Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
46 Cards in this Set
- Front
- Back
|
When may a pressure ulcer be unavoidable?
|
Deathbed - skin is an organ and it can fail too
Ambulance, ER, X-ray, surgery they don't think about pressure relief |
|
|
6 roles of PT in wound care
|
Prevention (all settings)
Mgt of wounds (outpt, hospital) Ancillary modalities Team member (nurses) Autonomous clinician (make decisions) Physician mgt (take orders or tell doc what ya need) |
|
|
What should you select tx strategies based on?
|
Wound status - not doc's orders
Wound changes from day to day - need to be proactive |
|
|
2 types of Stadards of Best Practice?
|
Evidence Based - National Pressure Ulcer Advisory Panel
Best Practices - expert opinion based for AI, pressure and neuropathic |
|
|
How do you identify pts at risk for pressure ulcer? What do you need to establish specifically for the pt?
|
Braden Scale or Norton Scale (used with comprehensive Risk Assessment)
Establish Tissue Tolerance for Pressure based on their skin tolerance |
|
|
Cons of Braden Scale? What can we do?
|
Leaves off some risk factors like radiation therapy that also compromise skin integrity
use with Comprehensive Risk Assessment |
|
|
Specific interventions for pressure ulcers to reverse risk factors for pressure ulcers?
|
Nutrition (adequate fluid, protein, calories)
Edema control Inc circulation Pressure relief Change meds Skin care - ie. tx dry skin Incontinence mgt - ie. moisture barriers |
|
|
Laundry list of risk factors for pressure ulcers?
|
Smoking
Moisture Friction/shear Pressure Malnutirion Age Dehydration Steroid use Chemo or radiation |
|
|
What can you do about unstable BP and prevention of pressure ulcers?
|
Not alot - don't turn em
Hemodynamically unstable: BP drops and goes only to vital organs, not skin |
|
|
What lab values do you want to keep an eye when preventing pressure ulcer?
|
Hgb
Pre Albumin and albumin Hemoglobin A1C (DM) BUN and BUN/creatinine CBC |
|
|
What sites are at highest risk for pressure ulcer for:
1. Sitting 2. Side lying 3. Recumbent 4. Commatose |
1. Isch tub's (90deg), spinous processes (kyphotic)
2. malleoli, knee epi's, GT, ear 3. Sacrum (shear) and heels 4. Occiput, nose/ears from cannula |
|
|
4 ways to relieve pressure
|
1. Bridging
2. Turning schedule 3. Positioning 4. Pressure redistribution mattresses or seat cushions |
|
|
Why is it important to avoid skin on skin contact for prevention of pressure ulcers?
|
Reults in pressure plus perspiration causes maceration
|
|
|
What is the point of pressure relief surfaces?
|
Spread pressure over larger surface
|
|
|
What are Low End Pressure Redistribution Surfaces: Grp 1 and give exampels
|
Do not consistently maintain interface pressures below capillary closing pressures in all body locations
Static: foam, air or gel mattresses overlay Water fill mattress OR, ER tables gurneys: gel or tempura foam |
|
|
What are Pressure Redistribution Support Services: Group II and III?
|
Pressure relief devices consistently reduce tissue interface pressure to a level below cap pressure.. "high end or high tech"
Grp II: Low air loss beds or Fluidized air or high air loss therapy Grp III: Kinetic therapy beds |
|
|
What are:
1. Low air loss beds 2. Fluidized air or high air loss therapy beds 3. Kinetic therapy beds |
1. Series of connected air filled pillows with low friction surface fabrics - air blowing thru it and can adjust pressure for various body segments
2. Silicone glass beads with air and fluid support (Clinitron). Air moves beads, which moves pressures around 3. Conitinuous passive motion beds |
|
|
What risk factors does the Braden Scale assess?
|
Sensory perception - ability to respond to discomfort
Moisture Activity Mobility - ability to change and control body position Nutrition Friction and shear |
|
|
How can you avoide pressure ulcers on the heels?
|
Float heals
PRAFO (pressure relief) such as SAGE boot that offers total contact pressure Foam boots (?) |
|
|
What may be a potential problem with plastic boots in preventing heel ulcers?
|
Could cuase pressure ulcers on side of foot or achilles
|
|
|
Ideas to reduce fricton pressure ulcers?
|
Draw sheet transers
Corn starch on bed sheets Boam boots and elbow pads Sheep skin (Ok for friction, not good for pressure - also very hot) |
|
|
What is IRD? How do you recognize it?
|
Incontinence related dermatitis
flat, red, warm with little bumps (little bumps differentiate it from cellulitis) Dermatitis is due to some allergen or secondary source.. ie urine or feces Can progress to cellultis and then to a pressure ulcer b/c more at risk for pressure ulcer with maceration |
|
|
What often causes a fungal infection?
|
IRD - urine or feces in a dark, warm, wet area that is a fungus breeding ground
|
|
|
What does slough or escar tell you about a pressure ulcer?
|
Full thickness, Stage III (pattern D) or stage IV (Pattern E)... as long as it's over a bony prominence
|
|
|
5 types of moisture barriers?
|
Transparent dresing (tacky on one side)
Ointments (ie. Calmoseptine) Polyurethane spray Adult diapers that wisc fluid away Catheter (approp for stage III or IV) |
|
|
What is Calmoseptine? Problem wit it?
|
Zinc oxide base... moisture barrier put directly on wound
Thick and hard to clean off so you have to rub hard which may damage skin USE mineral oil |
|
|
What is Polyurethen spray?
|
Moisture barrier "no sting barrier" that creates a thin plastic film that you can attach tape to and it protects teh skin
|
|
|
Recommendations to avoid shear forces? When are the exceptions?
|
Keep head of bed lower than 30 degrees
Stay out of recliner chairs or use pressure relief surface thin gel More position changes and pressure relief surfaces Acute CHF and COPD b/c can't breathe supine |
|
|
What is the MOI for shear forces?
|
Microtears of fascia and muscles
Often leads to tunneling and undermining |
|
|
How should a pt be positioned on their side to avoid pressure ulcers?
|
30 deg beteen supine and side to avoid GT pressure
|
|
|
W/c seat cushions from best to worst
|
Alternate air cushion
Roho/multiple air cell Gel Gel/foam combo Foam |
|
|
Appropriate seating options in the hospital?
|
Bedside chair - thin gel cushion
Cardiac/Geri chair - tempura foam or gel overlay |
|
|
How can we prevent pressure ulcers in w/c?
|
Spread pressure over largest area possible
Total contact with greater relief over vulnerable areas Prevent sacral sitting 2 finger rule on either side of w/c and under knees Can use wedge foam cushion.. (?) |
|
|
How can you have total contact for w/c with kyphotic pt?
|
Molded chair back with ...
2 metal stays that you can bend Recessed moldable back |
|
|
5 early signs of ischemia?
|
Intermittent claudication (recurs consistently when get to certain point)
Nocturnal pain relieved by dependent positiong Pain at rest Trophic changes Absent or reduced pulses |
|
|
What can onse cig do?
|
Cause spasms of arteries and 30% reduction of BF for 1 hour or more
|
|
|
How do you identify AIU?
|
Pedal pulses absent
ABI <.9 Shiny, taut, thin, dry, cool, pale skin with hair loss Rubor of dependency = flushing Venous filling > 20 secs Capillary refill (surface BF) Segmental pressure measurements |
|
|
What can we do to "treat' AIU outside of wound care?
|
Develop collateral circulation with progressive exercise
Positiong to inc BF Avoid compressive forces Prevent trauma to AI limbs |
|
|
How are antibiotics used once infection has been determined in AIU?
|
Systemically and topically.. difficult to get to wound systemically with poor perfusion
|
|
|
Recommendations for comined AIU/VIU?
|
Pumping to reduce edema
Neutral aleveation |
|
|
What to do for ABI...
<.05 .8 to 1.0 >1.0 |
<.05 refer to vascular specialist and compression therapy contraindicated
0.8-1.0 mild AI.. make sure doc is on board if you're going to do compression (Combined VI/AI) >1.0 refer to vascular specialist due to calcification |
|
|
Underlying cause of venous stasis ulcers?
|
Incompetent valves - HTN and congestion
Comibined lymphedema often COMPRESSION, ELEVATION, EXERCISE |
|
|
Characteristics of a VIU?
|
Edema
Hemosiderin staining Flaky skin Oozes serum Lower leg above medial malleoli |
|
|
Tx strategies for VIU.?
|
Eelvate and ex in elevated pos'n
Compression stocking Intermittent compression Multilayered wraps Unna boots CircAids Ted Hose (don't think so) |
|
|
What can we do for neuropathic ulcers outside wound care?
|
Control Blood sugar
Prevent frictionand pressure Prevent trauma Trim calluses Molded diabetic shoes (off load pressure) Education: insert hand before foot in shoe and instruct to visually inspect areas at risk (mirror) |
|
|
Where are nuropathic ulcers located?
|
MTH, heel, lateral malleolus
|
