disease ch 3 burns

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disease ch 3 burns
2012-01-26 12:01:02
disease burns

disease ch 3 burns
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  1. skin
    2 layers

    composed of fibrous connective tissue

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


    • outermost layer that contains nail beds
    • hair follicles
    • sweat glands
    • sebaceous glands
  2. skin is the largest organ of the body
  3. purpose of skin
    • 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
  4. skin
    • thermal(most common)
    • usually results of residential fires,
    • motor vehicle accidents
    • child playing w/ matches
    • improperly stored gasoline
    • space heater/electrical malfunctions


    • 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
  5. skin
    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)
  6. burns
    4 degrees
    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
  7. 1st degree burn
    red, very sensitive to touch and usually moist

    will blanch when touched

    no blisters
  8. 2nd degree burn
    produces blisters

    base of blisters may have erythematous or whitish with fibrous exudate

    sensitive to touch

    blanches with pressure
  9. 3rd degree burn
    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
  10. 4th degree burn
    all soft tissue, including muscle has been burned

    bone may be seen
  11. severity is measured by % of total body surface burned







  12. keys to assessing burns

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


    circumferential burns can cause total occlusion of circulation


    • 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
  13. burn recovery
    • long and arduous process and should focus on:
    • pain free motion
    • functional recovery
    • qualaity of life
    • survival
  14. severity/assessment of burns
    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
  15. average %TBSA(total burn site area) on admission
  16. treatment
    • 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
  17. wounds and scars
    wound healing: 3 stages
    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%

  18. scar formation
    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
  19. eschar
    adherent dead tissue that forms on skin with deep partial or full thickness burns
  20. skin grafting
    • surgery will decrease pain
    • scar formation
    • contractures
  21. autograft
    surgical transplantation of the person's own skin froman unburned area
  22. cultured epidermal autograft(CEA)
    • alternatives to autografts
    • skin is taken from cadavers
  23. microvascular skin flap
    deep wounds involving tendons or graft adherence is extremely doubtful

    surgically placed due to large areas
  24. pain(difficult to predict)
    • influenced by burn depth
    • location
    • patient age
    • gender
    • ethnicity
    • education
    • occupation
    • history of drug or alcohol abuse
    • psychiatric illnes
  25. pain protocol includes:
    • long acting marcotics
    • procedural pain(dressing changes, therapy,wound cleaning)
    • anziety medications
  26. schedule therapy sessions
    45 minutres after taking meds to increase effectiveness
  27. contracture development
    wounds heal by contracture
    • patients who lay in a flexed,
    • adducted and
    • fetal positioning(position of withdrawal of withdrawal from pain)
  28. contracture limits joint ROM by shortening
    • tissue
    • tendons
    • ligaments
    • blood vessels
    • nerves
    • calcium deposits surrounding the involved joints
  29. how burns affect OT
    psychiatric factors

    • depression
    • withdrawal reaction to disfigurement
    • regression
    • anxiety
  30. problems occure in
    • 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
  31. no cognitive impairments with this disorder
  32. treatment/OT
    dependent on stage or recovery
    • 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