Burns

Question 1

Burn size on Adults

Answer 1

Rule of nines

head/neck - 9%
arm - 9% (you have two so 18%)
trunk - 18%
leg - 18% (you have two so 36%)
groin - 1%

Question 2

Superficial (1st degree) burn

Answer 2

involves superficial epidermis

pain is min to mod

healing time is 3-7 days

Question 3

Superficial partial-thickness (2nd degree) burn

Answer 3

upper epidermis and upper dermis layers

Pain is significant, wet blistering w/erythema

healing time is 1-3 weeks

Question 4

erythema

Answer 4

redness of the skin or mucous membranes

Question 5

Deep partial-thickness (deep 2nd-degree) burn

Answer 5

Involves the epidermis/deep dermis layers, hair follicles and sweat glands

• Pain is severe - even to light touch
• can turn into a full-thickness burn due to infection
• Grafting may be considered to prevent infection
• Impairment of sensation
• Potential for hypertrophic scar
• Healing time is 3-5 weeks

Question 6

hypertrophic scar

Answer 6

excessive amounts of collagen which gives rise to a raised scar (over cut or burn)

Question 7

Full-thickness (3rd-degree) burn

Answer 7

Involves epidermis/dermis, hair follicles, sweat glands, and nerve endings

-Pain free! -No sensation to touch!

Burn is pale w/no blanching

Requires skin graft!

Hypertrophic scarring is high!

Question 8

Blanching

Answer 8

when you touch your skin near a burn a white spot means you have good circulation

Question 9

Subdermal Burn

Answer 9

Full-thickness burn to tissue, fat, muscles and bone

-charring is present, destruction of nerve

Peripheral nerve damage

Needs surgical intervention for wound closure/amputation

Question 10

escharotomy

Answer 10

surgical incision into the burn tissue to relieve pressure on extremities

Question 11

homograft

Answer 11

human cadaver graft (temporarily)

Question 12

heterograft

Answer 12

pig skin graft (temporarily)

Question 13

Autograft

Answer 13

Own skin (permanent)

Question 14

Cultured epithelial autografts (CEA)

Answer 14

own skin is grown and then grafted (permanent)

Question 15

OT Intervention: Splinting in antideformity positions

Answer 15

• Intrinsic plus for hands
• Opposite client’s posture
• Generally in extension for neck, elbows and knees
• Shoulder in abduction
• Hip in extension
• Anti-frog leg and anti-foot drop for lower extremity

Question 16

OT Interventions - Acute Phase

Answer 16

ROM, muscle strength and pain

-Splinting, positioning in antideformity positions, edema management

Question 17

Anticontracture Positioning: Neck

Answer 17

Netural to slight extension

Question 18

Anticontracture Positioning: Chest and Abdomen

Answer 18

Trunk extension, shoulder retraction

Question 19

Anticontracture Positioning: Axilla (armpit)

Answer 19

Shoulder abduction to 90 degree, external rotation

Question 20

Anticontracture Positioning: Elbow

Answer 20

Extension

Question 21

Anticontracture Positioning: Forearm

Answer 21

Neutral to supination

Question 22

Anticontracture Positioning: Dorsal Wrist

Answer 22

Wrist in neutral to 30 degree extension

Question 23

Anticontracture Positioning: Volar Wrist

Answer 23

Wrist in 30-45 degrees extension

Question 24

Anticontracture Positioning: Hand

Answer 24

Metacarpal extension, 70 degrees flexion, interphalangeal extension, thumb abducted and extended

Question 25

Anticontracture Positioning: Hip

Answer 25

10-15 abduction, neutral extension

Question 26

Anticontracture Positioning: Knee

Answer 26

Extension; w/anterior burn, slight flexion

Question 27

Anticontracture Positioning: Ankle

Answer 27

Neutral to 5 degrees dorsiflexion

Question 28

Anticontracture Positioning

Answer 28

Is critical because the position of greatest comfort is usually the position of contracture

Question 29

How long do you wait until you can do passive/active ROM w/exposed tendons or recent grafts

Answer 29

5-7 days

Question 30

How long should you wait after pain meds have been given?

Answer 30

30 minutes

Question 31

Heterotopic Ossification

Answer 31

Formation of bones in abnormal areas. - Loss of ROM is rapid - Use AROM exercise within the pain-free range to preserve as much joint movement as possible

Question 32

For edema measurement in the hand using a volumeter should be avoided because?

Answer 32

All wounds in the hand should be closed first

Question 33

Are silastic gel sheeting used on open wounds?

Answer 33

NO

Question 34

What are silastic gel sheeting used for?

Answer 34

Temporary use in the management of both old and new hypertrophic scars or keloid scars

Question 35

Pressure garment purpose

Answer 35

To provide pressure at the burn sight to decrease scarring and help circulation so less swelling is observed and to decrease a risk of infection

Question 36

How often a day should you wear your pressure garment

Answer 36

24 hours a day and remove for washing

Question 37

What is the initial skin treatment?

Answer 37

moist gauze wraps

Question 38

How long do patients wear gauze wraps?

Answer 38

Depends on skin healing. Some pts may need to wear the gauze for 2-3 weeks...

Question 39

What do you place on the skin that has adequately healed?

Answer 39

Xeroform

Question 40

What is xeroform?

Answer 40

Is placed on any small burn that has the potential for cracking or bleeding. This is placed on the area under the pts tubigrip

Question 41

What is tubigrip?

Answer 41

Helps to decrease swelling, prevent keloid scarring, decrease pain to sensitivity to the air, and to prepare the skin for a custom-made Jobst compression garment

Question 42

keloid scarring

Answer 42

firm, rubbery lesions or shiny, fibrous nodules

Question 43

What does a Jobst compression garment do?

Answer 43

Provide additional pressure and therefore serve to further decrease swelling, pain, scarring, skin sensitivity and remodeling of skin.

Question 44

Order of garments for burn pts

Answer 44

wet gauze wraps tubigrip Jobst compression garment