Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
59 Cards in this Set
- Front
- Back
|
Demographics of Burns.
Most common: Sex, Years of Age, and where burns occur. |
Males are more likely than female
The ages of 0-2 and 20-40 are most common Most burn injuries happen in the home |
|
|
OT Rehabilitation for burns encompasses
|
Evaluation, Assessment, wound care, prevention of contractures, positioning & splinting, ROM, Edema Control, Patient education, strengthening , ADL training, scar management, endurance & coordination
|
|
|
Evaluation/Assessment of Burns include
|
Method of Injury, Time since injury, TBSA, Location, Depth, wound status, age, PMH, Prior level of function, contracture risk, ROM, mobility, strength, function levels, family support, coping skills, home environment, discharge plan
|
|
|
Goals and outcomes for OT
*documentation practice |
Enhance wound healing, decrease risk of infection, Full ROM, Good strength, increase cardiovascular activity, minimize scaring, individual ADLs and ambulation, self management, Increase patient and family goals and outcomes through education.
|
|
|
What are the Functions of Normal Skin
|
Protection, Sensory Feedback, Thermoregulation, Identity, fluid control, selective barrier
|
|
|
Burns are classified by severity using
|
Depth, %TBSA, Age, Locations, complications, PMH, emotional state/coping skills, temperature of exposure, Duration of exposure
|
|
|
Indicators of severity
|
Blanching, Pain to touch (good), hair, and texture of burn
|
|
|
Superficial Burn
|
First Degree
Dry, no blisters Epidermis only 3-7 days to heal may result in pigment changes |
|
|
Superficial Partial Thickness
|
Second Degree Burn
Minor if less than %15 in adults Mostly caused by scald or short exposure Red, blanching with pressure blistering and very painful Epidermis and top part of dermis 7-21, no grafting, no/minimal scarring |
|
|
Deep Partial Thickness
|
Third Degree Burn/Second Degree
Under 20% moderate, More than 20% sever Caused by immersion, scald, flame Would thick blisters or firm texture Mottled patchy, cherry red Very painful Epidermis, papillary and reticulum Scaring, pigmentation changes |
|
|
Full Thickness Burn
|
Fourth Degree Burn
Severe if over 10% TBSA Chem, Electric, flame, scald Color is charred, waxy, dark No blanching No pain Completely through dermis to subcutaneous Will produce scar |
|
|
STSG
|
Split thickness skin graft that is harvested from the same person that it's applied. Includes epidermis and any portion of dermis. Important to have good ROM before graft
Mesh-perforated or Sheet Graft - no holes |
|
|
Skin graft protocol post op
|
Do not disturb for 4-5 days.
Dressing changes with non adherent gauze 3-5 days. Gentle ROM with doctors orders only on 7 days or sooner. Compromised with shearing forces. |
|
|
FTSG
|
Full thickness skin graft.
Includes epidermis and entire dermis. Allows for more durable coverage and sensation. Often used in palm burns. |
|
|
Flaps
|
May include muscle and blood supply.
Tram Flap: When they use skin next to burn in order for it to grow over. Keeps wound open longer, higher risk for infection. |
|
|
Post Op Treatment
|
if ROM before 5 days.
REMOVE DRESSING If dressing is stuck to the wound, wet dressing. |
|
|
Shearing Forces
|
Removal of skin graft by aggressive removal of dressing. Any slip or rub can cause harm.
Important to check splints for sites of pressure and shifting. Wrap splint with gauze not straps. Compression wraps are not applied till 2 weeks |
|
|
Global Edema
|
Dramatic fluid shift and global edema from overall trauma to the area.
|
|
|
Common Causes of Burns in Children
|
Scalds, hot objects, Fireworks, Gasoline, Cigarettes.
|
|
|
Age effects on burn injury
|
Kids have the ability to cool, ability for organs to accommodate to change, and a better healing capacity.
|
|
|
Contracture Prevention
|
Positioning
Minimize edema Prevent tissue destruction Maintain soft tissue in an elongated position Influence scar formation & management Increase active movement Splints Patient & Family education |
|
|
Areas at high risk for contractures
|
Neck
Axilla Hand |
|
|
Anterior Neck Burns
|
No Pillows Under Head
Frequent Cervical ROM Cervical collar or spint |
|
|
Axillary Burns
|
POSITIONING
Airplane splint Checking skin frequently Sensation changes ROM Patient Education |
|
|
Hand Burns -Dorsal
|
Protect extensor tendons
Prophylactic splinting - Intrinsic Plus Splint wristextension 0-30°,MCP flexion 70-90°, Full IPextension. (Coke Can) Careful PROM Sheet Graft NO FULL FIST |
|
|
Splints are used in burns too:
|
Maintain ROM
Prevent Contractual Protect at Joint Poor patient compliance |
|
|
How often should ROM be performed?
|
HOURLY
|
|
|
How do you tell a superficial partial thickness from a superficial?
|
The blistering
|
|
|
What is a subdermal burn?
|
Full thickness burn below the dermis that can include bone, nerve, and muscle. Caused from a long duration burn, or electrical
|
|
|
4 surgical interventions that occur with burns
|
STSG
FTSC Meshed Graft Sheet Graft Estcorotomy- insision to epidermis to allow for more room. Fasciotmy- opening of muscle fascia to help with compartment syndrome |
|
|
What is sepsis?
|
Very bad infection, purulent, red, swollen, increase in temperature, patient feels sick, increase in blood pressure.
|
|
|
How to get a clean environment?
|
Everything used is packaged, protective clothing, changing gloves, using cleaning materials, putting their hair up, hands washed
|
|
|
Temporary Levels of compression
|
Dressing for wounds, splints, and coban
|
|
|
Permanent compression
|
Compression garment, jobst, elastogel
|
|
|
How to loose a graft
|
sheer forces, wound vac, fluid build up
|
|
|
Chest and abdomen splint
|
Keep them supine & fully extended, maybe putroll under spine, Don’t sit them up for a long time
|
|
|
Volar Hand burn splint
|
Extend wrist and abduct fingers (hand out like tohigh five)
|
|
|
Scar Management
|
Moist Environment is best for dressing choice.
Compressive dressing Jobst Isotoner gloves Splinting Massage Vibration |
|
|
Hypertophic Scars
|
Thick, Red, Rigid
Respond to increased moisture & compression May receed More common in children, less in old |
|
|
Keloid Scars
|
Do not stay in boundries
Edema control AROM Prevent tendon adherence, joint contracture Education |
|
|
Patient Scenario: A35 year-old male sustained a full thickness tar burn to his right upperextremity while working on a roof. Hepresents today to the ED.
|
TherapyIntervention–Viewwounds during dressing change–Initiategentle isolated ROM–Initiatepositioning and/or splinting program–Beginpatient/family education
|
|
|
Patient Scenario: Patientwas taken to the OR for STSG – it is now POD 5 with good graft adherence
|
TherapyIntervention•MDcleared pt forROM•InitiateAROM and gentle PROM – issue HEP•AssessROM and splinting necessity•Wrapdonor site LE with elastic bandage toes→groinprior to OOB activity•Providepatient/family education
|
|
|
Trans vs. Disarticulation
|
Trans: Amputation across axis of long bone
Disarticulation: Through the center of a joint |
|
|
Partial Amputation
|
Amputation distal to the wrist
|
|
|
Forequarter Amputation
|
Amputation at the scapul-thoraic sternoclavicular joint.
|
|
|
Major concept to consider after amputation
|
Pressure points, and ulcers
|
|
|
What does skin breakdown look like?
|
Like a blister from a new pair of shoes: first red, then open wound
|
|
|
What is phantom Limb Pain?
How can it be treated? |
Pain in the area of amputation that can possibly lead to complex regional pain syndrome.
Interferes with daily life. Treatment is medication, desensitization, massage, mirror therapy, pressure, ultrasound, TENS. |
|
|
What is phantom sensation?
|
The ability to feel like lost limb is there
somewhat of an annoyance |
|
|
What is the distal part of the prosthesis called?
|
Terminal device, voluntary or non voluntary opening
|
|
|
Describe a prosthetic sock
|
U shaped sock, no seem of sock against body. Used to help shape the limb and with edema
|
|
|
Trans-humeral prosthesis:
How much distance from the elbow do you need for a residual limb? |
2 inches or more.
|
|
|
For some cable devices the harness gets under the axilla, what are some conerns?
|
Rubbing, axillary nerve palsy, wasting, inability to adduct.
|
|
|
3 things to use to shape a residual limb
|
Ace bandage
Wrapping of figure of 8 Tubular bandage Shrinker sock |
|
|
What method do you use to wrap a residual limb?
|
Figure of 8
|
|
|
Recent skin graph on amputation, when can you start ROM?
|
3-5 days. when a doctor says.
|
|
|
how long should am amputee initially wear aprosthesis?
|
15 mins to start, 30 mins a day. then increase by 30 mins.
|
|
|
New prosthetic arm- trying to cut a steak. Do you hold the knife inthe good arm, or bad
|
You hold fork with prosthesis, you cut steak with good hand.
|
|
|
Pre Op - OT
|
Patient Education
Psychological counseling Amputee peer counseling Maintain ROM for all joints Pain Control Shaping the wound |
