Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NBCOT > Burns > Flashcards

Burns Flashcards

1
Q

Burn

A

Thermal injury that destroys layers of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rule of 9s

A

Used with adults
- divides body into 9s or multiples of 9s to calculate total body surface area of burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lund-Browder chart

A

Children/infants
- more accurate method of calculating total body surface area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Superficial/1st degree burn

A
  • involves superficial epidermis
  • pain: min to mod, no blistering, min erythema
  • healing time: 3-7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Superficial partial thickness/superficial 2nd degree burn

A
  • involves epidermis & upper dermis layers
  • pain: significant, wet blistering, erythema present
  • healing time: 1-3 week
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Deep partial thickness/deep 2nd degree burns

A
  • involves epidermis, deep dermis, hair follicles, sweat glands
  • pain: severe even to light touch
  • erythema present w/without blisters
  • burn has high risk of turning into full-thickness burn because of infection; consider grafting to prevent infection
  • may have impaired sensation
  • high potential for hypertrophic scar
  • healing time varies from 3-5 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Full thickness/3rd degree burn

A
  • involves epidermis, dermis, hair follicles, sweat glands, nerve endings
  • burn: pain free, no sensation to light touch, pale, nonblanching
  • requires skin graft
  • extremely high potential for hypertrophic scar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Subdermal burn

A
  • full-thickness burn with damage to underlying tissue (fat, muscles, bone)
  • charring present; may have exposed fat, tendons, muscles
  • if burn is electrical: destruction of nerve along pathway is present
  • peripheral nerve damage is significant
  • requires surgical intervention for wound closure or amputation
  • extremely high potential for hypertrophic scar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mechanisms of burns

A
  1. Thermal: heat, cold, scald, flame
  2. Radiation: sunburn, x-ray, radiation therapy for cancer patients
  3. Chemical: acid (sulfuric acid, hydrochloric acid), alkali (dry lime, potassium hydroxide, sodium hydroxide)
  4. Electrical burn: high voltage vs low voltage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Burn results in tissue necrosis rather than direct heat production
A

Chemical burn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which is more severe: alkali or acid burn

A

Alkali

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which is more dangerous: high voltage or low voltage electrical burn?

A

Low voltage: at the same current
-causes greater muscle contraction, makes it more difficult for person to voluntarily control muscles to release electrified object

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes single muscle contraction & throws victim from the source, client more likely to have blunt trauma along with burn

A

High voltage direct current

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Emergent phase medical treatment focuses on

A

Sustaining life, controlling infection, manage pain
— can include IVs, intubation, escharotomy, fasciotomy, wound dressings w/anti microbial ointment for infection control, universal precautions for medical staff & family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Phase 0-72 hrs after injury

A

Emergent phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Emergent phase: sustaining life

A
  1. Risk of dehydration
  2. Hypo or hyperthermia: no temp control
  3. Fluid resuscitation
  4. Cardiopulmonary stability
  5. Escharotomy & fasciotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fluid resuscitation

A

Rapid leakage of IV fluid into surrounding extra vascular tissues = decreased plasma & blood volume, reduced cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is cardiopulmonary stability important?

A

If respiratory tract has sustained smoke inhalation injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What leads to compartment syndrome?

A

The inelasticity of the eschar (burned tissue) increasing internal pressure within fascia compartments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Symptoms of compartment syndrome

A
  • paresthesia
  • coldness
  • decreased/absent pulse in extremities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Escharotomy & fasciotomy

A

Release pressure within fascia compartments
- Escharotomy: surgical excision of eschars
- Fasciotomy: incision into the fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do wound dressing products do?

A
  • protect wound against infection
  • superficially debride wound & provide comfort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Types of wound dressings

A
  1. Topical antibiotics
  2. Biological dressing
  3. Nonbiological skin-substitute dressings: biosynthetic products such as biobrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Biological dressing types

A
  1. Xenografts: bovine skin, processed pig skin
  2. Allograft: human cadaver skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What pharmacological tx is used during emergent phase?

A

Narcotic analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Phase occurring 72 hours after injury or until wound is closed (days or months)

A

Acute phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Acute phase focuses on

A

Infection control, grafts, biological dressings, psychological support & team communication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Surgical intervention during acute phase

A
  1. Escharotomy & debridgement
    - removal of burned/dead skin to allow new vascularized skin to close up wound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Autograft

A

Transplantation of person’s own skin from unburned donor suite to burned receiving site

30
Q

Split-thickness skin graft

A
  • full epidermal & partial dermal layer taken from donor site
  • change of graft survival is high
31
Q

Full-thickness skin graft

A
  • full thickness of epidermal & dermal layers + % of fat layers taken from donor site
  • chance of graft survival less
  • outcome functionally/cosmetically better if graft adherence occurs
32
Q

Meshed versus sheet graft

A
  • meshed: donor graft is “meshed” & stretched to cover greater area of receiving area
  • sheet: donor graft removed & laid down on receiving area as is
33
Q

Rehabilitation phase

A
  • skin grafts
  • reconstruction surgery as needed for movement/function
34
Q

During emergent phase, what is the splinting protocol?

A

Antideformity positions
- hands: intrinsic plus (MCP hyper flexion, PIP hyperextension)
- oppose client’s posture
- neck, elbows, knees: extension (generally)
- shoulder: abduction
- hip: extension
- anti-frog leg and anti-foot drop for LE

35
Q

What phase includes clinical observation of bod parts affected by burns and information gathering on PLOF?

A

Emergent phase

36
Q

What phase of OT eval includes ADLs, psychosocial aspects, communication, cognition, ROM, muscle strength, pain?

A

Acute phase

37
Q

OT intervention during acute phase

A

Splinting, positioning in antideformity position, edema management, early participation in ADL, client/caregiver ed

38
Q

Anticontracture positioning during acute phase

A
  • neck: neutral to slight extension
  • chest/abdomen: trunk extension, shoulder retraction
  • axilla: shoulder abduction 100-120 deg, slight ER
  • elbow: extension
    -FA: neutral to supination
  • wrist: (Dorsal: neutral to 30 deg ext), (volar: 30-45 deg ext)
  • hand: (Metacarpal: 70 deg flex), (IP: 0 deg ext), thumb: abducted & extended
  • hip: 10-15 deg abd, neutral extension
  • knee: extension; anterior burn: slight flexion
  • ankle: neutral to 5 deg dorsiflexion
39
Q

How to manage edema during acute phase

A

Elevation of extremities, AROM if allowed, wrapping with elastic bandage unless bulky wound dressing is used

40
Q

ROM program during acute phase (precautions)

A

No PROM or AROM with exposed tendons or recent grafts (wait 5-7 days)
- otherwise implement as tolerated

41
Q

Protocol for pain during acute phase

A
  1. Coordinate with nursing on scheduled pain meds
  2. Treat 30 min after pain meds administered
  3. Visual imagery and relaxation to minimize pain
  4. Respect pain
  5. Explain procedures before starting
  6. Address fear factor that can exacerbate perceived pain early in intervention
42
Q

How to avoid pooling of fluid/blood in LEs in dependent or standing position during acute phase

A

Apply compression wrapping to provide vascular support to LEs before walking, standing, prolonged sitting w/feet in dependent position

43
Q

Immobilization period in postop phase

A
  • generally 3-10 days or until graft adherence is conformed
  • immobilization of donor site: 2-3 days if no active bleeding occurs
  • walking not resumed until 5-7 days for LEs
  • confirm with surgeon
44
Q

Positioning during postop phase

A

Same as anticontracture positioning
- promote greatest SA for graft placement
- surgeon may specify
- elevation, wrapping with elastic bandage at donor site

45
Q

Exercise & activity during postop phase

A
  • should be continued for uninvolved extremities
  • after immobilization period, start with gentle AROM to avoid shearing of new grafts
46
Q

What occurs during rehabilitation phase

A

Wound is healing, wound closure is stable

47
Q

Skin conditioning during rehabilitation phase

A
  1. Skin lubrication several times a day to prevent dry skin from splitting
  2. Skin massage to desensitize hypersensitive grafting sites/burn scars
  3. Use sunblock or sun protective clothing, avoid unprotected sun exposure
48
Q

Scar management during rehabilitation phase

A
  1. Compression therapy for edema control & scar compression
  2. Temporary interim pressure bandages/garments: elastic bandages, Conan wrapping of fingers, elastic aged tubular support bandages, thigh-high/knee-high hose, spandex bike pants, isotonic gloves, elastomer, closed-cell foam, silicone pad inserts
  3. Custom made compression garments
  4. Custom made pressure garment & insert
49
Q

When is use of compression garment indicated?

A

For all donor sites, grafted sites, burn wounds that take 2+ weeks to heal spontaneously

50
Q

When should custom-made pressure garments be worn

A

24 hrs per day except during bathing, massage, other skin care activity

51
Q

Therapeutic exercise & activity during rehabilitation phase

A
  1. Progressively graded
  2. Client education on skin lubrication & massage before exercise/activity
  3. Daily stretching, resistive exercises, activity to tolerance, coordination activities
52
Q

Splinting during rehabilitation phase

A
  1. Continue anticontracture positioning
  2. Use dynamic splint or serial casting to reverse contractures
  3. For hands: attend to extensor tendon injury and web space contracture management
  4. Splint of volar surface of hand for dorsal/volar hand burns for better positioning/comfort
53
Q

ADLs during rehabilitation phase

A
  1. Adaptive strategies, AE
  2. Identify abnormal movement pattern early to allow Pt to relearn normal movement patterns
54
Q

Client education during rehabilitation phase

A

Transition from hospital to home
1. Independent skin care protocol
2. Understanding of wound healing process
3. Compression therapy & positioning with practice applying garment & splint
4. Preservation of ADLs & IADLs with continuing exercise, activity program

55
Q

How long does scar maturation take

A

From 1-2 years

56
Q

Community re-entry protocols

A
  1. Improve skin tolerance for friction/shear from compression garments & inserts during activities
  2. activity tolerance training
  3. Adapt activity demands & environment if limitations in movement result from tight scar band/contractures
57
Q

What can occur psychosocially following burn?

A
  1. PTSD
  2. Adjustment period
  3. Counseling, support group, training in pain management, relaxation, stress management
58
Q

What causes contracture?

A
  1. Hypertrophic scar
  2. Tight scar band
  3. Prolonged immobilization
59
Q

How to address contracture

A
  1. Early implementation of anticontracture postioning
  2. Continuous exercise & activity programs
  3. Serial splinting programs
60
Q

Hypertrophic scar

A
  1. Most apparent 6-8 weeks following wound closure
  2. Most activity in initial 4-6 months
  3. Scar firmer/thicker, rises above original surface level of skin
  4. Can happen at donor site, at original burn area, with wound that doesn’t close spontaneously after 2 weeks
  5. Apply compression therapy early, continue until scar matures in 1-2 years
  6. Use scar gel pads/inserts to provide compression
61
Q

Heterotopic ossification

A

Formation of bones in abnormal areas (occurs in soft tissue around joint, joint capsule)
- elbow, knee, hip, shoulder
- rapid ROM loss, pain localized/severe
- hard end feel during PROM
- discontinue PROM & use of dynamic splint, begin AROM within pain-free range to preserve as much movement as possible
- usually requires surgical intervention if functional activity is limited

62
Q

Heat intolerance

A
  1. Loss of ability to sweat due to loss of sweat glands with split-thickness skin graft
  2. Pt may sweat excessively in unburned areas
  3. Accommodations/modifications (air conditioning) may be required at home, work, school
63
Q

Sun exposure

A
  1. Risk for sunburn is higher- use sun protective clothing, sunscreen, avoid prolonged exposure
  2. May affect outdoor work, playground activity
64
Q

Pruritis

A

Persistent itching
1. May lead to skin maceration, reopening of wound
2. Use compression garment, maintain skin lubrication, cold packs, antihistamine meds

65
Q

Child discharge plan following a burn

A
  1. Community-based therapist working in school system to help with adjustment
  2. Return-to-school program with or without child present
66
Q

Gentle AROM/PROM implementation protocols

A
  • begin as early as possible except during post-graft immobilization period
67
Q

Where to avoid placing splints

A
  • on surface of burned area
  • apply standard splinting positioning unless burns are circumferential
68
Q

Dorsal hand burn precautions

A
  • maintain Boutonnière precaution
  • avoid having client form active or passive composite flexion of fingers
  • ROM to MP with IP straight, ROM to IP with MP & DIP straight
69
Q

When should sensory testing for peripheral nerve damage occur

A

As soon as wounds are closed

70
Q

How to measure edema with burn

A

Do not use volumeter until all wounds are closed or with permission

71
Q

How to treat children with burns

A
  • structured play to achieve full ROM of affected body parts
  • child life specialists to reduce fear/stress when treating children

NBCOT (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions