Self-Care: Burns, Sunburns, and Wounds

What are the three phases of wound healing?

inflammatory, proliferative, maturation/remodeling

When does the inflammatory phase of wound healing start and how long does it last?

immediate, 3-4 days

Which phase of wound healing is the following?

- hemostasis is initiated by the release of thromboplastin from the injured cells to form a clot

- debris and bacteria is removed

- collagen is formed to stimulate wound healing

inflammatory phase

Which phase of wound healing is the following?

- formation of granulation tissue

- new connective tissue, new capillaries, and inflammatory cells

proliferative phase

When does the proliferative phase of wound healing start and how long does it last?

start on day 3 or 4, lasts ~3 weeks

Which phase of wound healing is the following?

- connective tissue closes wound

- epithelial cells resurface site of the wound

- continual collagen synthesis/breakdown

maturation/remodeling phase

When does the maturation/remodeling phase of wound healing start and how long does it last?

after 3 weeks, peaks ~60 days after injury

What kind of wound ONLY involves the epidermis? How long does it take to heal?

superficial skin injuries

usually heals within 3-6 days (usually without scarring)

Which kind of wound is characterized by the following?

burns are characterized by skin that is reddened, dry, unbroken, non blistering, blanches when pressure is applied to the skin, and painful to the touch

superficial skin injuries

What kind of wound involves the entire epidermis AND superficial dermis? How long does it take to heal?

superficial partial-thickness skin injuries

usually heals within 7-20 days

Which kind of wound is characterized by the following?

involves a break in the skin, drainage from the wound area may occur in addition to pain, edema, and erythema

superficial partial-thickness skin injuries

What kind of wound extends deeper into the dermis ("reticular dermis")? How long does it take to heal?

deep partial-thickness skin injuries

usually heals in 3+ weeks

Which kind of wound is characterized by the following?

burns- either wet or waxy dry, vary in color from patchy to white to red, do not blanch with pressure and may present with blisters that are easily unroofed

deep partial-thickness skin injuries

What kind of wound extends through the epidermis, dermis, and beyond (i.e. subcutaneous fat, tendon, muscle, or bone)?

full-thickness skin injuries

Which kind of wound is characterized by the following?

burns destroy all the skin appendages, may appear waxy white, leathery gray or charred black, do not blanch with pressure and have sensation only to deep pressure

full-thickness skin injuries

What are the proper wound cooling and cleansing counseling points for a patient?

1. remove from heat source

2. cool burn wound w/ cool running water (~59 F)

3. gently irrigate w/ clean tap water

4. don't pull on loose skin (may delay healing)

5. leave blisters in tact (let them burst on their own)

If a blister (from a burn) bursts, how should you counsel a patient to appropriately manage this?

- wash area with soap and water

- apply moist wound dressing

How have views on wound management changed from the past, and what are the current treatment recommendations for wound dressings?

historically - leave wound open to lead to scab formation

now - apply a moisture-retentive dressing to protect, prevent infection, and stimulate cell proliferation

What products are available to minimize scarring and of those, which are effective?

silicone therapy is considered gold standard

What are the goals of treatment for minor burns, sunburns, and wounds?

1. relieve symptoms

2. promote healing by protecting the wound from infection and further trauma

3. minimize scarring

What are some self exclusions of self treatment for minor burns and wounds?

- cuts longer than 1/2 inches

- continuous bleeding after applying pressure for 10+ min

- chemical/electrical/inhalation burns

- animal/human bite

- deep partial/full thickness type

- signs of infection

- circumferential burns

- has preexisting medical disorders

- foreign matter after irrigation

- chronic wound

- site of injury (face, hands, feet, major joints, genitals)

- burns 3+ inches in diameter

- injury doesn't heal or worsens after 7 days

What are some self exclusions of self treatment for sunburns?

- large area of blistering

- fever

- extreme pain

- headache/confusion

- lightheadedness

- vision changes

- severe swelling

- signs of infection

What are the two types of wound dressings do provide a moist environment?

- hydrocolloids

- transparent adhesive films

note: both can ONLY be used on uninfected wounds

What three types of wound dressings require frequent changes?

- gauze dressings

- non-adherent gauze

- adhesive gauze

Which type of wound dressing can provide thermal insulation?

hydrocolloids

Which type of wound dressing is readily available in a variety of shapes/sizes and can have special characteristics (i.e. clear bandages for discreet healing, waterproof adhesion, antibacterial fabric, cushioned fabric, and highly durable adhesion)?

adhesive bandages

What two types of wound dressings require secondary dress to adhere to the skin?

- gauze dressings

- non-adherent gauze

Which type of wound dressing is highly absorbent for exudating wounds?

gauze dressings

What are two systemic analgesics that can be used for minor burns, sunburns, or wounds? What's the purpose of them?

NSAIDs, APAP

to decrease erythema and speed healing time of burns

Can NSAIDs and APAP be used for short term or long term administration of minor burns, sunburns, or wounds?

short term administration

What are some examples of skin protectants for minor burns, sunburns, or wounds? What's the purpose of them?

- petrolatum

- dimethicone

- zinc oxide

- glycerin

- lanolin

- cocoa butter

- colloidal oatmeal

to protect injured area from irritation or friction; to prevent drying of the stratum corneum

What are the proper administration instructions of skin protectants for minor burns, sunburns, or wounds?

apply ~2-3 times daily

What are some examples of first-aid antibiotics for minor burns, sunburns, or wounds? What's the purpose of them?

bacitracin, neomycin, polymyxin B sulfate

to prevent infection and maintain a moist environment but NOT indicated for infected wounds

What are the proper administration instructions of first-aid antibiotics for minor burns, sunburns, or wounds?

apply topically after cleansing and before applying a sterile dressing (can do ~1-3 times daily)

What are some examples of topical anesthetics for minor burns, sunburns, or wounds? What's the purpose of them?

benzocaine, lidocaine

to temporarily relieve pain by interrupting transmission of electrical impulses

What are the proper administration instructions of topical anesthetics antibiotics for minor burns, sunburns, or wounds?

no specific instructions

be aware of systemic absorption by making sure patient is aware of appropriate clinical indications, safe concentrations, doses, and application instructions

What are some examples of first-aid antiseptics for minor burns, sunburns, or wounds? What's the purpose of them?

chlorohexidine, hydrogen peroxide, povidone-iodine solution

to destroy or inhibit growth of microorganisms in tissue

What are the proper administration instructions of first-aid antiseptics for minor burns, sunburns, or wounds?

no specific instructions

but note that prescence of exudate, serum, or blood may diminish effectiveness of antiseptics

What is the purpose of honey for minor burns, sunburns, or wounds?

highly viscous and delivers a moist healing environment

What is the purpose of aloe vera for minor burns, sunburns, or wounds?

promotes cooling effect for second degree burns

What is the purpose of "calendula" or 'pot marigold' for minor burns, sunburns, or wounds?

promote wound healing by its anti-inflammatory and antibacterial properties