal wounds. due to microorganisms in the sub-eschar plane that normal wound healing agents are ineffective against |
| what does wound care tx of a burn depend on? | depth of burn, risk of infection, size of burn, allergies and availability |
| superficial burn wound care | do not require wound care- just lotions or gels that aide with epidermis repair need to be monitored closely, as they may originally present as superficial (epidermal) burns but it takes a few days for it to fully present itself. |
| wound care for superficial and deep partial thickness burns | debridement frequent dressing changes to monitor, control exudate and assess for signs of infection |
| debridement for superficial and deep partial thickness burns | hydrotherapy, scalpels, forceps, mechanical debridement, and enzymatic debridement. |
| why are Frequent dressing changes needed to monitor depth | burns frequently will appear more superficial in the first few days, then show their true depth. |
| when are Frequent dressing changes: to control exudate needed | with use of antimicrobial agents with enzymatic debridement properties |
| why are Frequent dressing changes needed to assess for signs of infection | the sub-eschar plane harbors microorganisms that normal wound healing agents are ineffective against. |
| deep burn wound care | Requires debridement and graft/flap coverage |
| goal of wound care for deep burns | prevent onset of infection prior to surgical debridement and subsequent grafting |
| purpose of surgical debridement for deep burns | removes the bacterial burden decreasing infection rates, sepsis and mortality. It is performed prior to grafting |
| hypermetabolic rate | The ability to regulate core body temperature is lost in severely burned patients. Hypermetabolic rate compensates for this pronounced plasma and heat loss that patient suffer. |
| what is hypermetabolic rate characterized by | increased blood pressure, heart rate, insulin resistance and protein and lipid catabolism. This leads to increased resting energy expenditure |
| what can hypermetabolic rate result in | Failure to meet increased energy requirements can cause impaired healing, an enormous loss of lean muscle mass, infection and organ damage. |
| treatment of hypermetabolic state | Adequate and prompt enteral nutrition Environmental management: warming of the patient’s hospital room controls the hypermetabolic state Early wound excision and grafting |
| why is early wound excision and grafting important for tx of hypermetabolic state? | reduce infection risk and related need to produce inflammatory cellular responses to this. |
| Assessments to determine level of shock and metabolic complications (from PTA exam study guide) | Blood work Pulmonary function tests Bronchoscopy |
| what blood work may be needed to determine level of shock and metabolic complications | CBC, electrolytes, blood urea nitrogen (BUN), creatine, bilirubin, and arterial blood gases (determines how well lungs are able to move oxygen to blood and remove CO2 from blood). |
| Burns are unique because not only is the direct area affected but so is the remaining tissue, due____ changes in the cells | thermal |
| what causes hypertrophic scarring in burns? | remodeling phase is prolonged, it lasts up to 2 years |
| appearance of hypertrophic scarring | Red, firm, raised and within confines of original burn |
| prevention of hypertrophic scarring | early skin grafts for deep partial thickness and full thickness burns |
| plastic surgery for hypertrophic scarring | Z-plasty is performed to release the scar and then they surgically replace missing tissue |
| laser tx for hypertrophic scarring | penetrates the outer layers of the scar to stimulate new healthy skin growth. Doesn’t’ completely remove but improves the appearance of scars |
| purpose of compression therapy for hypertrophic scarring | enhances cellular remodeling which results in decreased height of scar. Improves hardness, color and thickness resulting in overall improvement in appearances. Low compliancy with this. |
| purpose of silicone gels/patches for hypertrophic scarring | soften and increases elasticity to improve appearance. Thought to do this by improving oxygen delivery to epidermis and dermis and hydrating the underlying skin layers. |
| early stages of rehab for burn healing | respiratory therapy prevent edema- elevate positioning- into elongation early ambulation -prevent DVT offloading to prevent pressure sores pain control early ROM immobilization for 3-5 days after grafting |
| why is early ROM important in burn healing? | The wound starts to heal immediately |
| pain control for early stages of wound healing | TEN’s with 60-100 Hz frequency has proven to be effective in reducing pain during dressing changes. Electrodes placed 5cm from burn area |
| Later stage rehabilitation: post healing phase for burn healing | Focus on muscle strength, endurance, balance and coordination after prolonged time in bed/hospital during early burn healing phase Scar management (compression, scar tissue massage, rom, silicone gel pads) Stretching of involved joints |
| Physical Therapy Assessment of the burn patient | aerobic capacity anthropometrics cognition dermatomal compression gait, functional mobility ROM mm testing posture reflex integrity self care/ home management burn assessment scar tissue assessment |
| burn and wound assessment nemonic | some - size elephants- edges eat - exudate pizza- pain in - induration their - tissue type pajamas - peri wound tissue |
| goals of PT and post burn rehab | Maintaining ROM Minimizing contracture development Prevention of deformity Scar tissue management Improving cardiovascular endurance Pain management Improving strength Maximizing functional ability Enhancing quality of life |
| PT scar tissue management intervention | stretching compression scar tissue management |
| Stretch into the position of ____ ____. ROM should not be isolated to one joint if multiple joints are involved. It should be combined motion | maximal elongation |
| how long should you hold stretch | until the skin turns white or at least 30 seconds |
| how often should stretch be repeated? | repeat 3-5 times every hour |
| how should a burn pt rest? | with the area in the elongated position |
| The position of____ is the position of deformity | comfort |
| purpose of compression garments/pressure therapy | Minimizes the production of scars by interfering with the production of collagen and assists in re-aligning the collagen fibers. Protects fragile new skin Improves circulation Decreases pain and itching Increases skin length |
| transparent face mask (TFO) | Worn when the persons face is at risk to scar Applies compression Custom made |
| how long should TFO be worn? | 18-20 hours |
| advantages of TFO vs fabric face mask | less visible and the therapists can better tell how well the mask is compressing and make adjustments |
| Benefits of Scar tissue massage on hypertrophic scarring following burns | reduce swelling Releases adherent tissue Improve ROM and blood flow Reduces hypersensitivity, pain, itching scar pliability regain sensation in the area Flatten scars reducing their visibility Prevent lymphedema Prevent scar depression |
| scar massage techniques | slide 45 |
Created by:
bdavis53102
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