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Conditions II > Burns > Flashcards

Burns Flashcards

1
Q

What is skin?

A
  • The soft outer covering of vertebrates
    •The largest organ in the body
    •Skin is .5 cm to 4.0 cm thick
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2
Q

T or F: Women have thicker skin than men.

A

False; men have thicker skin

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3
Q

T or F: The young and elderly have thicker skin than adults.

A

False; the young and elderly have thinner skin than adults

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4
Q

T or F: Skin on various parts of the body varies in thickness and blood flow

A

True

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5
Q

The skin is made up of what three different layers?

A

Epidermis, dermis, hypodermis

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6
Q

What layer are melanocytes found in? What is the purpose of melanocytes?

A

Epidermis; melanocytes produce a protective skin-darkening pigment melanin

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7
Q

What layer are langerhans cells found in? What are their purpose?

A

Epidermis; they protect your skin from infection and produce allergic reactions

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8
Q

What layer are merkel cells found in? what are their functions?

A

Epidermis; it is a touch receptor

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9
Q

What is the outermost layer of the skin called?

A

epidermis

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10
Q

which layer of skin contains blood capillaries, hair follicles glands, nerve endings and receptors?

A

dermis

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11
Q

What layer of the skin is subcutaneous and contains fat and blood vessels?

A

Hypodermis

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12
Q

What are the functions of the skin?

A
  1. Temperature regulation
  2. Protection
  3. Sensation
  4. Excretion
  5. Immunity
  6. Blood reservoir
  7. Vitamin D synthesis
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13
Q

How do you classify a burn?

A

By level of cellular injury
•Use of Laser Doppler Flowmetry (LDF), MRI, and thermography
•Most often clinical observation is the techniques used

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14
Q

T or F: Superficial burn is known as a second degree burn.

A

False; superficial is formally known as a first degree burn

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15
Q

T or F: Partial thickness is formally known as a first degree burn.

A

False; partial thickness is formally known as a second degree burn

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16
Q

T or F: Full thickness is formally known as a second degree burn.

A

False; full thickness is formally known as a third degree burn

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17
Q

What are the characteristics of a superficial burn?

A
  • Damage to cells on the epidermis only
  • Red painful intact skin
  • Heals spontaneously within 1-7 days
  • No scarring
  • “Think sun burn”
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18
Q

What are characteristics of a superficial partial thickness?

A
  • Damage to epidermis parts of the dermis
  • Red, wet, edematous, painful, blisters
  • Reepithelialize in 7-21 days
  • Minimal to no scarring
  • Hair may be spared/ grow back
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19
Q

What are characteristics of deep partial thickness?

A
  • Severe damage to dermal layer
  • Blotchy and white
  • Healing 3- 5 weeks (sluggish)
  • Grafted to expedite healing
  • Infection can lead to full thickness easily
  • Scaring
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20
Q

What are characteristics of full thickness?

A 
•Destruction of the epidermis, dermis and sometimes muscle/bone
•Apears:
–White/ gray
–leathery
–insensate
–contracted
•5-14 days via skin graft
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21
Q

What is the incidence and prevalence of burns?

A

•Burn Injuries Receiving Medical Treatment: 450,000
•Fire and Burn Deaths Per Year: 3,400
•Hospitalizations Related to Burn Injury: 40,000, including 30,000 at hospital burn centers
•Stats:
–Survival Rate: 96.1%
–Gender:
•69% male
•31% female
–Ethnicity:
•59% Caucasian, 19% African-American, 15% Hispanic, 7% Other
–Admission Cause:
•44% fire/flame, 33% scald, 9% contact, 4% electrical, 3% chemical, 7% other
–Place of Occurrence:
•69% home, 9% occupational, 7% street/highway, 5% Recreational/Sport, 10% Other

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22
Q

What are the types of burns?

A
  • Thermal Burns
  • Electrical Burns
  • Chemical Burns
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23
Q

How are thermal burns usually caused?

A

– flame
– scald
– flash
– contact with a hot surface

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24
Q

T or F: Thermal burns are most common in teenagers.

A

False; Most common in children and older adults

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25
What are the most common mechanisms for thermal burns?
Hot drinks and hot bathwater
26
T or F: Thermal burns vary in depth secondary to length of exposure to heat source
True
27
What type of thermal burns tend to be superficial or partial thickness burns?
Scald burns tend to be superficial or partial thickness burns
28
What type of thermal burns tend to be partial and full thickness?
Flame burns are usually partial and full thickness; contact burns can be partial to full thickness
29
What two types of thermal burns are considered "dirty wounds"?
Flame and scald; because debris from the fire or hot liquid can contaminate the wound
30
T or F: If the skin barrier is broken there is a greater | chance for infection
True; This may then change treatment option; such | as dressing choice
31
T or F: Electrical burns require special consideration because where the electrical current enters the body and exists
True
32
What type of burn typically has an entrance wound and an exit wound?
Electrical burn
33
Do electrical burns require cardiac monitoring?
Yes
34
What type of burns are caused by high voltage, low voltage or lightning?
Electrical burns
35
What type of burns are a result of reduction, oxidation, corrosion or the desecration of body tissue?
Chemical burns
36
T or F: Chemical burns alter pH and metabolism.
True
37
What setting do chemical burns usually occur in?
Industrial settings
38
What kind of burn can occur with misuse of household cleaners?
Chemical burns
39
T or F: Chemical burns tend to be shallow.
False; chemical burns tend to be deep
40
T or F: Chemical agents have to be neutralized.
True
41
T or F: Frostbite is a type of burn.
False; it is not a burn
42
T or F: Frostbite is treated at burn centers because it involves the skin and underlying structures
True
43
T or F: The severity of a frostbite depends on length of exposure to cold.
True
44
T or F: In the pre-thaw base, the area should be padded and warmed in a water bath about 100-103 F.
False; it should be in a water bath about 104-107.6 F
45
What should you do in the post thawing phase?
Minimize inflammation process
46
How many degrees can frostbite be classified in?
Classified into 1st, 2nd, 3rd, 4th degree
47
T or F: Injured tissues die immediately.
False; it may not die immediately. Wound "declared"
48
What does TBSA stand for?
Total body surface area
49
Who is part of the burn team?
* Burn or plastic surgeon * Nurse * Burn therapist (occupational therapist, physical therapist) * Nutritionist * Pharmacist * Case manager
50
What are the phases of burn management?
Emergent, acute, rehab
51
What phase is from 72 hours until wound is closed by healing or graft?
Acute
52
What phase is from the date of injury to 72 hours?
Emergent
53
What phase occurs until scar maturation can take place 6 months to years?
Rehab
54
What is part of the emergent medical treatment?
``` •Clean wound –2 to 3 x’s daily •Fluid resuscitation –Constant hydration •Establishment of tissues perfusion –Blood back to area •Cardiopulmonary stability •Eschar- Burned tissue –Greek for scab •Maintain airway –Escharotomy and Fasciotomy •Debridement –Remove eschar and necrotic tissue •Dressing for debridement •Infection prevention/control •Significant contracture risk ```
55
What do you do in the emergent phase OT treatment?
•Starts 0-72 hours post burn •Prevention contracture via splinting and positioning •Apply splints over burn dressing -Splint as soon as possible to stabilize joints •Anti-deformity positioning –Positions that are opposite to the deformity
56
What are positions that are opposites to the deformity called?
Anti-deformity positioning
57
How long can the acute phase medical treatment last?
Days to several months
58
What is part of the acute phase medical treatment?
* Skin grafting is completed if reepithelilzation has not occurred within 14 days or is not expected * Nutrition * Pain management
59
What do you do for management of burn wounds?
``` •Dressings –After the TBSA is calculated the burn is cleansed –Antibiotic applied –Silver-impregnated dressing •Hydrotherapy –Whirlpool loosens necrotic tissue –Increase circulation •Vacuum-Assisted closure •Surgery –Full thickness burns or burn not expected to heal in 3 wks •Temporary and Permanent wound covering ```
60
What are the types of grafts?
``` •Autografts skin from unburned area is used –Solid –Meshed •Temporary –Xenographs (bovine skin) –Allographs (cadaver skin) –Biological dressing ```
61
What happens in the acute phase OT assessment?
``` •Detailed IE –Age –burn mechanism –areas burned –% burned (TBSA) –Depth –Joints involved –Procedure (s) preformed •ADL’s & IADL’s •Psychosocial status and support systems •Behavior and Communication •Cognitive and perceptual status •Neuromuscular status (ROM and Strength) •Activity tolerance •Burn Scar Index (Vancouver Scar Scale) VSS –1-13 score on Vascularity, height/thickness, pliability, and pigmentation ```
62
What happens in the acute phase OT treatment?
* ROM and Strength * Splinting-Check daily fit * Positioning * Exercise * Environmental Modifications * Alternative Communication systems * Clients treatment tolerance may limited * Post-op splinting must be immobile 5-10 days * Anti-deformity positions (table 40-1) * Pain management * Client and family education * Discharge planning * Support and psychosocial adjustment
63
What happens in the rehab phase?
•Continues from Acute phase and continues till scar maturation –Can last up to 6 months –Scar become pale and decreased rate of collagen production •OT Role varies –Inpatient •Hands on need not able to return home safely yet –Outpatient •Hand therapy/ Upper quarter rehab
64
In what phase does the scar become pale and there is a decreased rate of collagen?
Rehab phase
65
What happens in the rehab phase OT assessment?
``` •Assess capacities and abilities •Homemaking •Work functioning •Performance components –Scar management –ROM –Strength –Activity tolerance –Sensation –Coordination ```
66
What happens in rehab phase OT treatment?
* Goal = return to previous level of function * ROM * Strength * Activity tolerance * Sensation * Coordination * Scar management * Self care- ADL’s may have need for assistive devices * Home management skills * Patient and family education * Psychosocial skills * Return to work
67
What is part of scar management?
``` •Massage •Pressure garments –Coban –Tubigrip –Isotoner gloves –Elsatomere –Closed cell foam ```
68
T or F: A scar massage aides desensitization.
True
69
T or F: A scar massage can only be done by an OT
False; Done several times daily by OT initially and then by patient and family –‘Desensitize’ the family to the scar
70
T or F: Scar massages help maintain suppleness.
True
71
How should you give a scar massage?
Massage to blanch, hold for a few seconds-client should report tension and not pain- feel pressure
72
What does hypertrophic scarring look like?
* Red * Raised * Inelastic * Increased fibroblasts * Nodular collagen which can limit function
73
What are some complications of burns?
* Prutitis-persistent itching * Microstomia-oral commisure contracture * Heterotrophic ossification * Myositis ossificans ( about 13% of all patients with burns) * Heat intolerance
74
What are some surgical options for burns?
``` •Debridement •Grafts •Reconstructive surgery –OT can recommend this in contracture limits occupational performance –Corrects deformities –Z-plasty-elongates soft tissue ```
75
T or F: Hand burns can lead to web space contractures and some precautions would be extensor tendon injuries.
True
76
What are some psychosocial and mental health factors with burn clients?
* Body image * Depression * Posttraumatic stress disorder (PSTD) * Decreased sleep

Conditions II (7 decks)

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