Burns

Question 1

What kind of burn involves the superficial epidermis, minimal to moderate pain, with healing time of 3-7 days?

Answer 1

Superficial (first degree) burn

Question 2

What kind of burn involves the epidermis and upper dermis layers, significant pain, wet blistering and eythema, with healing time of 1-3 weeks?

Answer 2

Superficial partial-thickness (superficial second degree) burn

Question 3

What kind of burn involves the epidermis and the deep dermis layers, hair follicles, and sweat glands, severe pain to even light touch, erythema, impairment of sensation, high potential of hypertrophic scaring, and healing time of 3-5 weeks?

Answer 3

Deep partial thickness (deep second degree) burn

Question 4

What kind of burn involves the epidermis, dermis, hair follicles, sweat glands and nerve endings, no pain, no sensation to touch, color is pale and non blanching, requires skin graft, potential for hypertrophic scar is very high.

Answer 4

Full thickness (third degree) burn

Question 5

How is a subdermal burn different from a full thickness burn?

Answer 5

• Subdermal burn is beyond that of full thickness now reaching to the underlying tissue such as fat, muscle, and burn.
• significant peripheral nerve damage

Question 6

What is the focus of the EMERGENT phase?

Answer 6

• sustaining life (fluids, temperature regulation)
• controlling infection
• managing pain
• May need escharotomy or fasciotomy to release pressure and prevent compartment syndrome

Question 7

What is the focus of the ACUTE phase?

Answer 7

• Infection control and grafts
• pain management
• nutrition and hydration

Question 8

What OT intervention is expected in the EMERGENT phase?

Answer 8

• Intrinsic plus for hands
• AVOID POSITIONS OF COMFORT (adduction/flexion)
• anti-frog leg, anti-foot drop

Question 9

What OT intervention is expected in the ACUTE phase?

Answer 9

• splinting and positioning in anti-deformity positions
• edema management
• early participation in ADLs
• client and caregiver education

Question 10

Identify position of wrist for a dorsal wrist burn

Answer 10

• wrist in neutral up to 30 degrees extension (never flexion)

Question 11

Identify position of wrist for a volar wrist burn

Answer 11

• wrist in 30-45 degrees of extension

Question 12

When is it appropriate to begin ROM program in a burn patient?

Answer 12

• During the acute phase you can implement ROM as tolerated UNLESS there is exposed tendons or recent grafts then NO A/PROM (must wait 5-7 days).
• post-op begin with AROM and progress to PROM as tolerated once adherence is confirmed

Question 13

What is the limiting factor in burns

Answer 13

PAIN

- Coordinate with nursing to provide therapy 30 mins after pain med administration

Question 14

What must be done if getting a client into a standing or upright position?

Answer 14

must apply compression wrapping to provide adequate vascular support and prevent pooling of fluid and blood in lower extremities.

Question 15

What is the OT focus of treatment immediately after a graft/surgery?

Answer 15

• Immobilization to allow for graft adherence. Follow surgeon, usually between 3-10 days.
• Exercise and movement of uninvolved extremities should be continued.

Question 16

When can a client begin walking after graft surgery?

Answer 16

Not until 5-7 days after grafting in lower extremeties

Question 17

What phase included wound is healed and wound closure is stable? What are the primary OT interventions in this phase?

Answer 17

• Rehabilitation Phase
• Skin conditioning
• Scar management
• Therapeutic exercise/activity, ADLs
• Splinting
• Education to transition home

Question 18

Describe recommendations of skin lubrication in burn patients

Answer 18

• should be performed several times a day

- should be performed before any exercise or activity to prevent shearing forces and overstretching

Question 19

Describe how to structure exercise plan in burn client during rehab phase

Answer 19

• progressively graded to regain strength and activity tolerance
• taught to perform skin lubrication and massage as pretreatment before exercise
• daily stretching, resistive exercise, and activity to tolerance

Question 20

Describe splinting in burn client during rehab phase

Answer 20

• dynamic splint or serial casting to reverse disabling or disfiguring contractures
• continue anticontracture positioning

Question 21

How long does it take for scar maturation?

Answer 21

1-2 years

Question 22

Identify precautions for a dorsal hand burn

Answer 22

• Maintain boutonniere precautions
• avoid having the client form active or passive composite flexion of the fingers during eval and intervention
• integrity of extensor hood should be performed before composite flexion is allowed to prevent rupture

Question 23

When would you expect sensory impairment in a burn client?

Answer 23

• any burns deeper than a deep partial thickness burn
• sensory testing and peripheral nerve testing can begin as soon as the wounds are closed
• for electrical burns, a gross sensory screening should be performed on involved limbs

Question 24

Describe heterotopic ossification

Answer 24

• the formation of bones in abnormal areas such as in soft tissue around the joint
• more common near elbow, knee, hip, and shoulder
• rapid loss of ROM, pain is localized and severe
• hard end feel during PROM
• if confirmed, discontinue passive and encourage frequent AROM w/i pain free range