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47 Cards in this Set
- Front
- Back
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Thermoplast -Advantages |
-Readily available in a variety of thicknesses -Most are easily reheated and modified -Can readily accept out-riggers and additional components -Light weight -Can be removed easily -Mostly water resistant -Can be easily cleaned
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Thermoplast -Disadvantages
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-Require fasteners of some sorts -Can be difficult to correctly mold to a stiff joint -Can trap moisture -May cause unnoticed pressure ulcers -Requires specialized equipment
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Plaster -Advantages |
-Quick and easy to apply -Requires minimal supplies -Superior conformation -Allows air circulation -Less expensive than Thermoplast -Cannot be removed unless therapist cuts off
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Plaster -Disadvantages
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-Difficult to keep clean -Not water resistant -Can be heavier for the pt than thermoplast -Can be messy to apply
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Fiberglass -Advantages
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-Superior rigidity -Light weight -Cannot be removed unless therapist cuts off -Can accept strapping
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Fiberglass -Disadvantages
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-Cannot get wet -Much less conformability than plaster -Expensive materials -Will cause pressure ulcers if applied incorrectly -Requires a special saw to remove
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Creep |
-Tissue permanently remaining in a lengthened state after being stretched and held under moderate tension for a long time -Creep occurs with dynamic splinting -has a constant pressure/tension
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Stress Relaxation
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-The continued decrease in stress needed to maintain a given deformation. -This occurs over time when tissues are stretched and held at a constant load/length. -Stress relaxation occurs with static-progressive splinting. -brings you to a certain end point and just holds the joint there, no more pressure after that
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-Emergent Phase |
24 to 72 hours post injury -Splinting is used to counteract the deforming position of edema, to support the extremity, and to maintain joint alignment (we don’t want it to get stiff! So put it in a functional position) -‘Safe Position’ splint -Splint is worn at all times except for ROM
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-Acute Phase |
72 hours to wound closure -Emergent phase to wound closure -Splinting can provide the stress need to orient the collagen being deposited during the early stages of wound healing as well as maintain joint alignment. -As the patients edema, ROM or wounds change, so does their splinting needs. -Vigilant oversight is needed to ensure that splints continue to provide safe and appropriate position for the patient. -As opposed to being all jumbled up as Jim was talking about -Splints are applied with bulk dressings or elastic bandages -Splint wear dependent on pt’s needs -Worn during all hours of sleep -As the pt’s ROM increases, their day time splint wear decreases -Care taken not to over immobilize the patient. -Static splints only
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Rehabilitation Phase |
Wound Closure to Scar Maturation -From graft adherence to scar maturation -Initially used to maintain ROM by opposing the force of contracting scar -Both dynamic or static splints can be used- pending skin condition -Casting has shown beneficial to provide positioning or serial casting to correct scar contraction of to increase ROM -Casting techniques can be used at any point throughout the rehabilitation phase -Splints in Rehab Phase
-if the skin is damaged, always use a static splint to prevent the shear forces -hypertrophic scar: raises on top of the skin, but does not exceed the boundaries of the wound
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Initial Assessment- rehab phase -What to look for:
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1. Skin contractures that already limit full AROM 2. Skin contractures that have the potential to influence AROM 3. Joint limitations with a soft end feel 4. Joint limitations with a hard end feel 5. Tissue hardiness/wound locations 6. Pt initial “buy in” for splinting/casting treatment
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What you need to know: |
-did your pt have full ROM at discharge from the hospital? -what is their home program? are they compliant? -does pain/fear limit their follow through? -If grafted: -how long did the wound take to close? -how much time was there in between injury and grafting? -if graphed – was it a sheet or meshed?
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Skin Contractures that Already Limit Full AROM 1. Elbows
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-examples of ther-ex include: -this is a common burn related injury -Elbow Extension Splint (picture below) -Position your patient in terminal elbow extension (preferably after tx of moist heat and ther-ex) then apply volar-based extension splint -put pt in terminal extension, stress-relaxation
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Skin Contractures that Already Limit Full AROM -Legs
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-this is another common burn-related injury -knee immobilizer for night use -NO PILLOWS behind the knees! -foot drop splint for Achilles burns -Examples of ther-ex include: -if the skin color is lighter than normal skin, it’s a mature scar, you can’t fix it
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Skin Contractures that Already Limit Full AROM -fingers
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-this is a common burn-related deformity -examples of ther-ex include: -1st Web Space Splint: -after achieving terminal palmar abduction of the thumb and full extension of the index and thumb digits, apply a 1st web space splint
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Skin Contractures that Already Limit Full AROM - shoulder
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-examples of ther-ex include: hot pack, massage, etc. but what happens when they leave? It’s just going to go right back where it was. You need constant stretching, which is where the splint comes in -place shoulder in 90 abductions then splint in place (airplane splint)
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Skin Contractures that Already Limit Full AROM Mouth |
-This is a very common burn related injury when the face is involved -A scar or skin graft will continue to contract until it meets an opposite and opposing force -microstomia device → -Examples of ther-ex include:
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joint Limitations with a Soft End Feel |
-examples of ther-ex include: -ASA HA -BrandonBowman -A scar or skin graft will continue to contract until it meets an opposite and opposing force |
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Joint limitations with a hard end feel
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-Examples of ther-ex include: -boutonniere deformity (L)
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Medicare Part B – |
* Limitations on usage
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Medicaid |
Covers same type of open wounds as Medicare Covers wound cleansers, cleansing supplies and most dressings covering the wound bed Medicaid allowances can be below cost of supplies Does not cover any supplies in a NH or MRDD-ICF |
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All insurances require: |
Physician’s order with wound location, size of wound (L-W-D), type of wound, amount of exudate, type of debridement, frequency of dressing change, type(s) of dressings to be used, and description of wound care. |
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If you acquire a wound (or nosocomial infection) |
in the facility, they are required to pay for it. Ex. SNF, hospital
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Protective Ointments |
help treat and prevent rash associated with diaper use or continued exposure to feces, urine or both. Use on intact, clear skin Use on red, dry skin Use on mild dermatitis Use on denuded skin Adheres to macerated skin Do not apply over deep or puncture wounds, infections or lacerations |
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Vitamins A & E |
help soothe and condition skin |
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Some contain clove oil |
with helps mask odor and slightly numbs the skin to help with pain |
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Karaya |
absorbs moisture and helps adhere to weepy, macerated skin |
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Extra Protection Barrier Ointment |
Protects skin from continued exposure to feces, urine or both. Usually contains high level of zinc oxide Will not wash away after repeated exposure to urine and feces zinc difficult to wipe off Contains Karaya to absorb moisture and adhere to weepy, macerated skin Some are fragrance free (alcohol is irritating to pts skin) Those with a higher petrolatum base can be clear so that you can see through the ointment |
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Dimethicone |
silicone oil that softens the skin without contributing to the lipids, or making the skin feel greasy |
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Antifungal Cream |
Antifungal cream is indicated for the treatment of Tinea cruris (jock itch), Tinea corporis (ringworm) and Tinea pedis (athlete’s foot). Water based, therefore absorbs quickly DO NOT USE IN AREAS EXPOSED TO URINE OR FECES Contains Vitamin E and skin conditioners |
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Deep Tissue Injury |
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.
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Stage II Wound Characteristics
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Dry, minimal moisture < 25% necrotic tissue Moist, lightly exudating > 25% necrotic tissue Moist, moderately exuding <25% necrotic tissue Wet, heavily exuding > 25% necrotic tissue |
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Dry wounds |
hydrate Wound gel with secondary dressing Hydrogel wafer with secondary dressing Transparent dressing if no exudate Thin hydrocolloid if none to slight exudate Soft silicone contact layer Moderate exudate – Thick hydrocolloid Foam dressings Greater than 25% necrotic tissue, debride, (autolytical, mechanical, enzymatic, surgical) |
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Moist wounds |
absorb and remove exudate Wound gel will slowly debride escar or slough Foam – thick or thin Alginate with secondary dressing loves these for wounds with massive amounts of fluid |
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Secondary dressings |
Bordered gauzes Island dressings-foam, guaze Woven or nonwoven gauze- prefers woven granulation tissue will grow into gauze Wraps ABD dressings More absorbent dressings |
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What to look for in a Transparent Dressing |
High breathability High vapor permeability, allows moisture to pass away from the wound and surrounding skin Application friendly (don’t pull out booty hair) Conforms to body contours Friendly adhesive |
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Wound Gels |
Donate moisture to the wound Maintains an optimal moist environment for wound healing Autolytically debrides – softens dry fibrin – 0.9% Sodium Chloride Apply to wound bed only – will macerate surrounding skin |
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Contact Layers |
Prevents damage to newly formed delicate tissue upon removal (like the shiny surface of a band-aid) Enables less frequent dressing changes Minimizes the risk of maceration Does not adhere to moist wound beds but to dry tissue only Minimizes trauma and pain on dressing changes Transparent for each wound inspection during application and wear Conforms well to body contours, promoting patient comfort during wear
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Foam Dressings |
Lite, Regular, Bordered Used for low, to moderate exudating wounds Foam dressings are designed for a wide range of wounds from skin tears and abrasions to surgical incisions, 2nd degree burns, blistering, partial and full thickness grafts, diabetic ulcers, venous and arterial ulcers. If signs of infections, use only if proper infection treatment is initiated and if recommended by treating physician. Benefits: Transfers exudate away from the wound Can be cut to shape (if not bordered) Designed to be changed every 3 days – can extend to 7 days |
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Hydrocolloids |
thin, regular & bordered Provides a moist wound environment required to activate local enzymes Provides a microbial barrier Adheres to slightly moist skin Can be used as a primary or secondary dressing Facilitates autolytical debridement of fibrin & necrotic tissue |
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Hydrocolloids uses |
Superficial and partial thickness wounds Full thickness wounds with an exudate management product, i.e. alginate or packing Dry necrotic wounds with a wound gel |
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Alginates/Hydrofiber Dressings |
Alginates absorb 20 times their weight Hydrofiber absorbs 5 to 6 times more than a gauze Both insulate the wound, or fill the dead space Both become non adherent as exudate diminishes Controlled wicking occurs Converts to clear gel or gel-fiber matrix Strong tensile strength allowing simplified application/removal |
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Alginates/Hydrofiber Dressings uses |
Deep or shallow wounds with or without undermining/tunneling – moist to wet wounds Cut to fit wound bed – Do not pack tightly – Will dry out surrounding skin
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Silver Dressings |
Silver timed release particles have now been added to all types of dressings. From foams, alginates, contact layers, absorbent gauzes, etc. They are effective at rapid and sustained release of silver – usually from 3 to 7 days The idea of silver is to inactivate wound related pathogens’ By reducing the number of microorganisms, the silver may also reduce odor. |
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Silver Dressings Uses: |
Lower extremity ulcers Pressure Ulcers Diabetic Ulcers Infected Wounds Do Not: Use on patients with a known sensitivity to silver Use during radiation treatment or where x-rays, ultrasound, or magnetic imaging may take place Do not mix with oxidizing agents such as hydrogen peroxide |
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Composite Dressings |
All in one dressing Has a contact layer -allows exudate to pass to absorbent pad Absorbent pad absorbing the exudate minimizing the risk of maceration Protective film which is semi permeable preventing wound fluids from passing through the dressing and protecting the wound bed from contamination. Bordered with an adhesive to keep the dressing securely in place |
