Podcast
Questions and Answers
During the rehabilitation phase for a client recovering from a burn, what is the primary goal of community reentry activities?
During the rehabilitation phase for a client recovering from a burn, what is the primary goal of community reentry activities?
- To promote the client's return to typical daily routines and participation in society. (correct)
- To improve the client's skin tolerance to friction and shear during activities.
- To ensure the client can tolerate compression garments for extended periods.
- To address symptoms of posttraumatic stress disorder through counseling.
What is the MOST effective intervention to prevent or reverse contracture deformities resulting from burns?
What is the MOST effective intervention to prevent or reverse contracture deformities resulting from burns?
- Postponing interventions until the scar is fully mature to assess the extent of the contracture.
- Focusing solely on improving skin tolerance for friction and shear.
- Administering pain management and relaxation techniques.
- Early implementation of anticontracture positioning along with continuous exercise and activity programs. (correct)
A client is experiencing hypersensitivity following a burn injury. What intervention is MOST appropriate during the client's transition from hospital to home?
A client is experiencing hypersensitivity following a burn injury. What intervention is MOST appropriate during the client's transition from hospital to home?
- Implementing desensitization techniques. (correct)
- Initiating compression therapy to manage hypertrophic scarring.
- Providing education on independent skincare protocols.
- Prescribing a continuing exercise and activity program.
What is the expected timeline for a hypertrophic scar to be most active after wound closure?
What is the expected timeline for a hypertrophic scar to be most active after wound closure?
A client with facial burns is having difficulty with oral hygiene and eating due to tightening around the mouth. What specific type of contracture is MOST likely affecting this client?
A client with facial burns is having difficulty with oral hygiene and eating due to tightening around the mouth. What specific type of contracture is MOST likely affecting this client?
During the rehabilitation phase, a client reports difficulty tolerating compression garments due to friction and shear. What intervention should the therapist prioritize?
During the rehabilitation phase, a client reports difficulty tolerating compression garments due to friction and shear. What intervention should the therapist prioritize?
What is the MOST appropriate initial action for an OT to take when a client demonstrates atypical movement patterns after a burn injury?
What is the MOST appropriate initial action for an OT to take when a client demonstrates atypical movement patterns after a burn injury?
What is the expected duration for scar maturation following a burn injury?
What is the expected duration for scar maturation following a burn injury?
Which of the following is the MOST appropriate initial temporary compression method for managing edema in a patient's fingers following a burn?
Which of the following is the MOST appropriate initial temporary compression method for managing edema in a patient's fingers following a burn?
A patient is being fitted for custom-made compression garments following a burn. What is the PRIMARY reason for wearing these garments?
A patient is being fitted for custom-made compression garments following a burn. What is the PRIMARY reason for wearing these garments?
When should a patient, who has custom-made compression garments, typically remove them?
When should a patient, who has custom-made compression garments, typically remove them?
Which of the following is the MOST accurate method for calculating Total Body Surface Area (%TBSA) burned, especially in children?
Which of the following is the MOST accurate method for calculating Total Body Surface Area (%TBSA) burned, especially in children?
Why are flexible inserts or conformers often added under custom-made pressure garments?
Why are flexible inserts or conformers often added under custom-made pressure garments?
A patient has burns on their entire left arm and the front of their trunk. Using the Rule of Nines, what is the estimated %TBSA burned?
A patient has burns on their entire left arm and the front of their trunk. Using the Rule of Nines, what is the estimated %TBSA burned?
What is the MOST important aspect to consider when progressing therapeutic exercise and activity for a burn patient?
What is the MOST important aspect to consider when progressing therapeutic exercise and activity for a burn patient?
What type of skin care should a client be taught to perform before engaging in an exercise and activity program?
What type of skin care should a client be taught to perform before engaging in an exercise and activity program?
Which layer of skin is affected in a superficial burn?
Which layer of skin is affected in a superficial burn?
What is the typical healing time for a superficial burn?
What is the typical healing time for a superficial burn?
In burn management, what is the primary purpose of anticontracture positioning?
In burn management, what is the primary purpose of anticontracture positioning?
For a patient with dorsal hand burns, what is generally the best splinting position advised?
For a patient with dorsal hand burns, what is generally the best splinting position advised?
Which of the following is NOT a characteristic of a superficial burn?
Which of the following is NOT a characteristic of a superficial burn?
Following a superficial burn, what is the likelihood of developing hypertrophic scars or contractures?
Following a superficial burn, what is the likelihood of developing hypertrophic scars or contractures?
Which component of the dermis provides structural support and elasticity to the skin?
Which component of the dermis provides structural support and elasticity to the skin?
What is the primary reason scar tissue becomes firmer and thicker after a burn?
What is the primary reason scar tissue becomes firmer and thicker after a burn?
A patient is admitted with a burn caused by brief exposure to hot liquid. The burn is red, painful, and dry, without blisters. How should this burn be classified?
A patient is admitted with a burn caused by brief exposure to hot liquid. The burn is red, painful, and dry, without blisters. How should this burn be classified?
In the case of Heterotopic Ossification (HO), after a confirmed diagnosis what is the MOST appropriate course of action regarding passive stretching?
In the case of Heterotopic Ossification (HO), after a confirmed diagnosis what is the MOST appropriate course of action regarding passive stretching?
Why is coordinating with nursing staff on scheduled pain management important for burn rehabilitation?
Why is coordinating with nursing staff on scheduled pain management important for burn rehabilitation?
A client who has had a split-thickness skin graft is experiencing heat intolerance. What physiological change is MOST likely causing this issue?
A client who has had a split-thickness skin graft is experiencing heat intolerance. What physiological change is MOST likely causing this issue?
What is the primary purpose of using scar gel pads or inserts in burn scar management?
What is the primary purpose of using scar gel pads or inserts in burn scar management?
A client is experiencing rapid loss of ROM, localized and severe pain, and a hard end feel during PROM after a burn. These are MOST indicative of what condition?
A client is experiencing rapid loss of ROM, localized and severe pain, and a hard end feel during PROM after a burn. These are MOST indicative of what condition?
What is the MOST critical education point to emphasize to a client and their family regarding pain management and ROM exercise following a burn?
What is the MOST critical education point to emphasize to a client and their family regarding pain management and ROM exercise following a burn?
A burn survivor is preparing to return to work in an outdoor environment. What is the MOST important precaution they should take regarding sun exposure?
A burn survivor is preparing to return to work in an outdoor environment. What is the MOST important precaution they should take regarding sun exposure?
Which type of skin graft involves transplanting the patient's own skin from an unburned area to the burn site?
Which type of skin graft involves transplanting the patient's own skin from an unburned area to the burn site?
What is the primary purpose of escharotomy and debridement in acute burn care?
What is the primary purpose of escharotomy and debridement in acute burn care?
During which phase of burn management is infection control the MOST critical, often involving both nonsurgical and surgical interventions?
During which phase of burn management is infection control the MOST critical, often involving both nonsurgical and surgical interventions?
What is a key advantage of using split-thickness skin grafts compared to full-thickness skin grafts?
What is a key advantage of using split-thickness skin grafts compared to full-thickness skin grafts?
A patient with extensive full-thickness burns requires a skin graft. Due to the large area that needs to be covered, which type of graft is MOST likely to be utilized?
A patient with extensive full-thickness burns requires a skin graft. Due to the large area that needs to be covered, which type of graft is MOST likely to be utilized?
In the emergent phase of burn care, what is the PRIMARY focus in the initial 72 hours?
In the emergent phase of burn care, what is the PRIMARY focus in the initial 72 hours?
What would be the MOST appropriate dressing for a burn if the goal is to use a biosynthetic product as a skin substitute?
What would be the MOST appropriate dressing for a burn if the goal is to use a biosynthetic product as a skin substitute?
What would be the expected treatment choice for a full-thickness burn?
What would be the expected treatment choice for a full-thickness burn?
Why is it important to exercise caution to avoid composite flexion when treating dorsal hand burns?
Why is it important to exercise caution to avoid composite flexion when treating dorsal hand burns?
In a patient with a deep partial-thickness burn, when should sensory testing for peripheral nerve damage be performed?
In a patient with a deep partial-thickness burn, when should sensory testing for peripheral nerve damage be performed?
What is the MOST important consideration for children who have sustained burns when creating an intervention plan?
What is the MOST important consideration for children who have sustained burns when creating an intervention plan?
What role do child-life specialists play in the rehabilitation of children with burn injuries?
What role do child-life specialists play in the rehabilitation of children with burn injuries?
What is a common emotional response observed in parents of children who have sustained burn injuries, that occupational therapists need to be aware of?
What is a common emotional response observed in parents of children who have sustained burn injuries, that occupational therapists need to be aware of?
What is the MOST important action an occupational therapist should take to promote a healthy parent-child relationship during burn rehabilitation?
What is the MOST important action an occupational therapist should take to promote a healthy parent-child relationship during burn rehabilitation?
Why might children experience greater difficulty reintegrating into student and playmate roles after a burn injury compared to adults?
Why might children experience greater difficulty reintegrating into student and playmate roles after a burn injury compared to adults?
What intervention is most helpful in aiding a child's return to school after a burn injury?
What intervention is most helpful in aiding a child's return to school after a burn injury?
Flashcards
Dermis
Dermis
The inner layer of skin, made of connective tissue including collagen and elastin.
Epidermis
Epidermis
The outermost layer of skin, consisting of four or five layers of epithelial cells.
Burn
Burn
A thermal injury that damages one or more layers of the skin.
Total Body Surface Area (%TBSA)
Total Body Surface Area (%TBSA)
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Rule of Nines
Rule of Nines
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Lund-Browder Chart
Lund-Browder Chart
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Superficial Burn
Superficial Burn
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Burn Scar Potential
Burn Scar Potential
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Xenograft
Xenograft
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Allograft
Allograft
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Nonbiological skin-substitute
Nonbiological skin-substitute
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Acute phase
Acute phase
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Nonsurgical infection control
Nonsurgical infection control
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Escharotomy
Escharotomy
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Autograft
Autograft
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Meshed graft
Meshed graft
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Compression therapy
Compression therapy
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Elastic bandages
Elastic bandages
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Custom-made compression garments
Custom-made compression garments
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Gradient pressure
Gradient pressure
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Anticontracture positioning
Anticontracture positioning
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Dynamic splint
Dynamic splint
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Skin lubrication and massage
Skin lubrication and massage
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Therapeutic exercise
Therapeutic exercise
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Adaptive Strategies
Adaptive Strategies
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Atypical Movement Patterns
Atypical Movement Patterns
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Skin Care Protocol
Skin Care Protocol
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Scar Management
Scar Management
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Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder (PTSD)
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Contracture
Contracture
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Hypertrophic Scar
Hypertrophic Scar
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Scar Formation
Scar Formation
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Heterotopic Ossification
Heterotopic Ossification
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Loss of ROM
Loss of ROM
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Pain Management
Pain Management
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Skin Care Post-Burn
Skin Care Post-Burn
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Heat Intolerance
Heat Intolerance
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Sun Exposure Risks
Sun Exposure Risks
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Boutonnière Precaution
Boutonnière Precaution
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ROM to MP
ROM to MP
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Sensory Testing
Sensory Testing
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Electrical Burn Screening
Electrical Burn Screening
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Child-life Specialists
Child-life Specialists
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Parental Emotional Impact
Parental Emotional Impact
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Community-based Therapist
Community-based Therapist
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Study Notes
Burn Rehabilitation
- General Considerations: Various resources, such as textbooks and online dictionaries, offer detailed information on burns and burn rehabilitation. These resources include information on skin anatomy, burn classifications by size, depth, and mechanism and different types of burns (superficial, partial-thickness, and full-thickness) as well as medical management.
Skin Anatomy and Definitions
- Skin Layers: Skin consists of two layers: dermis (composed of collagen and elastin) and epidermis (outermost layer with varying thicknesses depending on location and skin type).
Burn Classifications
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Burn Size: The Rule of Nines, a method for calculating total body surface area (TBSA) affected by burns, divides the body into sections representing 9% or multiples of 9%. The Lund-Browder chart is a more precise method accounting for variations in body size and age groups.
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Burn Depth: Burn wounds are categorized based on clinical assessment of appearance (e.g., erythema, blisters), sensitivity, and pliability. This includes superficial burns (epidermal involvement), superficial partial-thickness burns (epidermal and partial dermis involvement), deep partial-thickness burns (epidermal and deeper dermis layers involved including hair follicles and sweat glands), full-thickness burns (all layers including nerve endings), and subdermal burns (involving underlying tissues like fat, muscles, and bone).
Medical Management
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Initial (0-72 hours): Emergent care focuses on maintaining life, controlling infections, and managing pain. This includes intravenous fluids, intubation (if needed), surgical procedures like escharotomy and fasciotomy to relieve pressure. Wound dressings and antimicrobial ointments are used.
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Sustaining life: Skin acts as a moisture barrier and the client may face dehydration risks depending on extent of burn. Hypo- or hyperthermia may be issues if the skin is no longer intact., Fluid resuscitation may also be needed for the body to regulate temperature.
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Infection Control: Nonsurgical and surgical interventions may be needed to care for the wound
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Grafts: Autografts (using the client's own skin as transplant), split-thickness skin grafts (using superficial layers of skin), and full-thickness skin grafts (using the deeper layers of skin from the client's intact skin) may be used. Skin graft methods depend on the condition, size, and injury of the burn site and are vital for repair.
Surgical Excision and Controlling Infection
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Surgical excision of the eschars/incisions into the fascia can release pressure within the fascia compartments
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Wound-dressing products protect the wound, superficially debride the wound and provide comfort (e.g., topical antibiotics, biologic dressings, and nonbiological skin substitutes).
Rehabilitation Phase
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Acute Phase (0-72 hours to wound closure) Focuses on infection control and grafts, and biological dressings. Communication between medical providers and a team is critical.
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Components from preceding phases:
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Psychosocial support is crucial.
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Occupational therapists manage components of preceding phases (such as pain management) and newly emerged needs.
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Physical Evaluation: Obtain detailed history of burn etiology, medical and secondary diagnoses, wound assessment (extent, depth), joint mobility, strength, sensation, and functional limitations (ADL and IADL).
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Positioning and Splinting: Anti-deformity positioning for prevention of contractures, splints, or positioning devices, and exercises to facilitate ROM (range of motion) are involved.
Activities of daily living, communication, cognition, and pain management are also crucial parts of the rehabilitation.
Burn Related Complications and Management
- Contractures: These result from tight scars or immobilization and may limit joint movement. Treatment involves early intervention and ongoing anti-contracture positioning.
- Hypertrophic scars: Form due to increased vascularity weeks to months after wound closure, becoming firmer and thicker than normal skin. Management includes compression therapy and ongoing care.
- Heterotopic ossification: Bone forming in abnormal areas, often around joints, leading to loss of ROM.
- Pain: Respect the client's pain and address it appropriately.
- Psychosocial considerations: This stage of recovery can be emotionally challenging for the individual and their family.
- Skin tolerance: Ensure the client can tolerate compression or adaptive clothing.
Postoperative Management
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Immobilization:
- Critical for graft adherence.
- Duration varies, determined by the surgeon.
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Positioning: Same or similar positions to maintain joint positioning are prescribed.
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ROM and Exercise: Gentle, pain-free exercises maintain mobility and flexibility of unaffected body parts.
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Wound Care: Maintaining proper wound care with appropriate dressings is vital for healing.
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ADLs: Assisting with activities of daily living (ADLs) using adaptive equipment and training.
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Psychosocial Support: Addressing any psychological distress is very important
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Edema Management: Elevation, compression therapy, and/or specific devices are implemented to manage edema.
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Scar Management: Managing scars during healing.
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Pain Management: Addressing any pain or discomfort.
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Therapies: Occupational and physical therapy is provided as part of treatment.
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