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53 Cards in this Set
- Front
- Back
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epidermis
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Top layer of the skin
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dermis |
*hold most of the "organs" of the skin |
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edematous |
An accumulation of an excessive amount of watery fluid in cells, tissues, or body cavities. |
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exudate
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a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation |
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hypertrophic scar
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a cutaneous condition characterized by excess scar tissue, hypertrophic scars occur when he body overproduces collagen, which causes the scar to be raised above the surrounding skin; these scars take the form of a red raised lump on the skin
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full thickness burns
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burn injury that destroys the entire epidermal and dermal layers of the skin and extends down into subcutaneous fat |
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partial thickness burn
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burn injury which involves part or all of the epidermis. referred to as second-degree burn |
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layers of the skin
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-dermis -subcutaneous fat |
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skin functions |
-prevents loss of bodily fluids -controls boy temperature -sensory organ -excretory organ -produces vitamin D -influences body image |
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burns result in how many deaths yearly?
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10-20 thousand |
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best age to survive burns? |
*children, elderly, and diabetics have less of a chance of survival |
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survival best burns cover less that ___% of TBSA (total body surface area)
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20
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severity of a burn is determined by?
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-size |
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classification of burns |
-age of patient -health (past medical history) -injury source -part of body burned (head vs. chest) |
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what is used to estimate the size of the burn?
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*the patient's own palm is about 1% of his surface area |
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Rule of nines |
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depth of burns
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-partial thickness burns superficial vs deep -full thickness |
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superficial burn
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*1st degree -ex: sunburn -slight pain, edema, redness ( ) -wound is dry and doesn't form blisters |
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partial thickness burn superficial vs deep |
involves dermis *2nd degree -painful & edematous -blistering (deep) and sensitive to pin prick -don't be in a hurry to break blisters; they provide biological dressing and comfort -once blisters break those spots will be very painful -CAN heal spontaneously (superficial deep can NOT) -deep heal within 14-21 days *difference: dependent on how far into dermal layer |
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full thickness |
*3rd degree -spontaneous healing is NOT possible -dry (leather), unblistered, multi colored and charred -PAIN FREE |
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systemic response
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-metabolic: basal metabolic rate increased threefold -immunological: reduced immune response -cardiovascular: reduced myocardial contractility, increased capillary permeability, peripheral and splanchnic vasoconstriction |
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types of burns
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-chemical -electrical -radiation |
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thermal burn |
-three types |
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chemical burn
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*exposure to acid, alkali or organic substances |
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electrical burn
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-extent of injury depends on the type of current, the pathway of flow, local tissue resistance, and duration of contact |
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radiation burn
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-results from radiant energy being transferred to the body resulting in production of cellular toxins |
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at 7 days after a burn the burn should produce?
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exudate |
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burns to hands and feet |
-splint in functional position by night -keep elevated to reduce swelling |
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hands and burns
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-or if splinted for long period of time due to damaged tissue |
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hands and feet dressing |
-leave tips of fingers exposed -keep limb elevated |
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(positioning info with/without splints) neck |
-no pillows & mouth of patient should be closed |
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(positioning info with/without splints) shoulder |
-arms abducted to 60-90 degrees with slight IR |
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elbow |
-should be ranged w/ex daily and/or activity during day |
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wrist |
-30 degrees of extension |
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MCP's |
-PIP & DIP in full extension -thumb abducted and extended to maintain web |
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(positioning info with/without splints) hips |
-whether prone or supine-neutral extended position; legs abducted 15 degrees from midline |
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(positioning info with/without splints) knee |
-full extension |
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ankle |
- 90 degrees prevents from shortening of Achilles tendon |
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scar formation is an _______ process for the burn patient? |
ongoing |
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scars are dynamic and will? |
continue to grow and change through the maturation process for approximately eighteen months post injury |
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scars develop due to?
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excessive amounts of collagen production seen during the healing process |
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techniques for scar management
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-preserve ROM -splinting/positioning -protect underlying vulnerable structures -increase ROM/function -prolonged stretch -apply pressure to scar area which promotes collagen remodeling -scar massage |
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(scar management garments) tubigrip pressure garments |
-cotton bandage w/ circumferential elastic material -used as interim pressure while jobst (brand name) being ordered, patients should have two sets to rotate; hand wash |
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(scar management garments) jobst pressure gradient burn |
-measured by trained individual -worn as soon as wound is closed, worn 24/hr |
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(scar management) silastic elastomer (rubber) |
-elastomer produces soft tissue in detail while providing uniform pressure under splints and pressure garments *reduces hypertrophic scarring |
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(scar management) elastogel |
-soft protective, absorbent hydrogel that provides excellent protection ageist pressure and friction |
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early mobilization
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benefits of early mobilization
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-aided in prevention of DVT/PE -promotes functional independence -promotes overall well-being for patients -decreases time in ICU setting -takes a multidisciplinary approach -included nursing staff- allows for out of bed multiple times/days -discussion with physicians/PAs barriers to mobilization (pain control, sedation) |
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barriers to mobilization
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-good communication with nursing staff -pre-medication prior to therapy session -increases patient tolerance -achieve benefits of session -patient/therapists rapport (children) |
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medical complications
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-resp status- too tenuous for mobilization -vitals |
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cognitive impairments
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-patient and family cooperation -previous psychological involvement -fear -understanding of goals |
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proper positioning
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-burn wound healing begins as soon as injury occurs= need for early intervention -patients will rest in a position that creates least amount of pain (position of comfort= position of contracture) -importance of patient and family education -need to have continuity across all disciplines to ensure effectiveness of treatment (importance of communication (through documentation)) |
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role of OT
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2. treatment in both acute & outpatient (initiated day one and continues until healing) 3. ROM & stretching- passive/active 4. positioning 1. splinting: to prevent contractures, increase ROM and assist in scar management 5. edema control 6. patient family education 7.adaptive equipment needs 8.strengthening when indicated mobility before strengthening 9. fine motor control 10. desensitization- mediating CNS (tactile input) 11. ADL's initiation & completion |
