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MedPsych Exam 3 > Burns > Flashcards

Burns Flashcards

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1
Q

how does smoke inhalation injure?

A

Heat
Systemic Toxins
Smoke

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2
Q

what are primary burn diagnoses?

A 
Flame
Scald
Contact
Inhalation
Radiation 
Chemical 
Electrical 
Frostbite
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3
Q

what are the levels of frozen soft tissue effects?

A

–10 erythema, edema, numbness
–20 same plus blisters
–30 same bloody blisters
–40 full thickness injury to muscles, tendons, bone

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4
Q

how do you tx someone with frostbite that isnt totally frozen?

A

immersion in warm water. Do not allow refreezing

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5
Q

how do you tx totally frozen dead tissue?

A

CONSERVATIVE debridement

taking off dead skin

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6
Q

how do you recognize frostbite?

A

White or grayish- yellow skin area
Skin feels firm, waxy Numbness
Victim usually unaware

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7
Q

what is frost nip?

A

White insensate areas, usually on fingertips. Respond to warming, no permanent damage

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8
Q

what is chilblains?

A

Red swollen patches of skin exposed to cold with burning and/or itching sensation

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9
Q

what is trench foot?

A

Prolonged exposure to moisture and cold (non-freezing)

Foot: red, swollen, numb, bleeds easily, blisters

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10
Q

what are common causes of thermal injuries?

A 
Residential fires
MVA
Playing with matches
Improperly stored gasoline 
Space heater malfunction 
Arson
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11
Q

what are high risk groups for burns?

A

children: scalds
teens: flames, hot liquids
elderly

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12
Q

what are the 3 cell types in the epidermis?

A

Melanocytes = Base of epidermis, synthesize and secrete pigment

Langerhans cells = Migrate from bone marrow, initiate immune response, provide defense against antigens

Merkel cell = Slow adapting mechanoreceptors respond to touch

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13
Q

if layer of skin is destroys what happens to the cells in that layer?

A

they lose function

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14
Q

what are the 3 types of connective tissue in the dermis?

A

Collagen can regenerate the epidermis
Elastin and reticulin
Gel-like ground substance

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15
Q

what structures does the dermis contain?

A

Hair follicles, sebaceous glands, sweat glands, blood & lymphatic
vessels, and nerves

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16
Q

what types of cells are in the dermis?

A

Fibroblasts: secrete connective tissue matrix
Mast cells: release histamines
Macrophages: participate in immune response

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17
Q

what are the functions of the skin?

A 
Protects against infection
Prevents loss of body fluid
Controls body temp
excretory organ
sensory organ
Produces vitamin D
Determines identity, self-worth
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18
Q

what are the causes, involved skin, presentation & healing time of a 1st degree burn?

A

Causes = Sunburn, ultraviolet, short flash fire
Involved skin = Superficial epidermis
Clinical presentation = Red, edema, painful
Healing = 3-5 days, no pigment change

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19
Q

what are the causes, involved skin, presentation & healing time of a 2nd degree superficial burn?

A

Causes = Scalds, spills, flashes of flame
Involved skin = Epidermis, most of basal layer remains
Clinical presentation = pink or mottled red, blisters, weeping, painful
Healing = < 3 weeks, min scar or pigment change

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20
Q

what are the causes, involved skin, presentation & healing time of a 2nd degree deep burn?

A

Causes = Immersions, scalds, flame
Involved skin = Epidermis and dermis
Clinical presentation = Cherry red, pale, pain (+,-), skin pliable
Healing = > 3 weeks, severe scar may occur, may need grafting

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21
Q

what are the causes, involved skin, presentation & healing time of a 3rd degree burn?

A

Causes = Flame, chemical, electrical
Involved skin = Total skin destruction, may involve deeper structures (fat, muscles, bone)
Clinical presentation = Tan or pearly white, leathery, odor of burned skin, non- pliable parchment-like, anesthetic
Healing = Skin grafts required

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22
Q

what are the causes, involved skin, presentation & healing time of a 4th degree burn?

A

Causes = Prolonged exposure to source of heat or Electrical
Involved skin = Total destruction, burned to bone
Clinical presentation = May see burned bone or deeper structures (Mummified)
Healing = grafting or amputation

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23
Q

what are the factors that determine severity of burns?

A

age, medical history, extent & depth of injury, body area involved

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24
Q

what % burned is considered a minor burn for adults, children?

A 
Adult = 15% TBSA (1st and 2nd)
Child = 10% TBSA (1st and 2nd)
Both = 2% (3rd) as long as does not involve eyes, ears, face, genitalia
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25
what % burned is considered a moderate burn for adults, children?
``` Adult = 15-20% TBSA (2nd) Child = 10-21% TBSA (2nd) Both = 2-10% (3rd) not involving eyes, ears, face, genitalia ```
26
what % burned is considered a severe burn for adults, children?
``` Adult = 25% TBSA (2nd) Child = 20% TBSA All 3rd degree greater than 10% All burn of face, eyes, ears, feet, genitalia All electrical All inhalation Complications Pts in high risk groups ```
27
what is the hypovolemic component of burn shock?
Massive fluid loss from circulating blood volume Caused by increased capillary permeability for 24 hrs
28
what are the organs affected by burn shock?
Cardiac contractility diminished | Shunts blood away from kidneys, liver, gut
29
what is disrupted during burn shock?
Cellular metabolism
30
which effects pose greater threat to mortality?
systemic rather than local
31
what are symptoms of burn shock?
dull eyes, pupils dilated shallow, rapid breathing nausea, vomit, thirst weak, rapid pulse
32
how does invasion of bacteria occur?
Occurs when epidermis is broken | Dead tissue, warmth and moisture are ideal for bacterial growth
33
what are the priorities of a burn care pt?
Airway Breathing Circulation Disability (Mini-Neurologic Exam) Exposure/Temperature Control
34
what occurs during emergent phase recovery?
At site: est. airway, provide fluids | ER: use burn sheet to est. fluid needs
35
what are the steps for wound care?
Resuscitate pt for 48-72 hours Excise burn beginning post burn day 2 or 3 limited debriding Debride burn for no longer than 30-45 minutes Cover wound with cadaver skin Attempt to remove entire burn within 7-10 days Remove heterograft and cover wound with autograft
36
what are the topical antibiotics used and their implications?
Sulfamyalon: bacteriocidal, causes metabolic acidosis, painful Silver sulfadiazine: bacteriostatic, causes leukopenia, painless General approach: Sulfamyalon during day, Silver sulfadiazine at night
37
what are the acute care goals?
``` Scar Management Control edema Prevent loss of mobility Promote self-care Orientation activities/simulation Pt + family education ```
38
what is neutral positioning of burn body?
head: neutral shoulder: 60 degree abduction elbow: 30 degree abduction wrist: 30 degree extension metacarp: 60 degree flex digits: full extension leg: 15 degree abduction ankle: 90 degree flex
39
what are factors affecting positioning?
``` Associated injuries Tracheotomy Ventilator dependency Intravenous/arterial lines Pre-existing conditions Skin grafts and other surgeries ```
40
what is skin escahrotomy?
cutting of skin to allow expansion
41
what is an Allograft (Homograft, Cadaver)?
taken from a donor who is a member of the same species but in NOT genetically identical to recipient
42
what is an autograft?
taken from the recipients body
43
what is a full thickness graft?
graft that contains all the layers of skin but not contain subcutaneous fat
44
what is a Heterograft (Xenograft)?
graft taken from another species
45
what is a mesh graft?
the donor skin is cut to form a mesh so that it can be expanded to cover a larger area
46
what is a sheet graft?
the donor skin is applied without alteration to the site
47
what is a Split-thickness skin graft?
graft that contains only superficial dermal layers
48
what are possible complications after skin graft surgery?
``` Bleeding Graft failure Infection at donor or recipient site Poor healing Increased/decreased sensation No hair growth Contracture of graft ```
49
what are risk factors for complications?
Age (Newborn, 60 years & older) Smoking Diabetes Poor overall health
50
How do Skin graft procedures and other surgeries influence therapeutic goals?
Splints & positioning Adaptive devices for ADL Exercise (Continue with goals of earlier phase)
51
what are exercise goals for burn pts?
Reduce edema Maintain ROM Prevent skin contracture
52
what are exercise goals for burn pts that are sick?
Positioning, splinting, PROM, AAROM. AROM Stretch
53
when should pt start ROM after grafting? Ambulation & ADLs?
7-10 days | Ambulation & ADLs immediately
54
what are goals in rehab for burn pts?
Joint mobility & flexibility (via exercise) ADLs: increase participation as patientis able Strength & endurance Re-acquisition of social/vocational skills
55
what should be a primary goal in wound healing?
scar control
56
what are methods for scar management?
Positioning: Acute phase and continue Stretch: PROM and passive stretch, Splinting, casting Pressure:Early contact dressing, Splinting, Pressure garments
57
what is heterotopic ossification?
Bone formation in tissues that normally do not ossify
58
what is Calcific tendonitis?
due to scarring that shifts to other joints | Usually shoulder, pain with limited ROM
59
how does Joint dislocation or ankylosis occur?
result of faulty positioning or scar contracture
60
who is most likely to get Scoliosis or Kyphosis?
Usually in children with neck, trunk burns
61
what influences adjustment after burn injuries?
``` Pre-morbid personality Family stability Extent of burn Location of burn Hospital and outpatient environment Attitudes of burn team members & family Community support systems ```
62
what are the psychological effects during the acute phase?
Patient may be disoriented, fearful, in pain Survival issues dominate
63
how do OT's tx survival issues?
Repeat information, involve family/friends early in patient support Provide consistent/accurate information
64
what are the psychological effects during the sub-acute phase?
Pt is anxious about future-appearance, work, family, social, acceptance May see depression, withdrawal, emotional lability
65
what are the psychological effects during the rehab phase?
Long term adjustment issues continue especially if hands or face are involved
66
what does the burn care outcome depends on?
combined efforts of the pt and a well-organized multidisciplinary burn team
67
what are the burn care outcomes if left to spontaneous recovery?
severe scarring and contractures

MedPsych Exam 3 (7 decks)

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