Flashcards in Exam 1- Burns 2 Deck (33):
Rule of 9: what is it?
how we can decide how much of out body has been burnt
Rule of 9: chest %
Rule of 9: back %
Rule of 9: one arm %
Front is 4.5% and back is 4.5%
Rule of 9: one leg %
Front is 9% and back is 9%
Rule of 9: head %
Rule of 9: genital %
3 zones of burns
Coagulation zone of burns
~Bad enough burned that it dead (already dead)
~Need to clean out, relieve the pressure
Stasis zone of burns
~If we do not intervene, it will go to the coagulation
~if we intervene correctly, can go to hyperemia; if we don’t intervene correctly, can go to coagulation
Hyperemia zone of burns
~Just read and inflamed; trying to heal
Types of grafts
~Have been able to culture human fibroblasts and grow these cells- other human tissues
~Animals, usually pigs- will use split thickness- we need to have some of ret layer of the dermis
~Our body will reject it eventually, but it will keep the env appropriate for healing; after a while, our body will slough it off
Skin substitute grafts
~Will impregnate the gauze with something to help keep the wound from infection/ help heal
What is a split thickness graft?
~Leave some so that you body will heal
~epidermis and part of dermis
What is a full thickness graft?
the whole depth
~the full dermal thickness
~Can turn into mesh then will be able to stretch; turns it into a bunch of little wounds instead of one big wound (takes a lot less time!)
~It’s us; we are not going to reject it
~We can take a sample of our skin, send it to a lab, and get sheets of our skin (takes a month or more depending on the amount of the burn)
~Can make a wound to heal a wound
~Want to have less scaring on: Face, hands, genital, feet, joints
~Table 24.4 is good for positioning (will not have to write this for exam)
~Will take months to heal
How long does it usually take a scar to heal?
up to 2 years
what happens when a scar heals?
the skin will contract
~can lose PROM
~Can lose functional mobility
*have to stretch the tissue
what are the names of two types of bad scars?
Keloid and Hypertrophic
~goes up (not out)
~stays inside the boarders of the wound
~goes outside the original boundaries of the scar
~up and out
~people of color are more likely to have this
Why is positioning important?
~important for good ROM
~need to work on ROM to avoid contractures from forming
Scars and pressure
~~Deformed through wolfs law (PRESSURE)
~Pressure is huge for burn pts
~Pressure garments to decrease pressure; only to bath; helps to lay down collagen uniformly
~Under armor can help some (not as much) as an alternative- not as much pressure
What can you lose during a burn?
~ you can have sensation issues from losing some nerves
~Sabesous gland (need to add moisture)
~could have hair in weird areas now (have to start shaving now)
~can no longer sweat- will over heat (temperature control problem)- can get a heat stroke easier
~Tensile strength- it is weaker so be careful!
What is a Z-plasty?
~you do this when a scar is too tight
~will have to be careful with the two new scars
What is a good goal for venous?
What are categories for short term/ long term goals?
~size (undermining, etc)
Examples of goals
~Pts wound will have 50% decrease in eschar by 2 weeks so that that wound will be facilitated though the healing process
~Pt will have complete absence of eschar in 4 wks;
~Pt;s wound will diminish by 2 cm circum. in 4 wks;
~Pt's undermining will be absence by 4 weeks in order to promote a health wound bed to promote healing
Details on environment when goal writing
~many be full of ec, sloff, etc- removal
~by %, time (in order to facilitate a proper wound bed to facilitate healing)
~Goal for dry- want to moisten to reach proper moisture to promote healing