Epidermal healing:
Retention of ____ cells allows for epithelialization to occur
Viable
Epidermal healing:
Epithelial cells grow and proliferate, migrate to cover the ____
Wound
Epidermal healing:
Protection of _____ cells is critical
Epithelial
Epidermal healing: Loss of _____ glands can result in drying and cracking of wound; protection with moisturizing creams is important
Sebaceous
Dermal healing: Results in ____ formation (injured tissue is replaced by ___ ____)
Scars are initially ___ or ____, later become white
Scar
CT
Red, purple
Phases of healing: Inflamm phase: characterized by what 5 things? Lasts how many days?
Red, edema, warm, pain, dec ROM
3-10 days
Phases of healing: Proliferative, granulation, fibroblastic phase: lasts how many days?
Next 10-14 after inflamm
Phases of healing: Proliferative, granulation, fibroblastic phase:
What are the 4 primary events?
Angiogenesis
Granulation formation
Wound contraction
Epithelialization
Phases of healing: Proliferative, granulation, fibroblastic phase:
Fibroblasts synthesize collagen, GAGs and elastin. Type ___ collagen is initially deposited and later replace with type __ collagen and scar tissues
III
I
Phases of healing: Proliferative, granulation, fibroblastic phase:
________ are responsible for wound contraction in dermal tissues
Myofibroblasts
Phases of healing: Maturation phase:
Tissue remodeling lasts up to ____ years
2
Phases of healing: Maturation phase:
Normal mature scar is soft, _____, and ____
Takes over a _____ to occur
White, flat
Year
Phases of healing: Maturation phase:
At _____ weeks, scar is immature (bright pink)
6-12
Phases of healing: Maturation phase:
Hypertrophic scar may result: raised scar that stays within the boundaries of the burn wound and is ___, _____, ___
Red
Raised
Firm
Phases of healing: Maturation phase:
Keloid scar may result: raised scar that extends _____ boundaries of the original burn wound and is ___, ____, ____. More common in young ____ and those with ____ skin
Beyond
Red, raised, firm
Women, dark
Phases of healing: Maturation phase:
Hypotrophic scar: ____ and _______ below the surrounding skin
Flat and depressed
Burn Management:
Emergency care: Immersion in ____ water. If less than half the body is burn and injury is immediate, _____ ______ may also be used
Cold
Cold compress
Burn Management:
Emergency care:
Cover burn with _____ bandage or ____ ____
NO _____ or _____
Sterile
Clean cloth
Ointments or creams
Burn Management: Medical Management:
Asepsis and wound care
1. Remove ______ clothing
2. Wound _______
3. Topical medications (_______ agents): reapplied __ to ___ times daily
Ointments: Bacitracin, Polymyxin B, and Neomycin
Silver sulfadiazine: common topical agent. Avoid at _____ pregnancy, on infants less than ____ months and those with sulfa drug allergies
Sulfamylon: penetrates through _____. Avoid with sulfa drug allergies
Charred Cleansing Antibacterial, 1-3 times Term pregnancy, less than 2 months Eschar
Burn Management: Medical Management:
Asepsis and wound care: Dressings
Prevent ______ contamination, prevents ____ loss, and protects the wound
May additionally limit _____
Dressings include silver-impregnated, hydrogen’s, petroleum impregnated, and gauze dressings
Bacterial, fluid
ROM
Burn Management: Medical Management:
Establish and maintain _____, adequate ____, and resp function
A/W
Oxygenation
Burn Management: Medical Management:
Monitor: ____, serum _____ _____, ____ output, ___
___ function: provide nutritional support
ABGs, electrolyte levels, urinary, VS
GI
Burn Management: Medical Management: Pain relief (\_\_\_\_\_)
Morphine
Burn Management: Medical Management:
Prevention and control of infection:
______ and ______
____ pxns
Tetanus prophylaxis and antibiotics
STANDARD
Burn Management: Medical Management:
Fluid replacement therapy:
Prevention and control of _______
_____ fluid and _____ replacement
Shock
Post shock
Fluid
Burn Management: Medical Management:
Surgery:
Primary excision: escharotomies, fasciotomies may be required to prevent _____ effects. As the patient is stabilized, surgical removal of _____ begins
Tourniquet
Eschar
Burn Management: Medical Management:
Surgery:
______: closure of the wound
Allograft (homograft): temporary for large burns, used until ______ available
Grafts
Autograft
Burn Management: Medical Management:
Grafts:
Xenograft (heterograft): Use of skin from _____ _____
A ______ graft
Other species (pigskin) Temporary
Burn Management: Medical Management:
Grafts:
Biosynthetic grafts: combo of ____ and _____
Collagen and synthetics
Burn Management: Medical Management:
Grafts:
Cultured skin: _____ grown from patient’s own skin
Lab
Burn Management: Medical Management:
Grafts:
Autograft: use of ____ own skin
Pt’s
Burn Management: Medical Management:
Grafts:
Split-thickness: contains ____ and ____ layers of ____ from donor site
UPPER
EPI
DERM
Burn Management: Medical Management:
Grafts:
Full thickness graft: Contains ____ and _____ from donor site
EPI and DERM
Burn Management: Medical Management:
Escharotomy and fasciotomy with circumferential burns of the extremities and compression due to increased tissue ______
Edema
Burn Management: Medical Management:
Surgical resection of scar contracture (examples?)
Z-plasty: surgical incision in the form of the letter Z used to lengthen a burn scar
Burn Management: Burn Wound Healing:
Factors that affect healing including: what 4 things?
Nutrition
Infection
Associated illness (DM, CA, vascular insufficiency)
Cytotoxic treatments — aka people with life threatening lupus!
Burn Management: Burn Wound Healing:
Significant burn injury more likely in very _____ or the _____ who have thin skin
Young
Elderly
PT Goals, Outcomes, Interventions:
Burn Wound Cleaning/Debridement:
Use _____ control techniques at all times
Infection
PT Goals, Outcomes, Interventions:
Burn Wound Cleaning/Debridement:
Maintain _____ of burn wound by warming cleansing solutions, maintaining ambient temp and avoiding lengthy exposure of wet wound surfaces
Temp
PT Goals, Outcomes, Interventions:
Burn Wound Cleaning/Debridement:
Cleansing with ____ soap and ____ water
Some wounds or dressings benefit from ______, wet removal of dressings
Excess immersion is _________
Risks include auto contamination and electrolyte imbalance
Disinfectant
Warm
Soaking
CONTRAINDICATED
PT Goals, Outcomes, Interventions:
Burn Wound Cleaning/Debridement:
_____ _________: removal of loose, charred, dead skin
Wound debridement
PT Goals, Outcomes, Interventions:
Debridement:
Autolytic dressings: use of _____ dressings such as _____ or ______ to help remove eschar
Moist
Hydrogel or hydrocolloids
PT Goals, Outcomes, Interventions:
Debridement:
Surgical or sharp: excision of eschar using _____ surgical instruments
STERILE
PT Goals, Outcomes, Interventions:
Debridement:
Enzymatic: example?
Fibrinolysins
PT Goals, Outcomes, Interventions:
Debridement:
Mechanical: ___ to ___ dressings, pulsed lavage, gentle _____
Wet to dry
Washing
PT Goals, Outcomes, Interventions:
Rehab:
Overall goals: limit loss of ____, reduce ____, prevent predictable ______ through positioning and splinting, and prevent or reduce complications of ________
ROM
Edema
Contractures
Immobilization
PT Goals, Outcomes, Interventions:
Rehab:
Typically includes ______ daily therapy sessions times with planned ____ meds
Twice
Pain
PT Goals, Outcomes, Interventions:
Rehab:
Exercises to promote ____ ____ and chest _____
Deep breathing and chest expansion
PT Goals, Outcomes, Interventions:
Rehab:
Anti contracture positioning and splinting:
Starts from day ___ and continues for many months
1
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Anterior Neck: Common deformity? Stress what? Position with?
FLEXION
Stress HYPEREXTENSION
Position with firm (plastic) cervical orthosis
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Shoulder: Common deformity? Stress what? Position with?
ADDUCTION and IR
Stress ABD and ER and FLEX
Position with an axillary splint (airplane splint)
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Elbow: Common deformity? Stress what? Position with?
FLEXION and PRONATION
Stress EXT and SUPINATION
Position in EXT with posterior arm splint
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Hand: Common deformity? Stress what? Position with?
Common deformity is claw hand (intrinsic minus position)
Stress wrist ext (15), MP flex (70), PIP and DIP extension, thumb abduction (intrinsic plus position)
Position in intrinsic plus position with resting hand splint
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Hip: Common deformity? Stress what? Position with?
FLEXION and ADDUCTION
Stress EXT and ABD
Position in extension, abd, neutral rotation
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Knee: Common deformity? Stress what? Position with?
FLEXION
Stress EXT
Posterior knee splint
PT Goals, Outcomes, Interventions:
Rehab: Anti contracture positioning and splinting:
Ankle: Common deformity? Stress what? Position with?
PF
Stress DF
Position with foot ankle in neutral with splint or plastic AFO
PT Goals, Outcomes, Interventions:
Rehab:
Edema control: ______ of extremities, active ROM
Elevation
PT Goals, Outcomes, Interventions:
Rehab:
Stretching and early mobs, taking all joints through full ____
PROM
PT Goals, Outcomes, Interventions:
Rehab:
Red Flag: Schedule therapy to coincide with optimal pain med (______ minutes before session) and dressing changes/wound cleansing
Postgrafting: Discontinue exercise for ____ days to allow grafts to heal
30-45 min
3-5 days
PT Goals, Outcomes, Interventions:
Rehab (post-acute):
Continued _____, increasing _____
Progressive ______ to correct loss of muscle mass and strength
Minimize _____: Elastic supports to control ______
PROM, AROM
Strengthening
Edema, edema
PT Goals, Outcomes, Interventions:
Rehab (post-acute):
Scar management:
Massage and application of _______
Regular massage and touching of scars to ______ hypersensitive scars
Pressure garments to help prevent ______ scarring or _____ formation
Moisturizer
Desensitization
Hypertrophic, keloid
PT Goals, Outcomes, Interventions:
Rehab (post-acute):
Progressive ambulation to improve ___ endurance and activity tolerance
CV
PT Goals, Outcomes, Interventions: Rehab (post-acute): Preparation for home, work, play, school. Management of \_\_\_\_\_ pain Provide education and emotional support
Chronic