Conditions in OT Exam #1 - Burns & Cancer

Most Common Causes of Burns

Fire/flame: 43%

Scald: 34%

Contact: 9%

Electrical: 4%

Chemical: 3%

Other: 7%

Layers of Burns

Epidermis: superficial, 1st degree

Dermis: superficial / deep partial thickness, 2nd degree

Dermis: superficial / deep full thickness, 3rd degree

Subcutaneous Tissue: full thickness, 4th degree

Description of Burns

1st degree: redness and pain, dry wound

2nd degree superficial: clear blisters and weeping, wet skin, painful to touch

2nd degree deep: blisters with bloody fluid, appear white, painful

3rd degree: charred black, red, tan, or pearly white, thin-walled blisters, dry

4th degree: charred or mummified, total or partial function loss

Inhalation Injury

Commonly occur in settings of thermal injury in an enclosed space

• reduced oxygen

• cyanosis

• stridor

• facial burns

• hoarse voice

TBSA

Total body surface area

Burn Shock

Complication that may occur with burns in excess of 15-20% of TBSA

Loss of fluid of circulating blood volume

Hypermetabolism

Hypermetabolic response with increased energy and expenditure and protein turnover - up to 40% higher metabolic rate due to prolonged stress response

Hypertrophic vs. Keloid Scar

Hypertrophic: stays within wound boundary and will eventually fade; red, raised, rigid

Keloid: nodular proliferations that go beyond margins of original injury

Rule of 9’s

Debridement

Cleaning and removal of nonadherent and nonviable tissue

Eschar

Dead tissue that sheds from healthy tissue

6 Types of Cancer

1) Carcinoma

• Epithelial (skin, blood vessels, lining of organs)

2) Sarcoma

• Supportive and connective tissue (bone, cartilage, muscle)

3) Myeloma

• Plasma cells of bone marrow

4) Leukemia

• Blood-forming (bone marrow, lymphatic system)

5) Lymphoma

• Lymphatic system

6) Mixed Type

• More than one type of cancer

Benign

Cells are genetically similar, have slow growth, and are unable to spread;

no return after removal

In Situ

In natural or original place - early stage when cancer has not spread and is at its original site

Malignant

Invasive cancerous cells that’ve grown into surrounding tissue

Metastatic

Cancer from one organ or one part of the body that has spread to another organ or part of the body

4 Types of Leukemia

1) ALL - Acute Lymphocytic Leukemia

• Lymphocytes that originate in bone marrow

• Too many lymphocytes

• Most common child cancer

2) AML - Acute Myeloid Leukemia

• Lowers the number of healthy blood cells

• Myeloid cells proliferate uncontrollably, replacing normal bone marrow and reducing healthy red cells, white cells, and platelets

3) CLL - Chronic Lymphocytic Leukemia

• Lymphocytes in bone marrow

• Most common leukemia in adults

4) CML - Chronic Myeloid Leukemia

• Originates in myeloid cells

• Cells grow slowly

2 Types of Lymphoma

1) Hodgkin

• B-cells (immune cells)

• Large lymphocytes and noticeable lumps in lymph nodes

2) Non-Hodgkin

• B-cells or T-cells

• More common

Myeloma

Cancer of plasma cells

Originates in bone marrow

Signs & Symptoms:

• changes in bowel/bladder

• sores that don’t heal

• white patches in mouth

• unusual bleeding, coughing up blood

• thickening lump on body

• indigestion or dysphagia

• changes in skin

• nagging cough or hoarseness

TNM Staging

T: size of original tumor and if it has invaded nearby tissue

N: extent to which regional lymph nodes are involved

M: describes spread of cancer to other parts of the body (metastasis)

Parameters for TNM Staging

Tx - size can’t be evaluated

Tis - carcinoma in situ

T0 - no signs of tumor

T1 - size/extent of tumor

T2 - size/extent of tumor is greater than T1

T3 - locally advanced

T4 - spread to distant

Nx - can’t be evaluated

N0 - no lymph node involvement

N1 - regional lymph nodes are affected

N2 - disease is present beyond regional lymph nodes

N3 - disease is present in distant lymph nodes

M0 - no metastasis

M1 - metastatic disease is present in distant organs

Stages of Cancer

Stage 0: carcinoma in situ and early in development; not all cancers have a stage 0

Stage 1: localized cancer; often has a good prognosis

Stage 2 & 3: locally advanced; specific criteria based on the type of cancer

Stage 4: metastasized; cells have become undifferentiated

Radiation

Used to kill or damage cancer cells and is localized to the site

Chemotherapy

Agents administered through the bloodstream to kill the cancer cells;

systemic

Neoadjuvant vs. Adjuvant

Neoadjuvant: used prior to surgery to reduce the size of the tumor

Adjuvant: used after surgery to destroy any remaining cells

Ports & PICC

Port: central venous catheter located under the skin for drug administration - typically under the clavicle on upper chest; easier access to vein

PICC: peripherally inserted central catheter - line inserted into a vein on the inside of the upper arm which extends to a larger vein leading to the heart

Hormonal, Targeted, & Immunotherapy

Hormonal: uses body’s hormone levels to affect the cancer

Targeted: disables genes or proteins that cancer cells use to grow

Immunotherapy: bolsters immune system to recognize cancer cells and fight them off

Bone Marrow Transplant

Autologous: uses bone marrow from own person’s body

Allogenic: uses bone marrow from a donor

Graft vs. Host Disease

A condition that occurs when the donor stem cells that make up the new immune system perceive the body’s tissues and organs as foreign and therefore attack the body tissues

Chemo-induced Peripheral Neuropathy

Chemo’s effect on the peripheral nervous system - numbness, tingling, loss of sensation, shooting pain, burning

Cancer-related Fatigue

Persistent, subjective sense of tiredness or exhaustion related to cancer/treatment

Cancer-related Cognitive Impairment

A decrease in mental sharpness; associated with a decline in limitations with cognitive domains of executive functioning, attention, memory, and learning

Lymphedema

Chronic, inflammatory disease resulting from the failure of the lymphatic system - swelling, aching, discomfort

Cachexia

Syndrome causing extreme weight loss and muscle wasting, and can include the loss of body fat