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Flashcards in Burn Management Deck (37)
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1

High Risk Populations

Elderly
Young children
Physically disabled
Mentally ill
Workers in hazardous conditions

2

Skin Functions

Protective cover
regulates body temp
shields deep structures from injuries
protects nerve endings

3

Skin Anatomy : Epidermus

Regenerates

4

Skin Anatomy: Dermis

Nerve Damage and Sensory loss occurs
Does not regenerate: requires graphing

5

Classification of Burns is determined by

Type of burn
Depth of burn
TBSA= total body surface are involved in burn

6

Thermal Burn

Flames, steam, metal, frost bite

7

Chemical Burn

Acids: Usually work/industrial
Splash burns

8

Electrical Burn

Currents (usually the worst type of burns)

9

Radiation Burn

Sun burn, cancer survivors

10

Friction Burn

Vehical accidents: impact w/ gravel

11

Burn Depth: Superfical Partial Thickness

Damage to the epidermis and upper layer of dermis
Intact blisters and pain (pain indicates nerve endings are intact)
Heal w/in 7-21 days w/ minimal to no scaring

12

Burn Depth: Deep Partial Thickness

Injury to epidermis and severe damage to dermis
Blotchy & whitish
+ pressure sense
- light touch
3-5 weeks healing; often grafted
Once skin is grafted & haled sensory return is very limited

13

Burn Depth: Full Thickness

Usually smaller patches of area
Both epidermis and dermis are destroyed
May damage subcutaneous fat, muscle & bone tissue
Wounds are white and waxy
- sensation d/t destruction of dermal nerve endings
Require surgical care grafting or amputation

14

Medical Issues Related to Burns

Infection
Pulmonary complications (CO2 intake: house fires)
Metabolic COmplications: burns result in an increased need for calories: pts. have rapid weight loss: calories (protein) help promote healing and regulate body temp.
Cardiac/Circulatory complications: large demands are placed on vital organs. Pt. has increased swelling & fluid build up.
Heterotophic Ossification: pt. lay done tissue on tendons (sensative to ROM)
Neuropathy

15

Medical Management : Escharotomy

Surgical procedure done to circumfuernatal burns to releave compression. They make an incision to provide space for fluid to build up

Addition medical management: wound care

16

Medical Management: Septic Shock

Toxins are released into the body: bactira is in the blood stream resulting into a drastic drop in BP, increased confusion & agitation, increase in temp.

17

Medical Management: Excision

Removal of dead tissue

18

Drugs

Narcotics: morphine: used to calm & quiet pt. also avoid the pt. from using their caloric intake.
Analgesics: tylenol: inflimation
Antacids: stress ulcers
Antibiotics: Oral & topical: ant itch medication

19

Graft Types: Autograft

From pt; permanent

20

Graft Types: Homograft (allograft)

Skin donor; temporary (stapled)

21

Graft Types: Xenograft (heterograft)

Pigskin; temporary

22

Graft Types: Bilayer skin substitiute

Permanent skin substitute

23

Graft Type: Sheet Graft

Full Thickness
Scar massage (passive & active)
Focus on mobility & ROM on dorsal side to avoid claw deformity

24

Graft type: Mesh graft

Perforated to increase surface area

25

Key to healing grafts

Do not move any area that is freshly grafted.
They should be imobolized (7-10) days

26

Hypertrophic Scars

Increase in the following: vacularity, fibroblasts, myofibroblast, interstitial fluid, collagen

Jobst Garments (compression garments) used to prevent scaring. Prevent webbing (i.e. axilla, neck, flexion contractors, elbow, knees)

Issues w/ Jobst: compliance: provide the pt. w/ peer support & before & after pictures

27

Burn Eval: acute Phase

Edema
Functional A/PROM (pumping)
Strength (bed mobility)
Sensation: pressure, localization
Self care skills: low level A w/ dressing, glicerin swabs, urinal use

28

Burn Tx : Acute Phase

Prevent loss of jt./ skin mobility
Prevent loss of strength/endurance
Control edema (positioning vs manual manipulation)
Self-care skills
Education of pt./family - ON EVERYTHING (Jobst, splinting) education should be repeated frequently
Psychosocial support (body image)

29

Burn Splint : PAN Splint

Not a resting hand splint
Prevents claw deformity
Applyed w/ curlex wrapping vs straps
Wrist: flexion, MP: Flexion, IP: Extension

Boutiner deformities also occur along w/ extensor tendon ruptures

30

Hand ROM

Wrist flexion = finger extnesion and vice versa
Prevents stress on joints

31

Post Surgical - Operative Phase : Eval

Functional A/PROM (goniometry, keep exact records of ROM)
Strength: Dyno/Pinch, 9 hole peg (very standardized)
Self care: address the need for adaptive equipment (large handled devices, button hooks)
Sensation: dependent on wounds: 2point descrimination, localization (look at safety)
Mental status: coping and depression
Motivation

32

Post Surgical - Operative Phase : Tx

Positioning
Splinting: moves from static to dynamic
Exercises: increase strength, fine & gross motor exercises, adapt as they heal
Self-care : increased refinment & adaptive strategies
Cognitive stim: (d/t smoke inhalation) adaptive strategies
Psychosocial adjustment

33

Rehab Phase : Eval

Increased persions
A/PRROM (still standardized)
Strength
Sensation: sems winstein
Coordination: build of 9 hole peg
ADL's: move from self care to IADL's & Driving skills

34

Rehab Phase: Tx

Focus: Maximizing Functional Abilities
Positioning: still prevention contractors (sleep positioning)
Splinting
Sensory Reeducation: Compensation, visual awarness (safety)
Exercise: more active vs passive
ADL's: still push towards IADL's
Work-related skills
Scar control: SPF, hats, cover ups, used year round
Pt./family education

35

Dynamic Burn Splint: MP's are in

Flexion

36

Follow UP: Out pt OT or Burn Clinic

Life Long
Ongoing reconstructive/plastic surgeries
Exercise
Scar control
Splinting
Positioning
Work-Related Skills

37

Psychosocial Issues

Fear
isolation
guilt
frustration
loss
grief
body image disturbance