221 Integ: Burns

Front 1

what determines the amount of skin destruction with burns?

Back 1

based on temperature to which the skin is exposed

and length of time exposed

Front 2

what are the zones for burn wounds?

Back 2

Zone of coagulation
Zone of stasis
Zone of hyperemia

Front 3

Burn Zone of coagulation:

Back 3

Cells are irreversibly injured
Cell death occurs

Front 4

what is the burn zone of stasis?

Back 4

Cells are injured
May die without specialized treatment, usually within 24-48 hours

Front 5

what is the burn zone hyperemia?

Back 5

Minimal cell injury
Cells should recover within 7 days with no lasting ill effects

Front 6

what does the amount of skin damage depend upon?

Back 6

1. duration and intensity of heat

2. skin thickness

3. area exposed

4. vascularity

5. age

6. person's pigmentation

Front 7

Superficial Burn (first degree) damage is to:

Back 7

epidermis only (e.g. sunburn)

Front 8

what are 1st degree burns characterized by?

Back 8

1. Erythema: Pink or red appearance
2. No blistering (dry surface)
3. Minimal edema
4. Tenderness, delayed pain

Front 9

Healing/Scarring of 1st degree burn:

Back 9

1. some peeling of skin will occur
2. Spontaneous healing in 2-5 days
3. No scarring

Front 10

what tissue is damaged in superficial partial thickness burn ?

Back 10

aka 2nd degree

epidermis and dermis

Front 11

what are characteristics of 2nd degree burns?

Back 11

1. Bright pink or red appearance
2. Blanching with brisk capillary refill
3. Blisters, moist surface, weeping
4. Moderate edema
5. Painful, sensitive to touch
6. Temperature changes

Front 12

Healing/Scarring of 2nd degree burn:

Back 12

1. Spontaneous healing, typically in 7-21 days
2. Minimal scarring
3. residual skin color changes

Front 13

what is damaged in deep partial thickness burns?

Back 13

2nd degree

- Severe damage to epidermis & dermis with injury in nerve endings, hair follicles, & sweat glands

Front 14

what are characteristics of deep partial thickness burn (2nd degree)?

Back 14

1. Mixed red or waxy white appearance with slow capillary refill
2. Broken blisters, wet surface
3. Marked edema
4. Sensitive to pressure
5. Insensitive to light touch or soft pin prick
6. Severe pain

Front 15

Healing/Scarring of Deep Partial-thickness Burn (2nd degree):

Back 15

1. Healing is slow: 3 to 5 weeks
2. Hypertrophic and keloid scarring are common
3. Blanching

Front 16

what tissue is damaged with full-thickness (3rd degree burns)

Back 16

1.Complete destruction of epidermis, dermis, & subcutaneous tissues
2. May extend into muscle

Front 17

Full-thickness Burn (3rd degree) is characterized by:

Back 17

1. Tissues are white ischemic, gray, or black appearance
2. Parchment-like, dry leathery surface
3. Escar formation
4. No blanching; poor distal circulation
5. Insensate or little pain (nerve endings ore destroyed)
6. Risk of infection is increased
7. Often significant pain is experienced in the surrounding tissue, but not in the full-thickness area

Front 18

Healing/Scarring of Full-thickness Burn (3rd degree):

Back 18

1. surgical Removal of eschar (escharotomy) & skin grafting are necessary
2. Infection and Hypertrophic scarring (raised scar that stays within the boundaries of the burn wound) & wound contracture
3. Keloid (raised) scar that stays extends beyond the boundaries of the burn wound

Front 19

what is damaged with Subdermal burn?

Back 19

4th degree

-Complete destruction of epidermis, dermis, with involvement of subcutaneous tissues & involves the bone & muscle
-Destruction of vascular system, may lead to additional tissue necrosis

Front 20

Subdermal Burn (4th degree) occurs from what?

Back 20

Prolonged contact with a flame
Electrical burns

Front 21

Subdermal Burn (4th degree) is characterized by what?

Back 21

The skin is :

1. charred,

2. dry in appearance, or

3. mummified

Front 22

Additional complications likely with electrical burns:

Back 22

Ventricular fibrillation
Acute kidney damage
Spinal cord damage

Front 23

Healing/Scarring of 4th degree burns:

Back 23

1. Heals with skin grafting and scarring
2. Requires extensive surgery
3. Amputation may be necessary

4. Muscle paralysis common
5. Results in scar formation (injured tissue is replaced by connective tissue)
Scars are initially red or purple, later become white

Front 24

what is the extent of burned area determined by?

Back 24

% of the body's total surface area that has been burned &

depth of the burned areas

The Rule of Nines is a quick technique to estimate the total burned surface area of adults
The Lund-Browder classification is another system that is often used

Front 25

what are the percentages for the adult Rule of Nine

Back 25

Head and neck: 9 % (ant = 4.5% & post = 4.5%)

Anterior trunk: 18%

Posterior Trunk: 18%

Each arm: 9% (4.5% ant and 4.5% post)

Each leg: 18% (9% ant and 9% post)

Genitals: 1%

Front 26

what is the rule of nine for children?

Back 26

Head and neck: 17 % (ant = 8.5% & post = 8.5%)

Anterior trunk: 18%

Posterior Trunk: 18%

Each arm: 9% (4.5% ant and 4.5% post)

Each leg: 13% (6.5% ant and 6.5% post)

Genitals: 1%

Front 27

what is critical burns considered?

Back 27

10% of body with third-degree burns and 30% or more with second-degree bums
Complications common (e.g., respiratory involvement, smoke inhalation)

Front 28

what is considered moderate burns?

Back 28

Less than 10% with third-degree burns &

15%-30% with second-degree burns

Front 29

what is considered minor burns?

Back 29

Less than 2% with third-degree burns &

15% with second-degree burns

Front 30

what is the leading cause of death in patients with burns?

Back 30

infection

Front 31

what are the pulmonary complications of burns?

Back 31

1. Pneumonia
2. Smoke inhalation: results in pulmonary edema & airway obstruction
3. Restrictive lung disease from burns of the trunk

Front 32

what are metabolic complications of burns?

Back 32

1. Increased metabolic/catabolic activity
2. Leads to weight loss,

3. negative nitro­gen balance,

4. decreased energy stores

Front 33

what are cardiac and circulatory complications of burns?

Back 33

Fluid & plasma loss
-Fluid loss will initially decrease CO, which then gradually increases to normal or above normal levels

Front 34

what is the mechanisms of burn wound healing?

Back 34

Epidermis and dermis will heal by separate mechanisms

Front 35

Epidermal healing is accomplished by what?

Back 35

1. Epithelialization of viable cells that grow, proliferate, and migrate to cover the wound
2. PT should be concerned with protecting and moisturizing the epithelial cells to promote wound healing

Front 36

How does dermal healing occur?

Back 36

-Results in scar formation and follows the 3 phases described previously
If production rate of collagen exceeds breakdown, then hypertrophic or keloid scarring may result

Front 37

what are the purposes of debridement for burns?

Back 37

1. remove dead tissue,

2. prevent infection,

3. promote revascularization and/or reepithelialization of the burn area

Front 38

what is the purpose of topical medications for burns?

Back 38

Antibacterial agents such as nitrofurazone or Furacin, silver sulfadiazine or Silvadene, mafenide acetate or Sulfamylon, Bacitracin, and Neosporin are common agents applied to the wound

Front 39

what are considerations for wound dressings for burns?

Back 39

Secondary dressings are required over the topical agent to prevent bacterial contamination, prevent fluid loss, and protect the wound

Front 40

how is surgery used for burn treatment?

Back 40

-primary reason is the surgical removal of the eschar
-Early excision is:

1. easier on the patient,

2. promotes more rapid healing,

3. reduces infection and scarring,

4. is more economical than repeated debridement

Front 41

Skin grafting is used for what?

Back 41

To close a burn wound at the time of primary excision

Front 42

What is an Allograft (homograft)?

Back 42

-Skin taken from an individual of the same species, usually cadaver skin
-Temporary grafts for large burns, used until autograft is available
-Patient will receive the immunosuppressive drug cyclosporine

Front 43

what is an autograft

Back 43

Use of patient's own skin

Front 44

What is a Xenograft (heterograft)?

Back 44

Use of skin from other species, usually pigskin
Temporary graft

Front 45

What is Split-thickness graft?

Back 45

Contains epidermis and upper layers of dermis from donor site

Front 46

What is Full-thickness graft?

Back 46

Contains epidermis and dermis from donor site

Front 47

What occurs after the grafting procedure?

Back 47

Compression therapy

-Following grafting, the injured part is rested & pressure dressings are applied to reduce graft separation
-Pressure garments (custom pressure garments) are used to help prevent or minimize hypertrophic or keloid scarring

Front 48

When should prevention of contractures begin?

Back 48

day of admission

Front 49

what is the best method to reduce joint contractures

Back 49

institute a program of AROM every 2 hours within 24 hours of hospital admission

-PROM is 2nd best option for reducing contractures

Front 50

Common deformity and position for prevention or correction for anterior neck with burns:

Back 50

POSITION: Flexion
PREVENTION: Stress hyperextension with firm cervical brace

Front 51

Common deformity for shoulder with burns:

Back 51

POSITION: ADD & IR
PREVENTION: ABD & ER with airplane splint

Front 52

Elbow common deformity with burns:

Back 52

POSITION: Flexion & pronation
PREVENTION: extension and supination splint

Front 53

Hand common deformity with burns:

Back 53

POSITION: Claw hand (intrinsic minus position)

flexion & adduction of thumb
PREVENTION:

wrist extension (15°)
MCP flexion (70°)
PIP, and DIP extension
Thumb ABD

Front 54

Hip common deformity with burns:

Back 54

POSITION: Flexion & ADD
PREVENTION: hip extension & ABD

Front 55

Knee common deformity with burns:

Back 55

POSITION: Flexion
PREVENTION: extension, posterior knee splint

Front 56

Ankle common deformity with burns:

Back 56

POSITION:PF
PREVENTION: DF or splinted in neutral with AFO