Burns Flashcards
1
Q
1st degree burns involve the ______
A
epidermis
2
Q
2nd degree burns involve top layer and part of second layer (______)
A
dermis
3
Q
___ degree burns will be blistered, red and swollen
A
2nd
4
Q
______ patches may be evident in 2nd degree burns
A
white
5
Q
3rd degree burns = ____ thickness burns
A
full
6
Q
____ degree burns will look white or charred and the dead skin forms an _____
A
3rd; eschar
7
Q
3rd degree burn sites may be painless (T/F)
A
TRUE
8
Q
Burn severity and classification is determined by _____ and _____ ____ involved
A
depth; SA
9
Q
Most common chart used in burn units for assessment of burn SA?
A
Lund and Browder
10
Q
What comprises total body surface area in burn wound determination?
A
2nd degree + indeterminate + 3rd degree
11
Q
Flame injuries may be associated with ______ injury and tend to be deep ______ or full thickness
A
inhalation; dermal
12
Q
For ____ injuries, object must be extremely hot or contact abnormally long
A
contact
13
Q
Contact injuries tend to be _____ dermal or ____ _____
A
deep; full thickness
14
Q
_____ injuries = most common cause of burn injury in children
A
scald
15
Q
Scald injuries can range from _______ to _____, often mixed
A
superficial; deep
16
Q
High volt electrical burn = >_____ V
A
1000
17
Q
Low volt electrical burn = < ____ V
A
1000
18
Q
Things that are unique for electrical burns?
A
always have and exit wound; may have injury from current arc
19
Q
Hypothermia injury causes a decrease in what 4 things ?
A
- HR
- CO
- RR
- BP
20
Q
______ = localized body part freezing, compromised circulation
A
frostbite
21
Q
2 most common burn injury mechanisms for adults?
A
- fire / flame
2. scald
22
Q
3 risk factor that increase mortality rate from burn?
A
- increased age
- increased burn size
- presence of inhalation injury
23
Q
3 zones in a burn?
A
- zone of coagulation
- zone of stasis
- zone of hyperaemia
24
Q
Zone of _____ = point of max damage; irreversible tissue loss due to coagulate of constituent proteins
A
coagulation
25
Zone of _____ = characterized by decreased tissue perfusion, potentially salvageable with good resuscitation
stasis
26
Zone of _____ = outermost zone, will recover unless there is severe sepsis of prolonged hypo perfusion
hyperaemia
27
There is an ____ in capillary permeability which leads to loss of ____ and _____ into interstitial compartments
increase; proteins; fluids
28
Increase in capillary permeability leads to edema and hypovolemia, which leads to _____ ______
peripheral vasoconstriction
29
Inadequate CO post burn leads to inadequate ______/______ perfusion
tissue/organ
30
Renal effects of burn = loss of fluids from _____ _____ cases renal vasoconstriction, decreased renal blood flow and _____
intravascular spaces; GFR
31
Basal metabolic rate increases up to ___x original rate due to burns
3
32
There is a ______ immune response due to burns
reduces
33
Resp effects of burns = inflammatory mediators cause ______
bronchoconstriction
34
Resp effects of burns : ______ ______ = decreased O2 carrying capacity
carbon monoxide
35
5 signs of inhalation injury ?
1. singed eyebrows or nasal hairs
2. black nasal or oral discharge
3. grossly swollen lips
4. facial burns
5. hoarse voice
36
Inhalation injury: __-__ hrs = upper airway obstruction, pulmonary edema
0-24
37
Inhalation injury: __-__hrs = pulmonary edema
24-48
38
Inhalation injury: __ hrs = bronchiolitis, alveoli's, pneumonia and ARDS
48
39
With 1mm edema, airway resistance increased __x in in infants and xSA decreases by __%
16;75
40
With 1mm edema, airway resistance increases by __x in adults and x sectional area decreases by __%
3;44
41
5 steps to manage burn pts?
1. ax
2. dx
3. early mobilization
4. airways clearance
5. exercise program including ROM and positioning
42
Therapy role in early wound management (first 2-3 weeks)?
1. maintain max ROM
2. mobility
3. scar management
4. ADL
5. D/C planning
43
3 aspects of maintaining max ROM in early wound management?
1. AROM and PROM
2. positioning
3. edema management
44
Scar management begins day ___
1
45
Soft tissue time lines for joint loss of motion: 1-4 days
brun scar tissue contracture
46
Soft tissue time lines for joint loss of motion: 5-21 days
tendons and sheaths
47
Soft tissue time lines for joint loss of motion:2-3 weeks
adaptive muscle shortening
48
Soft tissue time lines for joint loss of motion:1-3 months
ligament and joint capsule
49
5 pain management techniques we can use?
1. liaise w/ team re meds
2. adequate compression support
3. distraction/relaxation, breathing techniques
4. TENS
5. itch control
50
For exercise prescription, focus on areas most likely to develop scar _____ _____, and ____ over joints
tissue contractures; elongation
51
Precautions to exercise prescription ?
1. pre-existing cardiac and pulmonary conditions
2. joint disease
3. excessive bone (HO; AROM allowed)
4. IV lines and ventilation support
5. exposed tendons
52
CI's to exercise prescription?
1. exposed joint
2. DVT/thrombophlebitis
3. compartment syndrome
4. new skin graft
53
PROM for pain pt's = slow prolonged stretch to point of _____, within pt's pain tolerance, multiple _____
blanching; reps
54
______ can be performed for skin graft adherence
AAROM
55
When is AROM appropriate post skin graft?
after first week
56
Follow ______ ____ ____ when ambulating post skin graft
progressive dependency protocol
57
What are the 5 steps in the progressive dependent protocol?
1. observe graft site
2. figure 8 wrap over dressing
3. place limb in dependent position (dangle)
4. elevate limb
5, remove wrap to reassess
58
_____ = potentially antimicrobial, prevents colonization and kills infection causing miro-organisms, has anti-inflammatory properties and is non-toxic to human tissue
silver
59
______ = bilayer silver ion delivery system, works for several days when wet
acticoat
60
Change acticoat dressing every __-__ days
5-7
61
5 considerations for sx decision making ?
1. TBSA involved
2. depth of burn
3. location of burn
4. time for wound to heal
5. circumferential burn
62
If the burn is circumferential, there is a need for _____-
escharotomy
63
____ ____ skin graft = skin transplant that requires a vascularized wound for graft to take
split thickness (STSG)
64
STSG is harvested using a ______
dermatome
65
STSG is always meshed (T?F)
FALSE; may be meshed
66
STSG = immobilized until _____ connections are made (approx __ days_
vasular; 5
67
STSG donor sites are from the epidermal layer (T/F)
FALSE ; epidermal and dermal layer
68
Most common site of STSG harvest?
anterior thigh
69
Can reharvest area of STSG within __-__ days
10-14
70
One advantage of STSG is decreased rate of _____ ______
primary contration
71
4 disadvantages of STSG?
1. cosmetic inferiority to FTG
2. decreased durability
3. hyperpiguentaion
4. increased risk of secondary contracture
72
Full thickness graft (FTG) involves more ____ layer
dermal
73
Donor sites of FTG?
groin or abdomen
74
____ often used for joint contracture revision sx
FTG
75
2 advantages of FTG?
1. decreased secondary contracture
| 2. improved cosmesis and durability
76
Disadvantage of FTG?
limited donor sites
77
CI for early management post skin grafting ?
NO ROM or mobilization for 5 days post grafting sx
78
3 precautions for early management post skin grafting?
1. shearing
2. fluid accumulation under graft
3. tension and movement
79
Management of skin graft in acute phase (1-2 weeks?)
1. elevate
2. immobilize (cast or splint)
3. wound care (recipient and donor)
4. controlled ROM
5. once healed, initiate regular moisturizing
6. begin light compression
80
Splint hand in _______ position
antideformity
81
Management of skin graft in the late phase (2 weeks +)?
1. progress ROM
2. continue compression
3. silicon inserts
4. static and/or dynamic splinting to minimize contractures
5. begin gentle scar message
6. education re sun protection
7. continue to progress mobility and ADL's
82
____ = collagen rich matrix deposited in all tissues (except ___) in response to tissue disruption
scar; bone
83
Scar is both central and problematic to wound healing (T/F)
TRUE
84
Good scar should not limit function, should be without ____, _____ or _____
adhesions; contratures; hypertorphy
85
Scar may remain metabiologically active for months (T/F)
FALSE - for YEARS
86
Stage __ of scar maturation = fibroblastic / proliferative, __- __ weeks, scar is soft, find and weak
1; __-__
87
Stage __ of scar remodelling = early remodelling, __-__ weeks, scar contracts, becomes red, hard, thick and strong
2; 4-12
88
Stage __ of late remodelling and maturation = __ - __ weeks, scar gradually becomes soft, supple, white and loose
3; 12-40
89
Custom made pressure garments = __mmHg of pressure
25
90
Custom made pressure garments assist in promoting ______ skin healing in deeper skin layers
organized
91
____ scar = extends beyond confines of original wound
keloid
92
Keloid scars are often resistant to treatment (T/F)
TRUE
93
_______ scar = bulky scar, stays within confines of wound
hypertrophic
94
Hypertrophic scars are often found in areas of _____
motion
95
Hypertrophic scars may be associated with wound ____/____ of closure
tension/timing
96
Wide spread scar occurs during _____ phase of wound healing when continued tension and mobility of the wound leads to a flat, widely spread or depressed scar
third
97
Wide spread scars (are/are not) a problem of excessive collagen deposition
are NOT
98
Therapeutic management of scar begins with ___ day of wound healing
first
99
Therapeutic management of scar stimulates ______ response and control ______ deposition
collagen x2
100
4 therapist goals with burn patient?
1. educate pt and family
2. maintain and/or restore active and passive ROM of involved structures
3. prevent deformity through ROM exercises, positioning, and scar management techniques
4. optimize functional capabilities including mobility and ADLS
