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Conditions II > Burns > Flashcards

Flashcards in Burns Deck (76):
1

What is skin?

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

2

T or F: Women have thicker skin than men.

False; men have thicker skin

3

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

False; the young and elderly have thinner skin than adults

4

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

True

5

The skin is made up of what three different layers?

Epidermis, dermis, hypodermis

6

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

Epidermis; melanocytes produce a protective skin-darkening pigment melanin

7

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

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

8

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

Epidermis; it is a touch receptor

9

What is the outermost layer of the skin called?

epidermis

10

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

dermis

11

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

Hypodermis

12

What are the functions of the skin?

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

13

How do you classify a burn?

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

14

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

False; superficial is formally known as a first degree burn

15

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

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

16

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

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

17

What are the characteristics of a superficial burn?

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

18

What are characteristics of a superficial partial thickness?

•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

19

What are characteristics of deep partial thickness?

•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

20

What are characteristics of full thickness?

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

21

What is the incidence and prevalence of burns?

•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

22

What are the types of burns?

• Thermal Burns
• Electrical Burns
• Chemical Burns

23

How are thermal burns usually caused?

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

24

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

False; Most common in children and older adults

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