Download - Wound Burn
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RCS 6080RCS 6080
Medical and Psychosocial AspectsMedical and Psychosocial Aspects
of Rehabilitation Counselingof Rehabilitation Counseling
Wound Healing, Burn
Injuries & Plastic Surgery
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WoundsWounds
Any breach in the surface of the body or
any tissue disruption produced by the
application of energyUsually physical injury
Abrasion, degloving injury
ontusion, crush injury
Incision, laceration
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Skin content refresherSkin content refresher
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Wound HealingWound Healing
As !ound heals"# $luid and cells drain fro% da%aged tissue
#'udate %ay be"learBloodyPus(containing
Proper !ound healing"# leanliness and care of lesion# Proper circulation
# )ood general health and nutrition
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Phases of healingPhases of healing
Infla%%atory# Bleeding*clotting
# +igration of WBs
# ell s!elling eparative
# -aying do!n of collagen . %igration of epith/ cells
# 0e! capillary loops
# Proliferation of fibroblastsstrands of collagen
onsolodative# reorientation .contraction of collagen
# collagen synthesisdegradation
vascularity
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CoplicationsCoplications
Hypertrophic scar 1
continued production
of collagen2eloid 1 3/!ith
e'tension into
surrounding tissues
Scar contracture
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Plastic surgeryPlastic surgery
Scar evision
# -aser resurfacing*der%abrasion
# 4(plasty
# S5in(grafting*flap surgery
# 6issue e'pansion
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!urn "n#uries!urn "n#uries
Statistics# Annually, there are appro'i%ately 7/89 %illion people in the US
!ho sustain burn injuries
# :f these, 9,9;; do not survive and 97,;;; re
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$ffects$ffects
Burn injury causes destruction of tissue, usually thes5in, fro% e'posure to ther%al e'tre%es ?either hot orcold@, electricity, che%icals, and*or radiation# 6he %ucosa of the upper )I syste% ?%outh, esophagus,
sto%ach@ can be burned !ith ingestion of che%icals# 6he respiratory syste% can be da%aged if hot gases, s%o5e,
or to'ic che%ical fu%es are inhaled
# $at, %uscle, bone, and peripheral nerves can be affected inelectrical injuries or prolonged ther%al or che%ical e'posure
# S5in da%age can result in altered ability to sense pain, touch,and te%perature
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!urn Classification % Cause!urn Classification % Cause
6he pri%ary cause of burn injury is e'posure tote%perature e'tre%es
# Heat injuries are %ore fre
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!urn Classification % &epth!urn Classification % &epth
:ld ter%inology
# 7st degree" only the
epider%is
# 8nd degree" epider%is and
der%is, e'cluding all the
der%al appendages
# rd degree" epider%is and
all of the der%is
# th degree" epider%is,
der%is, and subcutaneous
tissues ?fat, %uscle, bone,
and peripheral nerves@
0e! ter%inology
# Superficial" only the
epider%is
# Superficial partial
thic5ness" epider%is and
der%is, e'cluding all the
der%al appendages
# Ceep partial thic5ness"
epider%is and %ost of theder%is
# $ull thic5ness" epider%is
and all of the der%is
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!urn Classification % &epth!urn Classification % &epth
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!urn Classification % $'tent!urn Classification % $'tent
'tent# Burn injuries are also
classified in ter%s of the
percentage of the s5insurface injured ?6BSA@
# A relatively si%ple, but nottotally accurate, %ethod fordeter%ining the e'tent ofinjury is the rule of Ds
# 6he ABA classificationsyste% describes burninjuries as %ild, %oderate,or %ajor
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!urn Classification ( $'tent!urn Classification ( $'tent
)und * !ro+der)und * !ro+der# -und and Bro!der
+ore accurate Civides body into s%all areas sti%ates proportion each
area contributes# -und and Bro!der
+ore accurate Civides body into s%all areas sti%ates proportion each
area contributes 6a5es %ore ti%e and effort to
calculate than ule of 0ines%ethod
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!urn ,reatent!urn ,reatent# espiratory care
# Ad%inistration of fluids
# Wound care ?debride%ent@
# Pain control
# Plastic surgery ?eg" s5ingrafts@
# +onitoring for
co%plications
Infections ardiovascular
espiratory
# +assage & Physical therapy
%assage video
# Posttrau%atic stress
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Pathophysiology of !urn "n#uryPathophysiology of !urn "n#ury
Pathophysiology refers to the co%ple' chain of %echanis%sthat occur in the s5in ?local effects@ and in other organsyste%s ?syste%ic effects@ !hen a burn injury occurs, as !ellas !hat happens as the s5in regenerates and heals
# -ocal ffects
# Syste%atic ffects
# S5in egeneration and Scarring
# lectrical Burns
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!urn Scars % -eloid!urn Scars % -eloid
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!urn Scars % Hypertrophic!urn Scars % Hypertrophic
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!urn Scars % Contracture!urn Scars % Contracture
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!urn Scars % Contracture!urn Scars % Contracture
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!urn Scars % .onraised!urn Scars % .onraised
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Skin /raft ScarsSkin /raft Scars
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unctional )iitationsunctional )iitationsAcute -i%itations
# Patients %ay e'perience deliriu% that precludes theirparticipation in treat%ent
# de%a, pain, bul5y dressings, and i%%obili=ing splints i%pair
the personEs ability to perfor% usual daily activities# Sleep is fre
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Rehabilitation !urn ,reatentRehabilitation !urn ,reatent
Postdischarge# Wound care continues
# If there is a ris5 of hypertrophic scarring, or it has already started,continuous pressure applied to the area !ill prevent its progress
# )ar%ents need to be !orn 8; hours per day for up to 7 year (
unco%fortable, hot, and unattractive# ontracture control continues through P6 and*or :6
# econditioning and strengthening e'ercises begin
# ounseling is a possibility to !or5 on e%otional difficulties thathave resulted fro% the burn injury
# econstructive surgery %ay be needed if the functional orcos%etic li%itations are not responsive to rehabilitation treat%ent
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1ocational )iitations1ocational )iitations
It should be e%phasi=ed that %any of the functionalli%itations that have already been discussed are notovertly apparent
If they are not recogni=ed as valid, the could veryeasily conclude that a person is %alingering, !hining, orun%otivated
Seriousness, etiology, and site of the burn injury cansignificantly affect return(to(!or5 and ho! long it ta5es
All of the studies cited in the te't suggest that si=e, depth,and location are factors that influence ti%e to return to!or5
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Additional Resources andAdditional Resources and
"nforation fro the Web"nforation fro the Web :rgani=ations
# A%erican Burn Association ?!!!/a%eriburn/org@
# Burn Survivors :nline ?!!!/burnsurvivorsonline/co%@
# Phoeni' Society for Burn Survivors, Inc/ ?
!!!/phoeni'(society/org@
# FA0Gs Webpage ?!!!/jan/!vu/edu*%edia*burninj/ht%l@
http://www.ameriburn.org/http://www.burnsurvivorsonline.com/http://www.phoenix-society.org/http://www.phoenix-society.org/http://www.burnsurvivorsonline.com/http://www.ameriburn.org/ -
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Additional Resources andAdditional Resources and
"nforation fro the Web"nforation fro the Web Burn Injury ehabilitation +odel Syste%s funded by
0IC
# UW*BI+S University of Washington * Harborvie!+edical enter?http"**depts/!ashington/edu*u!nidrr*inde'/ht%l@
# U6*SW+ University of 6e'as * South!est +edicalenter ?!!!/s!%ed/edu*burntrau%a@
# SBI() Shriners Hospital for hildren* Burn Institute?!!!/shrinersh
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Additional Resources andAdditional Resources and
"nforation fro the Web"nforation fro the Web elated Articles fro% Burn Survivors :nline
# 6he I%pact of econstructive Surgery?!!!/burnsurvivorsonline/co%*articles*oad6oesto
ration/asp@
# hild burns survivors report good