burns

Question 1

transparent film dressing

Answer 1

• semi-occlusive
• primary or secondary dressing
• reduces infection risk
• creates moist healing environment

Question 2

hydrogel sheet dressing

Answer 2

• hydrates wound
• keeps bacteria out
• promotes autolytic debridement

Question 3

alginate dressing

Answer 3

• primary wound care dressing
• can absorb large quantities of exudate

Question 4

autolytic debridement

Answer 4

• body’s own enzymes break down nonviable tissue
• hydrogel sheet dressing to promote

Question 5

mechanical debridement

Answer 5

• hydrotherapy
• wet-to-dry dressings
• wound irrigation followed by suction

Question 6

autograft

Answer 6

transplanting someone’s own skin from unburned area to burned area

Question 7

split-thickness graft

Answer 7

full epidermal & partial dermal layers & a % of fat layers from donor site
- graft survival is high

Question 8

full thickness graft

Answer 8

• full thickness of epidermal & dermal layers & % of fat layers from donor site
• graft survival is less
• outcome better if graft adherence occurs

Question 9

meshed graft

Answer 9

stretched to cover greater surface area

Question 10

sheet graft

Answer 10

donor graft laid down as is

Question 11

how is edema measured with a burn?

Answer 11

circumferential measurements (no volumeter)

Question 12

when is scar management completed after a burn?

Answer 12

6-12 weeks after wound closure

Question 13

when is the emergent phase of a burn?

Answer 13

0-72 hours after

Question 14

xenografts

Answer 14

biologic dressing
- bovine skin, processed pig skin to protect skin from infection, debride, comfort during emergent phase

Question 15

allograft

Answer 15

human cadaver skin
-protect skin from infection, debride, comfort during emergent phase

Question 16

superficial/epidermal burn

Answer 16

1st degree
- superficial epidermis
- PAIN: min to mod
- BLISTERING: none
- min erytheme (redness)
- HEALING TIME: 3-7 days

Question 17

superficial partial thickness burn

Answer 17

superficial 2nd degree
- epidermis & dermis
- PAIN: significant
- BLISTERING: wet
- erytheme
- HEALING TIME: 1-3 weeks

Question 18

deep partial thickness burn

Answer 18

deep 2nd degree
- epidermis, deep dermis, hair follicles, sweat glands
- PAIN: severe, even to light touch
- erythema, with or without blisters
- high risk of turning into full thickness burn due to infection
- consider grafting to prevent infection
- SENSATION: highly impaired
- high potential for hypertropic scar
- HEALING TIME: 3-5 weeks (varies)

Question 19

full thickness burn

Answer 19

3rd degree
- epidermis, dermis, hair follicles, sweat glands, nerve endings
- PAIN: none
- SENSATION: none, even to light touch
- burn is pale, non blanching
- requires skin graft
- very high potential for hypertrophic scar

Question 20

subdermal burn

Answer 20

• full thickness burn with damage to underlying tissue (fat, muscle, bone)
• charring, exposed fat, tendons, muscles
• electrical burn = nerve pathway destruction
• significant peripheral nerve damage
• surgical intervention for wound closure or amputation
• extremely high potential for hypertrophic scar

Question 21

which burn phase includes charring?

Answer 21

subdermal burn

Question 22

what burn phase has no pain?

Answer 22

full thickness/3rd degree

Question 23

during what burn phase are skin grafts required?

Answer 23

full thickness/3rd degree

Question 24

what types of precautions are necessary during the emergent phase of burn?

Answer 24

0-72 hrs after burn
- universal precautions for staff/family

Question 25

what pharmacological treatment is used during the emergent phase to manage pain?

Answer 25

narcotic analgesics

Question 26

escharotomy & debridement

Answer 26

removing burnt/dead skin, allowing new vascularized skin to close up wound

Question 27

how long does the acute phase of burn last?

Answer 27

72 hrs after injury to wound closure (days or months later)

Question 28

basic first aid for a 1st degree burn

Answer 28

1. immediately immerse in cool water/cool compress 2. apply sterile dressing to cover area

Question 29

protocol for dorsal hand burns

Answer 29

- Boutonniere precaution - avoid active or passive composite flexion (ROM to MP with IP straight, ROM to IP with MP & DIP straight, confirm extensor hood integrity before composite flexion allowed)

Question 30

ROM protocol for burn areas

Answer 30

gentle AROM/PROM early as possible except for post graft (wait until graft has adhered before AROM initated)

Question 31

what should be done for LEs before standing, walking, prolonged sitting are attempted after a burn?

Answer 31

compression wrapping for vascular support beforehand to avoid pooling of fluid/blood in LEs

Question 32

protocol following skin graft

Answer 32

1. splint hand in safe position for 5-7 days to allow graft to take & wounds to heal (prevent deformity) 2. AROM/PROM when graft has fully adhered

Question 33

how long is hand in safe position after skin graft?

Answer 33

5-7 days

Question 34

during which type of burn protocol is gross sensory screening completed?

Answer 34

electrical burns due to peripheral nerve involvement

Question 35

scar management protocol after a burn

Answer 35

- mobilization orthosis (sub max stretch) - massage (manual, graded vibration) - compression (gloves, tubular gloves) - desensitization (graded touching, textures) - ROM (active, passive) - thermal modalities (ultrasound, moist heat)

Question 36

which modalities should be applied in scar management protocol after a burn?

Answer 36

ultrasound, moist heat

Question 37

pruritus

Answer 37

persistent itching, can lead to reopening of wound & skin maceration - tx: compression garments, skin lubrication, cold packs, antihistamines

Question 38

edema management during acute phase of burn

Answer 38

elevate, AROM (if movement allowed), wrap with elastic bandage unless bulky wound dressing is used

Question 39

Splinting with hand burns

Answer 39

- Splint opposite if burn is on volar side of hand (will develop contracture if not) - if burn is on dorsal side of hand, put it into extension as well (splint on same side)- makes client more functional - want position of discomfort

Question 40

Intrinsic plus

Answer 40

Safe position/antideformity/clam digger position - MCPs in 70-90 degrees flexion - IPs in 0 degrees extension