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MED/SURGE: LAST UNIT ON BURNS/WOUND CARE

Terms in this set (92)

what type of electrical current often penetrates skin and therefore damages the skin?
alternating current
What type of electrical current typically causes DTI?
high voltage
What type of burns continue to burn until deactivated?
chemical
What type of burn is dry, bright red, or pink that blanches under pressure?
first degree
will there be edema or blisters with first degree?
no
How long does it take for first degree burns to resolve?
3-5 days
moist, weeping, with possible blistering burns with local erythema and edema and immediate capillary refill are classified as:
second degree
how long does it take for superficial second degree burns to heal?
10-14 days
What is the differentiating factor for 2nd superficial and deep burns?
sluggish capillary refill
White eschar may be present in what level of burns ?
deep 2nd + >
What is the healing time of deep 2nd degree burns?
3+ weeks
adipose tissue exposed and insensate burn areas may be involved in what degree of burn?
3rd
What level of burn exposes deep tissues and will not heal without surgery?
4th
the Lund-Browder burn assessment is great for children < __ y.o.
16
A burn which is <2% full thickness in adults is considered:
minor
A burn which is <10% partial thickness in adults is considered:
minor
A burn which is <1 % FT in children is considered:
minor
a burn that is <5% PT in children is considered:
minor
a burn that is 2-5% FT in adults is considered:
moderate
a burn that is 10-20% PT in adults is considered:
moderate
A burn that is 1-5% FT in children is considered:
moderate
A burn that is 5-10% PT in children is considered:
moderate
A burn that is >5% FT in adults is considered:
major
A burn that is >20% PT in adults is considered:
major
A burn that is >5% FT in children is considered:
major
A burn that is >10% in children is considered:
major
What would a score of 13% PT be classified as in both children and adults?
adults: moderate
children: major
massive fluid shift causing hypovolemia and edema
burn shock
> ___% total body burns are at high risk for burn shock
50
Decreased body mass after a burn is common d/t:
increased basal metabolic rate and increased fat catabolism
Debride and clean a wound ___-___ times a day
1-2
Burn wounds should be ___ as to not be exposed to infection
covered
Zone of a burn that is central with irreparable damage, characterized by coagulation, ischemia, and necrosis.
zone of coagulation
zone of a burn that is the area of cellular injury and compromise that may convert to a ZOC if necrosis widens or deepens.
zone of stasis
zone of a burn that is of minimal cellular injury and surrounds the zone of stasis
zone of hyperemia
In what phase of PT would you focus on wound care, positioning, initiate mobility, controlling edema, splinting, and AROM?
acute phase/subacute (inflammatory)
in what phase of PT would you provide wound care, gait training, exercise, modalities, and compression?
immediate phase (proliferative)
In what phase of PT would you provide compression, scar massage, exercise, modalities, soft tissue mobilization, and vocational rehab?
late phase (remodeling)
How often should you cleanse topical agents from a burn wound?
with every dressing change
open and close ___ so that they do not impede the healing process
blisters
____ ____ agents should be covered with a non-adherent impregnanted gauze and bulky gauze dressing with short-stretch compression.
topical antimicrobial
Do ROM while dressings are (on/off) to achieve full ROM
off
Fingers should be wrapped:
individually
How should the neck be positioned to avoid contracture?
neutral
how should the shoulders be positioned to avoid contracture?
ABD, FLEX to 90
How should the elbows be positioned in order to prevent contracture?
extended
how should the wrists/hands be positioned to avoid contracture?
intrinsic plus
how should the hips be positioned to avoid contracture?
ABD/neutral ROT/no flex
how should the ankle be positioned to avoid contraction?
neut ROT/ slight DF
ROM should be performed multiple times a day except over areas of:
grafting
Wrap the LE to prevent ___ ___ in the dependent positions
venous pooling
What procedure must be done to ensure proper wound healing and graft acceptance?
debridement
When should a graft be considered?
not expected to heal in 3 weeks
What type of split thickness skin graft heals rapidly and has the highest survival rate, but has poor cosmesis?
mesh
What type of split thickness graft is more cosmetic but has a lower graft survival?
sheet
What type of dressing is the most cosmetic with minimal secondary contraction and is the most resistant to trauma, but has the lowest graft survival and the donor site will need covering (so you create a second wound)?
full thickness
What type of graft requires more time to heal?
full thickness
What type of grafts can serve as a temporary covering due to rejection, but are also very expensive?
xeno graft or cadaver
a temporary bilayered __ ___ is a layer of silicone and porcine-based dermal layer
skin substitute
What is a very expensive graft that is cultured in a lab?
cultured epithelial autograft
How long is a patient typically immobilized after a graft?
3-5 days
no ROM of __ crossed by graft until cleared by the MD
joint
elastic ___ before ambulation should be applied after a graft or when going into a dependent positioning.
compression
use an ___ if a skin graft crosses an ankle or knee joint
orthosis
a scar does not distend when skin grows and this presents a problem for:
children
a scar ___ may be needed around joints to accomodate for growth (such as growing breasts after puberty on a female child burn victim)
release
what scale rates the aspects of scarring on pliability, height, vascularity, and pigmentation for 0-14 with a lower score being less severe?
vancouver scar scale
when massaging a scar tissue, apply enough pressure to ___ the scar
blanch
start gently with a scar massage and progress to deep tissue or friction massage to realign ___
collagen
how often should you preform scar massage and for how long?
3-6 times daily for 5-10 min
What modalities can be used for wound cleansing in the inflammatory/proliferation phase of healing?
whirlpool/hand-held hose/shower
What modalities can be used for ROM/scar pliability in the maturation phase of burn healing?
therapeutic heat, paraffin, ultrasound
With what degree of burns is functional mobility lost and scarring most likely?
superficial partial thickness and greater
should the forearm be supinated or pronated for contracture prevention?
supinated
should the shoulder be flexed or extended for contracture prevention?
flexed
how should the hip be positioned for contracture prevention?
extension, abduction, neutral ROT
___ burns heal quickly due to increased vasculature but also scar frequently because of thin skin
face
___ is common in maturing scar tissue d/t deficiency of skin oils resulting in a dry surface
pruritis
the ___ may cause a scar to be permanently hyperpigmented
sun
If a burn heals within 14 days spontaneously without pigment change, what kind of garments should you use?
no garment
if a burn heals within 10-14 days and is on dark colored skin, will you need compression?
maybe
if a burn heals between 14-21 days on any ethnicity, will you need compression?
maybe
if a burn heals in more than 21 days, will you need compression?
yes
external compression approximates ___ pressure
capillary
you need at least ____ mmHG of compression for histological/clinical significance
25
you should initiate compression within ___-___ months post burn for best results but should be applied as soon as possible following wound closure
3-6
how long should you wear compression?
23 hours/day, 6 mo-2years
when hypertrophic scar is no longer red, raised, or rigid or no further progress is made, discontinue ____.
compression
hard clear plastic mask molded to the facial features of a patient to apply a more uniform pressure over the face than a fabric mask, and can be lined with silicone or gel sheets for comfort or better fit
transparent face mask
passive stretching and active exercise should be performed for how long in an inpatient setting?
30-60 min
acutely, prevent the heart rate from exceeding __- bpm above the patient's resting
20
extubation within __ hours of treatment is a contraindication to exercise
8
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