160 Final Flashcards
Signs of Wound Infection
Redness
Swelling
Warmth
Odor
Yellow Crust formation
Pus, cloudy, watery fluid
Low grade fever, chills
Tender lumps/swelling at neck, armpit, groin
Tissue texture
Red streaks running from wound out
Post Surgical Swelling
Sweeling near the incision site is rish in protein. Distally is softer and pitting
Swelling occurs to the whole arm
Cellulitis
localized swelling and redness of the subcutaneous tissue
Sometimes combined with fever
commonly LE, can occur UE and face, torso
Manual Techniques for Lymph edema
Message, light gentle strokes in direction of lymph flow
Proximals to distal to proximal
Fibrotic tissue requires more “kneading”
Exercise techniques for lymphedema
Low exertion, slow and rhythmic
Diaphragmatic Breathing
Careful with weight lifting
Aerobic
Exercise with compression garments if possible
Posture
ROM in all extremities
Swimming is good, cautious with skin care
Documentation of a Wound
Size, Depth Location
Color
Odor
Alt Sensation
Circulation
Wet/Dry
Surrounding skin appearance
Stages of Wound Infection
Stage 1 - Erythemia of the skin. Epidermis still intact.
Stage 2 - Dermis penetrated. Wound is usually moist and pink with no necrotic tissue
Stage 3 - Subcutaneous penetrated. Tunneling and Undermining can ossur. Exudates and infection may be present.
Stage 4 - Deep tissue (fascia, bone, tendons) are affected. Tunneling, infecetion, exudates can occur.
Wound Dressings
Wet to wet - Stage II, III, IV, and unstaged
Wet to Dry - Stage II, IV for debridement
Transparent film - Satge I, II, with blister formation, over boney prominences, and non infected wounds
Hydrocollid - Stages II, III with minimal drainage
Hydrogel - Stages II, III
Wound Dressing Purpose
Stop the spread of infection, from wound to other areas
Prevent contamination
Control hemmorhage
Absorb wound drainage
Assist in wound healing
Compression Wrap Purpose
Prevent re-accumulation of Evacuated lymph fluid
Pressure applied to reduce filtration
Improves muscle and joint pumps
Breaks up fibrotic tissue
Facilitate protein absorption
Debridement Methods
Sharp - scalpel
Mechanical - hydrotherapy
Chemical - rarely used
Autolytic - bodies own enzymes to rehydrate necrotic tissue
Enzymatic - application of gels to rehydrate necrotic tissue
Bilogical - maggot therapy
Pressure relief techniques
Chair pushups
Lean from side to side
Airflow beds
Freq position changes
Bed incline at min 30 degrees to prevent sliding
Lymphedema
(characteristics)
Feeling of fullness in area
Tightness of skin
Affects LE, sometimes UE
Loss of motion in wrist, hands, ankle
Uncomfortable, not painful
Asymmetrical
Lymphedema
(Skin Changes)
Shiny
Tough
Blisters
Papillomas: small benign epithelial tumors
Hyperkaratosis: Thickening of the outer layer of skin
weeping, oozing lyph fluid
Superficial skin lesions
Lymphedema
(treatment)
Compression bandages help to prevent further swelling
Manual exercise, and exercise
Hyperglycemia
*Too little systmeic insulin
Flushed, dry skin
drowsy
thirsty
high glucose in urine
fruity odor breath
Vomiting
Loss of appetite
*Treat with insulin
Hypoglycemia
*Low blood sugar d/t excessive insulin
Perspiration
Anxiety, irritability
Shakey, trembling
Weakness
Pale moist skin
Convulsion
Confusion
*Treated with candy, juice, rest
Measuring edema accuracy
Boney landmarks
Same tape meaurer
Tension gauge
Same person to meaure (if possible)
Taken in CM
Relaxed position
Steril Field Rules
- Steril person’s withing a sterile field only
- Once package is opened, borders are contaminated
- Waist/Table top above is sterile
- Top of table is sterile only
- Movement within, breaks field
- Particles (coughing, talking) breaks field
- Prepare close to time needed
- Non-sterile person can prepare sterile field
Venous insufficiency
Venous flow in poor
Dark dusky appearance
Dry and flaky
Low protein
Arterial Insufficiency
Thin, red, shiny skin appearance
Hairloss
Painful with elevation
Ascites
Abdominal swelling. Can travel into LE
Commonly caused by liver cirrhosis
Anasarca
General edema in very ill pts
CHF, Renal failure, Electrolyte imbalance
Lipedema
Low protein primarily in the LE
Women
Does not include dorsal swelling
Lymphedema and Kinesio taping
10 % tension
high anchor
increases space for fluid to flow back up into
Amputation Levels
Preserve as much boneand joints as possible. Determined by presence of pulse.
TT - Mid Tibia
TF - Mid Femoral
Hip Disartic - Removal through acetabulum
Symes - Ankle (malleoli and below)
Transtarsal - Mid tarsals
Chopart - Ankle (saves Calcaneus and talus)
Jewett Hyperextension
Limits flexion and puts paient into extension
TLSO
Milwaukee Brace
Extended up to the neck
Scoliosis
Boston Brace
Helps with scoliosis
Clamshell, TLSO
Clamshell Brace
Used when the spine/spinal cord has been injured
Prevents flex, ext, twisting
Phantom Pain
Pain sensation felt where the limb used to be
Treatment: TENS
Message
Heat
Biofeedback
Subtalar Neutral
About 0-5 degress inversion
Femoral anti- retro version
Antiversion of 12-15 is normal
The angle of the femoral head within the acetabulum
Tibial Torsion
Normal is 15-20 ER
Pulmonary Edema
Excessive accumulation in the lungs
Often caused by L ventricular Failure. Also from injury
Heat stroke
Diaphoresis, dry
Flushed or gray
Elevated temp
Nausea
Labored breathing
Strong rapid pulse
Pupils contract then dilate
Collapse, convulsing
Unconsciousness
Heat exhaustion
Profuse sweating
No fever
Weak rapid pulse
Shallow rapid breathing
Pale
Collapse
Nausea
Unconsciousness
Norm pupils
Heat exhaustion & stroke treatment
Move to cool shaded area with good airflow
Ice to groin, axilla, forehead
EME personell
Heat exhaustion can lead to heat stroke
- Refusal of liquids
- Vomiting
- Schock
- LOC
Fracture
Procedure
Gather info on cause, location, pain
Restrict mvmnt
Monitor HR, BP
Palpate for swelling, tenderness, deformity, bruising
Apply support with firn object
Cover with sterile dressing
If Spinal fx is suspected (use 3 ppl to log roll onto a flat board)
Evaluate neurological function and sensation
Call for transport
Burn
Procedure
Remove agent causing the burn
If chemical dilute with water
Remove clothing around burn, not what is a part of the wound
Remove jewelry
Call EME if bad
Observe for shock, resp distress
Call for transport
Seizures
Procedure
Place pt in safe location, position. Move objects out of way
Keep airways open. (not by placing anything in the mouth) Head tilt, jaw thrust
Monitor respiration. May have an episode of tonic contraction of all muscles, ceasing resp for 50-70 secs. when breathing returns it will be slower and deeper.
Allow rest
Fall
Risk Factors
>65
Impaired vision/hearing
Use of A.D.
Decreased strength, flexibility, balance, coordination, proprioception
Prev Hx of falls
Seizure, syncope, vertigo
Medication
Inattentiveness to while walking
Shock
Procedure
Determine cause
Calm pt
Cool compress
Monitor HR BP
Place person supine, legs elevated
Control bleeding if present
Call for Treatment
Monitor
Allergic RXN
Procedure
Initial
- Calm Pt
- Identify/remove agent
- Apply ice/calime for itch
- Observe for increased signs
- Obtain/refer for med assist
Severe
- Check aiways (if compromised, get assist and begin CPR)
- Assist with ingestion/injection of meds (if DIB, do not ingest)
- Pt supine, LE elevated to prevent shock
Allergiv RXN
Signs
Acute:
- Itchy skin
- Rash
- Redness
- Swelling
- Sneezing
- Hives
- Itchy/watery eyes
Severe
- Facial swelling
- DIB, wheezing
- Abd pain, Nausea, Vomiting
- Dizziness, syncope
Autonomic Hyperreflexia
Dysreflexia
Sympathetic response to a noxious stimulus below the lesion of injury. (Cervical to T6 injury)
- HTN
- Headache
- Profuse sweating
- Red skin blotches
- Goosebumps
- General ill feeling
- Convulsion
- Poss unconsciousness
Autonomic Hyperreflexia
Treatment
Place pt recumbant or sitting (not supine)
Identify and remove stimulus
Monitor vitals
Obtain Med assist
Cardiac Arrest
Treatment
CPR
911
AED
Plantar Fascia
Plantar aponeurosis
Originates medially off calcaneal tuberosity and atatches at the base of the proximal phalanges
Provides stability durig toe off phase.
Support longitudinal arch or foot
Metatarsalgia
Pain at the metatarsal heads due to fatty pad atrophy causing compression of th plantar digital nerve
Morton’s Syndrome
Neuroma in the plantar digital nerve because of compression
Try to redistribute the pressure from the 2nd and 3rd MTP to the proximal hallux and stabilize rearfoot
Shoe: Longe medial counter, wide oe box, thomas heel or wedge
Post Surgery Pre Porsthetic
Limb care
Edema control
- Wrapping
- RIgid removal dressings
Desensitization
Preventing scar tissue
Phantom sensation
Strengthening (prevent contractures)
- Hip flex/ext
- Kne flex, ext
Quadrilateral socket construction
Post wall - Brim to Ischial Tuberosity (hip in 15-20 flex
Medial wall - Same height as post wall, groove cut out for pressure releif. Slight Add for abd stretvh
Ant wall - 2 1/2 inches taller to keep ischium on seat
Lat wall - Same as ant wall to stabilize limb in prosthesis
Distal end - Designed for pt comfort
- Total contact, hard plastic end
- Distal air chamber - soft leather pad
- Open
Abducted Gait
Prosthetics
High Medial Wall
Too long
Abductor contracture
Circumducted gait
Prosthetic
Knee locked in ext
No PF
Too long
Weak hip flex
Abd Contracture
Lat trunk bend gait
Prosthetics
Short limb
Weak Abductors
High medial wall (pain)
Low lateral wall (stability)
Vaulting Gait
Prosthetics
Knee locked in ext
Weak hip flex
Too long
Lumbar lordosis gait
Prosthetics
Tight hip flex
Short ant wall
Painful ischial WB
Weak hip ext
Weak abdominals
Unever step length gait
Prosthetics
Weak stump
Poor balance
Hip flex contracture on unaffected side
Weak hip ext
Improper socket fit
Pain
Not enough flex
Terminal swing impact gait
Prosthetics
Not enough knee friction
Excessive hip flex with strong hip ext
Foot slap gait
Prosthetic
Heel too soft
DF foot
Knee Flex
Foot too posterior
PF bumper too soft
