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35 Cards in this Set
- Front
- Back
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What are the 3 E's?
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Explain
Expose Examine |
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7 points to explain
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1. What is the name of the therapy?
2. What does this therapy do? 3. How does this therapy work? 4. What will this therapy feel like? 5. How will this therapy be applied to the patient? 6. What are the contraindications for the use of this therapy? 7. Does the patient have any questions? |
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4 steps to Expose
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1. Ask the patient to point to the area involved
2. Instruct the patient in regards to gowning or removal of clothing. Make sure that the patient understands why this is necessary. 3. Instruct the patient accordingly to achieve patient comfort 4. Maintain patient modesty at all times |
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3 things to Examine for
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1. Inspect for signs of edema, redness, bruising, vascular fragility, as well as open wounds, rashes, or scars
2. Examine the area for tenderness,spasm, adhesions, and alterations in pain or temp sensation 3. For testing purposes your inspection and examination should be verbalized as it is performed |
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Explain Cryotherapy
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Cryotherapy is useful to dec pain, reduce hemorrhage, stop or slow swelling, and to reduce myospasms. It reduces pain by blocking the pain gate, sedating local nerve endings and the production of enkephalins. Hemorrhaging and swelling is slowed through vasoconstriction of the bld vessels. Myospasms are reduced through effects on the muscle spindle fibers.
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Explain CBAIN
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As cryotherapy is applied you will most likely feel a cold sensation which may then progress to burning the aching and finally numbness. For some people the pain can become somewhat intense. Please let me know if you cannot take the pain, however the effects of the therapy will not be as great if you cann't reach the numbness stage.
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Contraindications to Cryotherapy
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Impaired circulation such as peripheral vascular disease, Raynaud's disease, cardiac conditions (6 mos following MI due to risk of marked drop in bld pressure following prolonged exposure to cold), patients who do not exhibit reactive hyperemia (Baruch test: fingernails across chest)
Conditions with poor sensory perception - Peripheral nerve injuries, late stage Diabetes, or the very old Hypersensitivity to cold (Cryesthesia), such as in previously frostbitten areas Rheumatoid or gouty arthritis (erosive arthritides) Chilblain (pernio) congestion/swelling of skin due to cold application Paroxysmal cold hemoglobinuria (rare acquired hemolytic syndrome) |
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Ice Pack Protocol
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(warm) Moist towel to prevent frostbite and aid conduction
elastic bandage cover ice pack no more than 20 min every 2 waking hours or until numb, whichever comes first |
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Ice Massage Protocol
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Ice to skin with either a circular or back and forth motions
firm but not heavy pressure 7-10 min (numbness) melting ice colder care over bony prominences |
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Ice Bath Protocol
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hands, feet, wrists, ankles
1:1 ratio crushed ice:water cover area 10 min (numbness) possible severe pain/fainting |
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Explain Heat
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Heating modalities are useful to dec pain, inc circulation, inc joint motion, assist healing and to reduce myospasms. It reduces pain by blocking the pain gate, sesdating local nerve endings and the production of enkephalins. Inc circulation occurs thru vasodilation of the blood vessels. Inc joint motion occurs thru softening of the muscles and tendons/ligaments surrounding the joint. Healing is assisted through inc phagocytes, lymphocytes and inc lymphatic flow. Myospasms are reduced thru effects on the muscle spindle fibers.
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Contraindications to Superficial Heat
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Deficient vascular system either peripheral vascular diseases due to organic diseases or advanced cardiovascular disease
Areas of diminished sensation (over scars, diabetic neuropathies) over deep inflammatory processes especially when suppuration exists Acute stage of injury, or edema Patients with bleeding tendencies (hemophilia, peptic ulcers, uterine fibroids) Active TB Over the low back or pelvis during pregnancy Malignancy in the area (inc metabolism may inc tumor activity) The very old, young, or debilitated individuals Metal |
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Hydocollator pack protocol
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6 layers of toweling (1")
20-30 min examine after 5 min remove if no heat perceived |
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Contraindications to Deep Heat
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all superficial heating contra's
Over epiphyseal plates in the young Over any metal over moist dressings, if treating over a wound, apply dry dressing and change frequently Occlusive arterial disease, varicosities, phlebitis Care over bony prominences Over adhesive taping or casts where perspiration can build up and cannot be removed Fluid filled areas or organs (includes breast implants) Advanced osteoporosis Pacemakers Over tests, ovaries less susceptible Patients undergoing radiation therapy Brain Contact lenses, eyes Hearing aids, watches at least 2 m away |
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Diathermy explaination
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As the therapy is applied I need you to let me know when you first start feeling something, I will then dec/inc as necessary to acheive the desired dose level, but it should never feel uncomfortable.
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Diathermy Protocol
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Towel inbetween
Dose 1 (subsensory) Acute - 2-5 min Dose 2 mild heat, Subacute - 20 min Dose 3 moderate but pleasant heat, Subacute - 20 min Dose 4 Vigorous heat, well tolerated, Chronic - 20-30 min |
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3 types of ultasound units
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LSI US
Mettler Sonicator 730 unit Sonicator Plus 994 Mettler combo unit |
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Soundhead rules
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kept in constant motion
circular or longitudinal stroking pattern moving approx 4 cm per sec with enough pressure to cause slight indentation of the treatment area, but not enough to squeezee out the conduction medium treatment area should be no more than 2-3 times the size of transducer head |
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Ultrasound explanation
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US is used for thermal, mechanical, chemical, and neural effects. It can be used as both a heating and non-heating modality. As a heating modality it can be used to dec pain, inc circulation and disperse fluids, inc joint motion, assist healing and to reduce myospasms. As a non-thermal modality it can be used to dec pain, disperse fluids and assist healing.
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How does US reduse pain
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It reduces pain by blocking the pain gate, sedating local nerve endings and the production of enkephalins.
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How does US inc circulation
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Inc circulation occurs thermally through vasodilation of the blood vessels.
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How does US disperse fluid
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Fluid disperses through mechanical micromassage.
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How does US inc joint motion
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occurs thermally through softening of the muscles and tendons/ligaments surrounding the joint
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How does US assist healing
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Healing is assisted thermally through inc phagocytes, lymphocytes, and inc lymphatic flow and chemically throuch inc fibroblast activity, protein synthesis, and tissue regeneration
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How does US reduce myospasms
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thermally through effects on the muscle spindle fibers
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Contraindications to US
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Heating and Electrical contra's
Fractures Over epiphyseal areas in young Metal Over complete joint replacements Vascular problems involving thrombophlebitis due to rick of emboli Bony prominences - use immersion Acute infections Reproductive organs |
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LSI US unit Protocol
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Only 1 MHz
Starts when pick up soundhead Turn intensity all the way down Start timer (a little more) Set pulse setting (duty cylce) Gel and contact soundhead with pt Turn up intensity to desired setting stop by putting back soundhead (or pushing down handle) Use as immersion if over bony prominence |
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Mettler 730 US unit Protocol
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Turn machine on (switch in back)
Set time Select pulse or continuous Select w/cm2 button Attach appropriate soundhead Apply gel and place on pt Press start button Set intesity Hold button |
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Mettler Sonicator Plus 994 US unit Protocol
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Turn machine on (switch in back)
Press US button (upper left) Set time Select duty cycle Select w/cm2 Select 1 or 3 MHz Apply gel and place on pt Set intensity with upper right dial Start button (diamond) Hold button |
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US Direct Contact Acute Care Settings
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Time: 4-6 min
1 MHz Intensity: .5-1.5 w/cm2 Duty: Pulsed 10-20% 3 MHz Intensity: .5 w/cm2 Duty: 50% |
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US Direct contact Subacute care settings
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Time: 6-8 min
1 MHz Intensity: .75-1.25 w/cm2 Duty: 20-50% 3 MHz Intensity: .75-1 w/cm2 Duty: 50% |
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US Direct Contact chronic care settings
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Time: 8-10 min
1 MHz Intensity: 1.0-2.0 w/cm2 Duty: 100% 3 MHz Intensity: .5-1.0 w/cm2 Duty: 100% |
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US Immersion acute care setting
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Time: 4-6 min
1 MHz Intensity: 1.0-2.0 w/cm2 Duty: 10-20% |
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US Immersion subacute care setting
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Time: 6-8 min
1 MHz Intensity: 1.25-1.75 w/cm2 Duty: 20-50% |
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US Immersion chronic care setting
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Time: 8-10 min
1 MHz Intensity: 1.5-2.5 w/cm2 Duty: 100% |
