PT and Burns - Class 5

Question 1

PT initial evals

Answer 1

chart review

objective eval

assessment

plan

Question 2

chart review should include

Answer 2

MOI/extent

%total body surface area, location, inhalation injury?

hospital course

PMH, PSH

meds, allergies

social history

precautions

referring MD

Question 3

social history

Answer 3

married or single

w/ or w/o family

occupation

house or apartment/stairs, elevator

ETOH

prior to admission

Question 4

prior to admission

Answer 4

level of fxn

ADs

hand dominance

Question 5

objective eval

Answer 5

vital signs

mental status

AROM

PROM

burns

muscle strength

motor fxn/muscle tone

sensation

Question 6

vital signs

Answer 6

from nursing flow sheets if necessary

Question 7

burns

Answer 7

depth

location

size = %TBSA

appearance –> red, blood base v necrotic areas

wound treatment

Question 8

muscle strength

Answer 8

specific muscle testing is indicated in nerve distribution areas

important and helpful w/ electrical injury involvement

Question 9

what should we take into consideration –> objective

Answer 9

pt is heavily medicated and sometimes sedated

Question 10

during the initial eval we should try and find out

Answer 10

when the pt is going to be tanked or when they receive their dressing change

Question 11

%TBSA can be found

Answer 11

on the chart

Question 12

how do we check if a burn is circumferential

Answer 12

lift pt’s extremities

look anterior and posterior

Question 13

how long do burns take to show themselves/demarcate

Answer 13

2-3 days

initially they might look more superficial than they really are and vice versa

Question 14

assessment

Answer 14

includes PT assessment

candidate for therapy, to ambulate independently or be sent home w/ or w/o care

Question 15

plan

Answer 15

consists of PT tx

5-6 days/week

for A/PROM techniques

transfers

strengthening and ambulation

Question 16

first couple days post burn goals of medical team

Answer 16

fluid resuscitation

critical care techniques

Question 17

PT intervention –> couple days post burn

Answer 17

CPT/percussion

PROM technique

positioning can be included
–> as long as nursing and OT are aware and in agreement

Question 18

what is important

Answer 18

consistency!

Question 19

tx must be

Answer 19

aggressive and regimented

should be seen 2x a day

Question 20

when should we review the chart

Answer 20

daily for changes

note surgeries, donor sites and grafts

Question 21

what should we look for

Answer 21

signs of infection

staples left intact

Question 22

when performing P/AAROM to elbows and knees

Answer 22

be sure it is GENTLE

Question 23

what can aggressive PROM at the knees and elbows cause

Answer 23

heterotrophic ossification

Question 24

who should we notify with problems

Answer 24

the proper HCP

Question 25

as the pt begins to heal

Answer 25

some scar bands may begin to develop around or near joints

Question 26

what may occur when the pt performs thier exercise program

Answer 26

the skin may blanch

Question 27

occasionally the pt or PT may cause

Answer 27

an auto release of their scar band or skin contracture and bleed notify MD

Question 28

outpatient

Answer 28

use of modalities such as paraffin heat and ice can be beneficial depending on sitatuation and sxs

Question 29

paraffin

Answer 29

an excellent modality to soften hard tight skin

Question 30

paraffin --> where should it be used

Answer 30

exposed area make sure the area is healed w/o opened areas

Question 31

to use paraffin we should

Answer 31

stretch joint until it is blanched

Question 32

set up of paraffin

Answer 32

take 4x4 gauze and dip it into the paraffin several times --> until impregnated with it let paraffin drop over paraffin bin until it stops dripping place gauze on joint --> approx 1-2 min use w/ prolonged stretch 1-3 min

Question 33

what should we remember --> paraffin

Answer 33

grafted skin usually has decreased sensation and decreased ability to dissipate heat always check every 20-30 s

Question 34

tx planning objectives

Answer 34

prevent the loss of ROM and fxn restore lost motion and fxn return to preburn fxnal status (PTA) or educate pt to fxn w/ disability

Question 35

disability doesnt mean

Answer 35

handicap

Question 36

tx planning --> tx interventions

Answer 36

proper positioning, splinting and exercise compliment one another along continuum of interventions tx concept tx location time of day frequency of txs

Question 37

tx concept

Answer 37

to impart stress in a controlled manner to cause scar tissue to remodel

Question 38

what time of the day is the worst

Answer 38

mornings but there is benefit in achieving ROM early for use throughout the day

Question 39

when should we schedule tx sessions

Answer 39

to coincide w/ administration of pain meds

Question 40

by later afternoon pt may be

Answer 40

fatiguede w/ the day's activities can benefit ROM

Question 41

frequency of tx

Answer 41

continuous 1-6x per day

Question 42

formal tx is

Answer 42

therapist guided

Question 43

informal

Answer 43

self ROM nurse or family supervised

Question 44

ROM is used as a

Answer 44

guide

Question 45

positioning objectives

Answer 45

control edema prevent tissue destruction maintain soft tissues in an elongated state

Question 46

control edema

Answer 46

elevate extremities when lying or sitting UE when ambulating

Question 47

when is it most critical --> edema

Answer 47

first 72 hours

Question 48

when sitting --> edema

Answer 48

pts arms at the level of their heart

Question 49

preventing tissue destruction

Answer 49

pressure areas

Question 50

preventing tissue destruction includes

Answer 50

turning schedule alternate positions dermal pads for head and heels maintain heels off bed use for specialty beds

Question 51

maintain soft tissue in an elongated state--> how should the pt be positioned

Answer 51

position opposite the location of the burn wound

Question 52

what should we extend --> elongated state

Answer 52

flexor surfaces

Question 53

there are --> elongated state

Answer 53

positioning techniques for specific body areas

Question 54

heterotopic ossification pathogenesis

Answer 54

unknown

Question 55

suspected etiologies --> HO

Answer 55

calcium mobilization

Question 56

what is calcium mobilization from --> HO

Answer 56

immobilization high protein intake microtrauma >20% of total body burn

Question 57

incidence of HO

Answer 57

0.1-3.3% in retrospective studies 13/14-23% in prospective studies

Question 58

burn program exercise objectives

Answer 58

reduce edema and promote circulation prevent scar tissue contractures and deformity prevent deconditioning preserve muscle strength and joint mobility maximize lung fxn promote maximum fxnal independence