-
skin
2 layers
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
-
skin is the largest organ of the body
-
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
-
skin
cause
- 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
-
skin
stats
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)
-
burns
signs
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
-
1st degree burn
red, very sensitive to touch and usually moist
will blanch when touched
no blisters
-
2nd degree burn
produces blisters
base of blisters may have erythematous or whitish with fibrous exudate
sensitive to touch
blanches with pressure
-
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
-
4th degree burn
all soft tissue, including muscle has been burned
bone may be seen
-
severity is measured by % of total body surface burned
small
15%
moderate
15-49
large
50-69
massive
>70
-
keys to assessing burns
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
-
burn recovery
- long and arduous process and should focus on:
- pain free motion
- functional recovery
- qualaity of life
- survival
-
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
-
average %TBSA(total burn site area) on admission
14%
-
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
-
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%
l
-
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
-
eschar
adherent dead tissue that forms on skin with deep partial or full thickness burns
-
skin grafting
- surgery will decrease pain
- scar formation
- contractures
-
autograft
surgical transplantation of the person's own skin froman unburned area
-
cultured epidermal autograft(CEA)
- alternatives to autografts
- skin is taken from cadavers
-
microvascular skin flap
deep wounds involving tendons or graft adherence is extremely doubtful
surgically placed due to large areas
-
pain(difficult to predict)
- influenced by burn depth
- location
- patient age
- gender
- ethnicity
- education
- occupation
- history of drug or alcohol abuse
- psychiatric illnes
-
pain protocol includes:
- long acting marcotics
- procedural pain(dressing changes, therapy,wound cleaning)
- anziety medications
-
schedule therapy sessions
45 minutres after taking meds to increase effectiveness
-
contracture development
wounds heal by contracture
- patients who lay in a flexed,
- adducted and
- fetal positioning(position of withdrawal of withdrawal from pain)
-
contracture limits joint ROM by shortening
- tissue
- tendons
- ligaments
- blood vessels
- nerves
- calcium deposits surrounding the involved joints
-
how burns affect OT
psychiatric factors
- depression
- withdrawal reaction to disfigurement
- regression
- anxiety
-
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
-
no cognitive impairments with this disorder
-
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
|
|
