Wound Care - Ch 4 And 8

Front 1

3 OVERALL things to do with wound care PT

Back 1

History
Systems Review
Tests/measures

Front 2

Information to get in history about past/current wound

Back 2

Acute vs. chronic
Insidious onset vs. trauma
Diagnostic, blood work, wound culture, arteriogram, radiological studies

Front 3

Systems to include in systems review

Back 3

CV/CP: HR, BP, RR, edema, pulses
MSK: posture, ROM, strength
NM: gait, mobility, balance
GI: nutrition assessmen
Urogenital: incontinence and ulcer risk
Integumentary: color, scars, hair, nails

Front 4

What wound characteristic do you measure for every wound?

Back 4

Location
Size
Tunneling/undermining
Wound bed
Wound edges
Drainage
Odor

Front 5

Overall general wound assessment for every wound

Back 5

Wound characteristics: location, size, tunneling/undermining, wound bed/edges, drainage and odor
Periwound and associated skin: structure, quality, color, appendages, edema, temperature
Circulation
Sensory integrity

Front 6

Options for measuring the size of a wound?

Back 6

Direct measurements: LxW and probe for depth, describe with clock method
Wound tracings
Photos
Volumetric
Total body SA

Front 7

PROs vs. CONs of wound tracings?

Back 7

PROs: more accurate representation of wound size, can be done on grid paper to get exact area
CONs: time consuming

Front 8

What type of wounds is tunneling/undermining common in?

Back 8

Neuropathic and pressure ulcers

Front 9

What do you need to document concerning the wound bed?

Back 9

Types of tissue, amt. of granulation, necrotic tissues and other structures as a percentage
Slough, eschar, adherence, exposed mm, tendon, etc

Front 10

Slough vs. eschar

Back 10

Slough is yellow or tan and ha a stringy mucinous consistncy
Eschar is black necrotic tissue that can be soft or hard. Lifely to be full thickness if present

Front 11

Dif types of wound drainage

Back 11

Serous: protein rich with few WBCs = inflammatory
Sanguinous = red when fresh or brown when dried due to blood
Purulent: infection

Front 12

How should wound odor be documented?

Back 12

Present or not present

Front 13

What things should you document about the periwound?

Back 13

Structure and quality (dry vs. macerated, turgor, calluses, etc)
Color: blanchable? Erythema = inflammation or infection. Light/pale = dec BS
Appendages: no hair = AIU
Edema: VIU
Temp: inflamm or infection or AIU if dec'd

Front 14

What aspects of circulation should you assess for every type of wound?

Back 14

Peripheral pulses (0-4) - f/u with doppler if absent
Capillary refill: indicator of surface BF

Front 15

What aspects of sensory integrity should you assess with every type of wound?

Back 15

Especially w/ DM, neuropathy, burns
Less than 5.07 = loss of protected sensation

Front 16

What is the 5 PT method?

Back 16

Method to identify wound etiology
Pain, position, presentation, periwound, pulses, temp

Front 17

Purpose of wound irrigation?

Back 17

Remove loosey adhered debis, bateria, exudate, dressing residue, topical agents
Faciltates debridement
Promotes moist wound healing

Front 18

Purposes of whirlpool?

Back 18

Same as wound irrigation plus...
Promotes circulation, dec pain
ROM is easier

Front 19

Indications for whirlpool

Back 19

Infected wound
Nondraining wound (AIU)
Wounds with thick escar or exudate

Front 20

Contraindications for whirlpool

Back 20

Wounds that have edema, draining or are macerated
Tunneling/Undermining
VIU's
Incontinent w/ perineal submersion
Cardiac instability

Front 21

Disadvantages of whirlpool

Back 21

Time consuming and expensive
Cross-contamination
Cannot calibrate irrigation machine

Front 22

What type of modalities would you use for healing granular wounds?

Back 22

ONLY gentle irrigatoin

Front 23

Purposes of pulsed lavage?

Back 23

Irrigates wound bed with precisely calibrated pressure
Maintains moist wound bed
Facilitates debridement
May enhance granulation tissue formation, epithelialization, and tissue perfusion

Front 24

Contraindications for pulsed lavage?

Back 24

Exposed deep tissue
FAcial wounds
Anticoaulants

Front 25

Advantages of pulsed lavage over whirlpool

Back 25

Can be used in any setting
Quick and inexpensive
Low risk cross contamination
Tunneing/undermining wounds
May be used for VIU (does not iinc edema

Front 26

Purposes of ESTIM

Back 26

Restores current of injury
Galvanotaxis
Stimulates cells
Inc BF
Combats infection
Reduces edema
Enhances autolysis

Front 27

Indications for ESTIM

Back 27

Chronic or recalciatrant wounds - clean or infected
Has not responded in 30 days to conservative tx (Medicare)

Front 28

Contraindications for ESTIM?

Back 28

General ESTIM precautions
Untreated osteomyelitis
Topical agents with heavy metal ions
Sensory neuropathy

Front 29

What polarity should you use for ESTIM?

Back 29

Cathodal (neg): infected wounds
Anodal: (pos) promote granulation and epithelializtion

Front 30

Parameters for ESTIM?

Back 30

80-135 Hz
75-200 volts, submotor
45-60 mins

Front 31

How is low-frequency US with saline mist proposed to work?

Back 31

Produce changes at cellular and proein levels due to greater amt of cavitation and acoustic streaming
Enance all 3 phases of wound healing, inc collage deposition, enhance wound contraction, improve scar pliability

Front 32

Contraindications for US?

Back 32

Untreated osteomyelitis
Active, profuse bleeding
AI
DVT

Front 33

Disadvantages of US?

Back 33

Less research
Only small wounds
Contamination
Painful

Front 34

Purposes of NPWT?

Back 34

Inc BF, Dec edema
Inc angiogenesi, granulation, epithelialization
Dec bioburden
Maintain moist, warm wound env

Front 35

Contraindications for NPWT?

Back 35

Necrotic or body cavity wounds
Osteomyelitis
Exposed BVs

Front 36

Indications for HBO?

Back 36

Chronic, slow-healing hypoxix wounds that reverese wih TCOM test

Front 37

Contraindications for HBO?

Back 37

DVT, CHF, COPD
Prego, SEVERE AI