disease ch 3 burns

dermis


composed of fibrous connective tissue

• includes collagen
• elastin
• capillaries
• llymphatic
• nerve endings

epidermis

• outermost layer that contains nail beds
• hair follicles
• sweat glands
• sebaceous glands

• environmental barrier that protects against UV rays
• chemical contamination
• bacterial invasion
• moisture
• barrier
• temperature regulation
• influences individuals bodoy image, personal identity
• enhances nonverbal social interaction

• thermal(most common)
• usually results of residential fires,
• motor vehicle accidents
• child playing w/ matches
• improperly stored gasoline
• space heater/electrical malfunctions

chemical

• result with contact
• ingestion
• inhalation
• injection of acid or alkalis which causes necrosis and extend the burn slowly over a period of time

• electrical after contact with faulty wiring
• high-voltage power lines-due to generation of high heat(9032 degrees f)

with electric current, the affect of the skin and tissue underneath the point of contact occurs immediately

can be any size or depth

sunburn or friction burn due to skin rubbing against a course surface

1-2 million people suffer from burns annyally in the US

globally 6 million people are affected by burns

1.25 million per year in te US, in which 51,000 require hospitalization

5500 die despite advances in burn care

a fatal permanently disfiguring and incapacitating injury (emotionally and physically)

1. superficial(1st degree) sunburn

• limited to epidermis
• causing erythema and pain

2. partial-thickness(2nd degree) blisters

• epidermis and part of the dermis are damaged
• produces blisters and mild to moderate edema and pain

3. full-thickness(3rd degree)black/tarey

• epidermis and dermis are damaged
• no blisters, brown/white/black leathery tissue and thrombosed vessels are visible

require surgical intervention such as skin grafts or wound closure

4. subdermal(4th degree) down to the bone

damage extends through deeply charred subcutaneous tissue to muscle and bone

• requires surgical intervenetion for wound closure
• amputation
• reconstruction

red, very sensitive to touch and usually moist

will blanch when touched

no blisters

produces blisters

base of blisters may have erythematous or whitish with fibrous exudate

sensitive to touch

blanches with pressure

do not produce blisters

skin surgace is white and pliable or black

charred and leathery or bright red because of hemoglobin

pale 3rd degree burns can be mistaken for normal skin although it does not blanch with pressure

all soft tissue, including muscle has been burned

bone may be seen

small

15%

moderate

15-49

large

50-69

massive

>70

location

• face
• hands
• feet
• genitals are the most serious due to functional loss

configuration

circumferential burns can cause total occlusion of circulation

history

• of other medical problems:
• diabetes
• peripheral vascular disease
• chronic alcohol abuse

patient age

younger than 4 and over 60 have higher incidence of complications and higher mortality

smoke inhalation can cause pulmonary complications

other injuries

• sustained with the burns:
• falls
• open wounds
• deformity from explosions

• long and arduous process and should focus on:
• pain free motion
• functional recovery
• qualaity of life
• survival

based on %(%TBSA)

rule of 9/lund browder chart

• 9% head/neck
• 4.5% LUE
• 4.5% RUE
• 9% LLE
• 9% RLE
• 18% trunk(9% F/9%BK)
• 1% perineum

14%

• survival
• sterile conditions to decrease infection
• airway
• breathing
• circulation
• controlling bleeding
• maintaining body temperature
• edema control
• nutrition
• hydotherapy
• surgical(grafts/wound closure)
• vacuum assisted closure
• pain management

1. inflammatory phase:

• lasts 3-10 days
• vascular and cellular response to wound to attack bacteria
• debride wound and initiate healing process
• wound in painful, war, red, anddevelops edema

2. proliferation phase

begins on the 3rd day after wound and lasts until healed

• revascularization
• reepithelialization
• contraction of burn takes place

wound is red, raised, rigid and scar forms

strength of scar is poor

3. maturation phase

begins on the 3rd week and can last upto 2+ years afer injury or last constructive surgery

• the fibroblasts leave and collagen remodeling takes place
• reddening fades
• scar softens and flattens
• strength of scar is 80%

l

1. hypertrophic

thick, rigid, erythematous scars that becomes apparent 6-8 weeks after wound closure

2. keloid

• large
• irregular-shaped scar caused by excessive collagen formation

adherent dead tissue that forms on skin with deep partial or full thickness burns

• surgery will decrease pain
• scar formation
• contractures

surgical transplantation of the person's own skin froman unburned area

• alternatives to autografts
• skin is taken from cadavers

deep wounds involving tendons or graft adherence is extremely doubtful

surgically placed due to large areas

• influenced by burn depth
• location
• patient age
• gender
• ethnicity
• education
• occupation
• history of drug or alcohol abuse
• psychiatric illnes

• long acting marcotics
• procedural pain(dressing changes, therapy,wound cleaning)
• anziety medications

45 minutres after taking meds to increase effectiveness

• patients who lay in a flexed,
• adducted and
• fetal positioning(position of withdrawal of withdrawal from pain)

• tissue
• tendons
• ligaments
• blood vessels
• nerves
• calcium deposits surrounding the involved joints

psychiatric factors

• depression
• withdrawal reaction to disfigurement
• regression
• anxiety

• self-care
• productivity
• leisure
• sensorimotor
• cognitive

• psychosocial due to:
• quarding positions of flexion and abduction
• loss of ability to work
• ROM
• weakness
• disuse
• pain
• contractures
• deformities dependingon area burned
• deconditioning due to bed rest/immobility/multi surgery recoveries
• metabolic disorders
• sensory regulation loss-tactile
• proprioceptive
• temperature
• pressure sense
• fear
• anger
• hostility
• depression
• loss of self-esteem

• cognition/reorientation
• psychologicalsupport due to grief, depression and disfigurement
• reducing edema
• ROM
• strengthening
• activity tolerance
• ADL's
• patient and caregiver education
• splinting to preserve grafts
• positioning to support post-op orders
• adaptive techniques
• contracture reducing
• scar management
• mobility
• skin conditioning
• compression therapy
• community modification
• adaptive equipment
• social skills