705 Flashcards
1
Q
mechanisms of heat transfer
A
conduction
convection
radiation
conversion
2
Q
shortwave diathermy microwave diathermy infrared light UV light Laser Are all forms of
A
electromagnetic therapy
3
Q
By direct contact of body with heat or cold modality
A
conduction
4
Q
particles (air or water) move across the body, creating a temperature variation
A
convection
5
Q
transfer of heat from a warmer source to a cooler source through a conducting medium such as infrared lamps transferring heat through air
A
Radiation
6
Q
converting one type of energy to a thermal energy
A
conversion
7
Q
when does cryotherapy have the greatest benefit
A
acute injury
8
Q
cold therapy indications
A
acute, chronic pain acute swelling myofascial trigger points muscle guarding, spasms acute muscle/ligament sprain acute contusion bursitits tenosynovitis tendinitis delayed onset muscle soreness
9
Q
instructions for cryotherapy
A
within 24 hours of acute injury
apply for less than 20 min without pressure
BMI >25 will require longer
10
Q
contraindications for cryotherapy
A
impaired circulation peripheral vascular disease hypersensitivity to cold skin anesthesia open wounds or skin conditions infections
11
Q
indications for heat therapy
A
subacute, chronic pain subacute, chronic inflammatory conditions resolution of swelling.edema removal myofascial trigger points muscle guarding, spasms subacute muscle/ligament sprain subacute contusion
12
Q
contraindications for heat therapy
A
impaired circulation peripheral vascular disease skin anesthesia open wounds or skin condiditons acute musculoskeletal conditions
13
Q
typical temp of a warm whirlpool
A
98-110 degrees F
14
Q
typical temp of a cold whirlpool
A
50-60 degrees F
15
Q
treats chronic joint pain
relaxes stiff muscles
improves blood flow
helpful for chronic skin disorders such as eczema and psoriasis
increases ROM for people with arthritis, bursitis and other chronic conditions
A
Paraffin
16
Q
characteristics of diathermy
A
thermal and non thermal effects
depth of penetration deeper
maintains higher temp 2-3 times longer than heating pad
17
Q
emits electromagnetic energy at a much higher frequency 915-2450 MHz
frequency increases the penetration of energy in the tissue decreases, thus providing a more shallow tissue heating effect
generate a stronger electrical feild
A
microwave diathermy
18
Q
continuous and pulsed
three specific frequencies and corresponding wavelengths
13 MHz, 22m
27 MHz, 11m
40 MHz, 7m
heating of deep tissues (continuous) or non thermal physiological effects (pulsed)
A
shortwave diathermy
19
Q
occurs when both the biological tissues and oscillating generator are oscillating at the same frequency
only with complete resonance can the electromagnetic energy be fully delivered to the tissues
A
tuning
20
Q
size of transducer that is producing the vibration
A
Effective radiating area
21
Q
some parts of crystal may emit more energy than others (hot spots) move sound head at all times
this can be 6:1 or less and be acceptable
means on area of head is emmitting 6xs more energy
A
beam non-uniformity ratios
22
Q
in ultrasound frequency and depth of penetration are
A
inversely related
higher frequency less penetration
lower frequency deeper penetration
23
Q
transforms mechanical energy to electircal energy
A
piezoelectric effect
24
Q
propagation through tissue
A
more dense tissue- closer together the molecules are and faster the energy will be transmitted and more energy will be absorbed
25
contraindications for ultrasound
```
not over abdomen or low back during pregnancy
not to eyes, genital or over heart
not over pacemaker
not over tumors or abdominal growth
not over infection or abscess
not over ischemic areas
not to insensate areas
not in presence of thrombus
not to epiphyseal plate in growing children
```
26
ultrasound is used to enhance delivery of selected medication into tissue
phonophoresis
27
contraindications for massage
```
edema from total system fialure
acute inflammatory edema
any area known or with suspected clot
any site of known or suspected aneurysm
tumors
over open lesions, conditions that spread
abnormal abdominal mass
non union FX
graft sites
```
28
long stroking, gliding movements following length of muscle
used to apply lubricant
begins and ends massage
not intended to move deep muscle mass
physiological effect when moving from periphery towards heart
effleurage
29
kneading, compress and release movements used to lift subcutaneous tissue up and off underlying structures
petrissage
30
small circular strokes with deep pressure done with the thumb; linear strokes done with sides of hand, finger tips, back of hand heel of hand
used to loosen/soften tight mm tissue
friction
31
percussive strokes using alternating hands in rapid rhythmic motion
tapping: finger tips
hacking: ulnar boarder of hands
cupping
pinchment: alternate pinching with thumb and index finger
tapotement
32
transmitting trembling motion from PT hands onto tissue
use after deep pressure of trigger point
used for joints after deep stroking
vibration
33
pull skin in opposite directions perpendicular to muscle
connective tissue massage
34
find tender area and may feel tightness in the area
apply pressure with finger or thumb
duration 1-5 min/point
trigger point massage
35
weight of water pushing against a surface
| filtration force
hydrostatic pressure
36
attraction of water to large molecules
| attracts water in from the interstitial space
osmotic pressure
37
lymph organs
```
thymus
lymph nodes
spleen
tonsils
lymph follicles of mucous memebrane
```
38
lymphatic failure
transport capacity normal
lymphatic load increased
dynamic
| edema
39
lymphatic failure
transport capacity decreased
lymphatic load normal
mechanical
| lymphedema
40
lymphatic failure
transport capacity decreased
lymphatic load increased
combination
| lymphedema
41
lymphatic failure
transport capacity normal/decreased
lymphatic load increased due to right ventricular failure
hemodynamic
| cardiacedema
42
lymph drainage contraindications
```
malignant diseases
acute infection
DVT
cardiac edema
renal fialure
radiation fibrosis (local)
peripheral arterial disease (compression)
```
43
the upward thrust acting in the opposite direction to the force of gravity
the more deeply immersed you are in water, the less you weigh
allows a reduction in oint compression forces by being weightless
buoyancy
44
the pressure exerted by a fluid at equilibrium due to the force of gravity
hydrostatic pressure
45
ideal temp for aquatic therapy
92 degrees
46
contraindications for aquatic therapy
```
any infection
fever
heart failure
UTI
incontinence
epilepsy
blood clots
fear of water
```
47
```
aquatic therapy technique
similar to tai chi
slow movements and deep breathing
movements must flow
decrease pain, increase balance
```
ai chi
48
aquatic therapy technique
method of muscle re-education
therapist uses physiclal properties of water to interact with patient
bad ragaz
49
aquatic therapy technique
water and land based therapy
starts in water working on balance and postural awareness
focus on vertical alignment first, incorporate exercises in different planes
burdenko method
50
aquatic therapy technique
uses games for variety of educational and therapeutic reasons
used mainly with pediatrics and patients with disabilities
no buoyant aids are used
purpose is water freedom
hallwick
51
```
aquatic therapy technique
cradling one on one program
free flowing nature promotes self-awareness of muscle tension
promote relaxation
decrease pain
```
Watsu
52
contraindications for e stim
patients with an electronic demand-type cardiac pacemaker
over the carotid sinus
internally
over the eyes
transcranially or int he upper cervical regions in patient with history or CVA
transthoracically (careful of heart)
over any area that would have a tendency to hemorrhage
over laryngeal or pharyngeal muscles
53
where is a motor end plate generally found
proximal 1/3 of the muscle
54
movement of charged particles
| measured in amps
current (I)
55
change in electrical potential between two points
the greater this is the deeper we can drive current into the body
how hard we push the current
voltage (V)
56
relative opposition to movement of charged particles
| measured in ohms with direct current or impedence with alternating current
Resistance (R)
57
events in a definded amount of time, measured in pulses per second (pps), cycles per second (cps or Hertz), beats per second (bps)
frequency
58
intensity or maximum voltage
| generally in millivolts (mV)
amplitude
59
Frequency: muscle contractions generally don't get any stronger than ______. we use ______ with a long ______ pulse duration
50 Hz
20-40 Hz
>300 ms
60
frequency: sensory stimulation is generally delivered at _________ as a shorter pulse duration
80-120 Hz
61
getting used to a feeling and diverting attention from it
accommodation
62
modulations that can delay accomodation
amplitude modulation
| frequency modulation
63
current flow in one direction for a finite period of time
phase
64
the time from the beginning to the end of an electrical event (even if the waveform leaves and returns to the baseline several times)
pulse
65
positively charged atoms
cations
66
negatively charged atoms
anions
67
negative terminal, attracts cations
cathode
68
positive terminal, attracts anions
anode
69
patients often report feeling a slight tingle prior to muscle movement but before it becomes painful, why is this
sensory fibers can be slightly bigger than motor fibers (pick up faster)
cutaneous nerves are near the skin surface where the current density is the greatest
70
stimulating bigger nerve fibers will override any signals coming from smaller ones through inhibitory interneurons
gate theory of pain control
71
electrotherapeutic current that stimulates peripheral nerves
TENS transcutaneous electrical nerves stimulators
72
electrotherapeutic current that stimulate muscle directly
neuromusclular electrical simulators NMES
73
gold standard for acute pain management
2 channels
variety of features depending on the unit
TENS transcutaneous electrical nerve stimulation
74
electrotherapeutic current contraindications
```
cardiac pacemakers
HX of cardiac arrythmias
phrenic or urinary bladder stimulators
deep brain stimulators
carotid sinus (scalene triangle)
temporal lobe
eyes
larynx locations
malignancy
superficial skin lesion
pelvic region in pregnancy
anxiety
```
75
pain inhibition level 1
periphery
| subsensory
76
pain inhibition level 2
occurs in dorsal horn
| sensory
77
pain inhibition level 3
involves hormonal system
| motor
78
pain inhibition level 4
involves brainstem sites and dorsolateral funiculus
| noxious
79
pain inhibition level 5
involves cortical area
| placebo
80
pain inhibition at the subsensory level
microcurrent electrical nerve stimulators MENS
| peak amplitude below 1 mA (too low to stimulate either nerve or muscle)
81
pain inhibition at the sensory level
below motor threshold
| conventional TENS
82
pain inhibition at the motor level
used for subacute or chronic pain
| visible muscle contraction
83
current density is affected by ______
| placing the electrodes closer together results in _______
spacing of the electrodes
| superficial current density
84
1 pps=
muscle twitch
85
10 pps =
summation
86
25-30 pps =
tetanus
87
NMES electrode placeement
active electrode should be negative
| negative electrode placed distally and positive electrode placed proximally
88
contraindications for iontophoresis
near venous/arterial thrombosis or thrombophlebitis
over areas impaired sensation
cardiac pacemaker
89
the drug electrode should be the same as the _________ for iontophoresis
drug polarity
90
in iontophoresis positive drugs should be placed under the ________ and negative drugs should be placed under the ______
anode (positive electrode)
| cathode (negative electrode)
91
most common med used for iontophoresis and used to treat inflammation
what electrode should it be placed under
dexamethasone (DSP)
| has a negative polarity, cathode
92
iontophoresis
used for pain
polarity
lidocaine
| positive
93
iontophoresis
| size of electrode: current density should not exceed ______ is the cathodes is used or ____ if the anode is used
0.5 mA/cm^2
| 1 mA/cm^2
94
most common problem associated with iontophoresis
chemical burns
| occurs because of current not ion
95
interferential beat frequency for pain
80-150 bps
96
interferential beat frequency for edema
1-10 bps
97
interferential beat frequency for muscle rehab
20-50 bps
98
phases of wound healing
hemostasis
inflammatory
proliferation
remodeling
99
occurs immediately after injury
vasoconstriction
platelet aggreation
fibrin deposition, clot is end product
hemostasis
100
clean wound site for tissue restoration, vasodilation and phagocytosis
provides hemostatsis- vasoconstriction platelet aggregation, thromboplasitn makes clot
inflammatory phase
101
time for inflammatory phase
starts at time of injury and lasts 3-7 days
102
```
would defect fills in with new tissue, skin integrity restored
angiogenesis
granulation
collagen synthesis by fibroblasts
wound contraction occurs
```
proliferation
103
time frame for proliferation
3-5 days post injury - 3 weeks
104
capillary buds extend into the wound bed. endothelial cells fill wound space creating capillaries with loose junctions and gaps in endothelial lining causing edematous look
capillary loops look like small granules: granulation
angiogenesis
105
will not exceed 70-80% of tensile strength f original
begins as granulation tissue is formed
balance between collagen synthesis and lysis
remodeling
106
time frame for remodeling
21-28 days after injury to 1-2 years
107
imbalance in collagen synthesis and lysis, dehiscence, keloids
chronic remodeling
108
healing sequence continuous and within expected time frame
| little or no complications
acute wounds
109
failure or delay of healing component
dont respond to regulatory growth signals
associated with: repeated trauma ppor perfusion/oxygenation, excessive inflammation, concomitant disorders/genetic factors
chronic wounds
110
causes of incident pain
debridement
| major trauma
111
causes of episodic pain
dressing changes,
open to air,
medication cleansing
112
causes of continuous pain
underlying cause,
infection,
disease process
113
what unit do you use to measure a wound
cm
114
length of a wound is measured
12:00-6:00
115
width of a wound is measured
3:00-9:00
116
deepest area of the wound bed
depth
117
tissue loss into the depths of the wound
deadspace
measue the pathway and document the time on the clock
tunneling
118
tissue loss parallel to wound surface
undermining
119
loss of epidermis and down into but not through the dermis
partial thickness
120
through the dermis extending down to subcutaneious tissue, muscle may have exposed structure
full thickness
121
inspection and palpation at least withing 4 cm of wound edge
periwound
122
capillary refill: longer than _____ then arterial occlusion
2-3 seconds
123
venous refill:
less than ______ venous insufficiency
_______ normal
greater than _____ arterial insufficiency
5 sec
5-15 sec
15 sec
124
pulse grading
```
0=absent
1+= barely palpable
2+= plapable, but diminished
3+= normal
4+= prominent, suggestive of aneurysm
```
125
ABI
ankle/brachial systolic
126
measurement of O2 diffusing across the skin from the capillary beds
grading
transcutaneous oxygen measurment
| 30 mmHg will heal/debridement safe
127
ABI results
>1: calcifed vessels if diabetic, do not exceed 250 mmHg, non compressible and may damage artery
128
exchar
black
129
fibin
stringy
130
what to document on exudate
amount
color
character
131
epidermal involvement
erythema, tenderness, pain
cause: sunburn, hot liquid
superficial burn
132
dermal involvement
barge blisters, pain, edema, weeping
cause: hot liquid, flame injury, flash injury
superficial partial thickness burn
133
```
small amount of dermis remains
white or charred
blood flow compromised
less pain
cause: flame, chemical, electrical injury
```
deep partial thickness burn
134
into to through subcutaneous tissue
| cause: flame, chemical, and electrical
full thickness burn
135
result of complete or partial arterial blockage limiting perfusion causing tissue necrosis/ulceration
arterial
136
```
coronary disease
CHF
COPD
hypertension
diabetes mellitus
end stage renal disease
hypercholesterolemia
```
illnesses associated with arterial wounds
137
location: between toes and distal tips of toes, dorsal aspect of foot and over phalangeal heads, tibia, LATERAL MALLEOLUS
thin dry skin, absence of hair, shiny, smooth, cool to touch
pulses absent or diminished
arterial wound
138
dry gangrene, "punched out" smooth edges, erythematous halo, black/gray necrotic tissue
wound is painful
decreased pain and increased skin redness int he dependent position
increased pain and skin pallor with elevation
claudication
arterial wound
139
caused by valvular incompetence, obstruction of deep venous system, or congenital absence or malformation of venous valves
venous ulcer
140
dull ache or heaviness c/o pain in dependent position
| decreased pain with elevation
venous ulcer
141
location: superior to malleoli, usually medial
eschar or slough, wed, yellow fibrous, moderate to heavy exudate, irregular and shallow wound edges
surrounding skin is dry and scaly, presence of vericose veins, hemosiderin staining
pulses present
venous ulcer
142
Location: tips of toes, lateral aspect of the foot and dorsum of the foot, metatarsal heads especially 1st and 5th, heels, midfoot, and at location of orthopedic deformity
diabetic ulcer
143
all wounds have delay in healing
| surrounding skin is cracking; callous formation
diabetic ulcer
144
the most common type of diabetic neuropathy
| causes pain or loss of feeling in the toes, feet, legs, hands and arms
sensory neuropathy
145
causes changes in digestion, bowel and bladder function, sexual response, and perspiration
can affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes
autonomic neuropathy
146
results in muscle atrophy and weakness
motor meuropathy
147
stage 1 pressure ulcer
intact skin with non-blanchable redness of a localized area usually over a bone prominence
148
stage 2 pressure ulcer
partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed without slough
may also present as an intact or open/ruptured serum filled blister
149
stage 3 pressure ulcer
full thickness tissue loss
subcutaneous fat may be visible
may include undermining and tunneling
150
stage 4 pressure ulcer
full thickness tissue loss with exposed bone tendon or muscle
151
unstagabel pressure ulcer
full thickness tissue loss in which the base of the ulcer is covered by slough or eschar in the wound bed
152
purple or marron localized area os discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and or shear
deep tissue injury
153
skin tears without tissue loss
category I skin tear
154
skin tear with partial tissue loss
category II skin tear
155
skin tears with complete tissue loss
category III skin tear
156
TIME for wound bed preparatin
tissue debridement
inflammation and infection control
moisture balance
epithelial edge advancement
157
delivery of a fluid or cleansing solution to the wound surface by mechanical force
remove debris
cleaning
158
removal of non-viable tissue and foreign materials from the wound
debridement
159
safe irrigation
4-15 psi
160
low pressure irrigation
161
high pressure irrigation
8-15 psi
162
presence of bacteria on the wound surface that are not actively multiplying
contamination
163
presences of replicating micro-organisms
colonization
164
presence of replicating microorganisms, beginning to cause local tissue damage
critical colonization
165
invasion of bacteria into healthy surrounding tissue
| lab results equal or greater than 100,000 organisms
infection
166
advancing kerotinocytes at wound edges roll under. Migration stops due to keratinocytes touching each other
epiboly
167
a bacterial film present on most chronic wounds which blocks healing, can be removed by maintenance debridement
biofilm
168
attraction of a cell in response to a chemical signal
chemotaxis
169
```
involuntary weight loss
muscle wasting
presence of edema without cardiac cause
poor wound healing
cracking at edges of mouth
hair loss
chronic infections
lethargy
poor skin turgor
```
signs of malnutrition
170
```
dry mouth
cracked lips
sunken eyes
dark urine
poor skin turgor
trouble swallowing
smooth shiny tounge
```
signs of dehydration
171
betadine
dakins soulution
acetic acid
hydrogen peroxide
topical antiseptics
172
```
iodosorb
aquacel AG
silvadene
silverlon
anticoat
hydrofera blue
```
antimicrobial dressings
173
triple antibiotic ointment
bactroban (mupirocin)
polymyxin
bacitracin
topical antibodies
174
indicated for:
moist, pressure, infected wounds
provides moist environment, high absorptive capacity and protects agianst contamination and trauma
contraindicated for dry wounds
alginates
175
indications: partial and full thickness
encourages deposition of collagen, absorbent, may use with topical agents
contraindicated for full thickness burns or eschar
collagens
176
indications:
partial to full thickness wounds
minimal to heavy drainage, granulation tissue, necrotic tissue
autolytic debridement
composites
177
indications:
partial and full thickness
minimal to mod drainage
donor sites, skin grafts
protect wound base from trauma during dressing changes, introduce topical medications and wound fillers to the wound
contraindications
not for dry , shallow, eschar , copious exudate
contact layers
178
indications:
mod to heavy drainage, autolytic debridement or softening
granulation tissue, compression, hypergranulation
contraindicated for dry wounds, cavity wounds
foam
179
indications
partial and full thickness
necrotic tissue
scant to mod drainage
autolytic debridement, promotes granulation and epithelization
contraindications: infected wounds, tunnels, undermining, lesions, caution with diabetic feet
hydrocolloids
180
```
indications:
partial and full thickness wounds
granulation tissue
necrotic tissue
burns.
contraindications: not recommended for highly exudative wounds
```
hydrogels
181
```
indications
light to heavy exudate
partial to full thickness
necrotic tissue
granulation tissue
infected wounds
contraindications: dry wounds
```
specialty absorptive
182
```
indications
superficial wounds with minimal drainage
partial thickness
eschar
granulation tissue
contraindications: does not adhere well in moist environment
risks for epidermal stripping
```
transparent films
183
```
indications
partial to full thickness wounds
minimal to mod drainage
infected wounds
cavity wounds
contraindications: dry wounds
```
wound fillers
184
how often should you reposition in bed
every 2 hours
185
how often should you adjust in sitting
every 15 min
186
magnitude of the voltage
amplitude
187
measure of the force of the flow of electrons
voltage
188
measure of the rate of the flow of current
amperage
189
unidirectional and continuous
| one second or longer duration
direct current
190
unidirectional or bidrectional
interrupted
milliseconds or less duration
pulsatile
191
individual waveform
pulse
192
component of the pulse that rises in one direction above or below the baseline
phase
193
ratio of on time/total cycle time
duty cycle
194
```
twin peaked monophasic
no alkaline/acidity effects
greater penetration
short pulse duration at higher frequencies
pain, edema, spasm, weakness
```
high voltage pulsed current
195
monophasic or biphasic low voltage microcurrent
long pulse duration at low frequency
bone healing, wound, pain
microcurrent (MENS)
196
pulsatile polyphasic waveform
| strengthening
Russian
197
```
muscle re-education
edema
contracture management
atrophy reduction
strengthening
```
NMES
198
asymetrical balanced waveform
| pain
TENS
199
chronic disorder characterized by the abnormal accumulation of lymph fluid in the tissues of one or more body regions
lymphedema
200
lymphatic failure
transport capacity = normal
lymphatic load = increased
treat with RICE
dynamic (edema)
201
lymphatic failure
transport capacity = decreased
lymphatic load = normal
treat with CDT
mechanical (lymphedema)
202
lymphatic failure
transport capacity = decreased
lymphatic load = increased
treat with CDT
combination
| lymphedema
203
lymphatic failure
transport capacity = normal/decreased
lymphatic load = increased due to right ventricular failure
hemodynamic (cardiac edema)
204
brief swelling in hand
| subclinical
stage 0 lymphedema
205
edema
soft
pitting
no pain
stage 1 lymphedema reversible
206
```
edema
fibrotic changes, difficult to pit
can reduce edema to normal
can soften filaments but not reverse fibrosis
no pain
```
stage 2 lymphedema spontaneously irreversible
207
severe edema
fibrosis
no pitting, too much fibrosis
pain and skin discoloration
stage 3 lymphedema irreversible
208
```
bilateral
symmetrical involvement
pitting
foot involvement
stemmer negative
soft edema
typically no ulcerations
elevation effective
```
orthostatic edema
209
```
bilateral symmetrical
soft edema
quick refill with pitting attempts
no foot involvement
cellulitis
skin discoloration- hemosiderin
hx of CHF stemmer negative
elevation effective
```
venous insufficiency
210
```
bilateral
symmetric
soft edema
quick refill with pitting attempt
elevation effective
discoloration, occasionally
hx of CHF
stemmers negative
```
CHF
211
```
bilateral
associated with obesity
symmetrical
soft edema
minimal pitting
elevation ineffective
stemmer negative
```
lipedema
212
```
gold standard
manual lymph drainage
compressive bandaging/garments
therapeutic exercise
skin care and hygiene
patient education
```
complete decongestive therapy (CDT)
213
contraindications for CDT
```
malignant diseases
acute infection
DVT
cardiac edema
renal failure
radiation fibrosis (local)
peripheral arterial disease (compression)
```
214
percentage for burns
9% for head, each UE, anterior chest, posterior chest, abdomen, posterior lower back, each anterior and posterior portion of the LE
1% for the perineum
215
epidermis only
slight edema no blisters
painful because the nerve endings are still intact
superficial burn
216
epidermis and papillary layer of the epidermis
red, mottled, edematous
blisters, painful
spontaneous healing minimal scarring
superficial partial thickness burn
217
epidermis and to the reticular layer of the dermis
deep partial thickness burn
218
all epidermal and dermal, may include subcutaneous layer
| requires grafting
full thickness burn
219
subcutaneous tissue involvement
| significant surgical intervention potentially including amputation
subdermal burn
