9] Modalities Flashcards by Keren Poulose

 Soften adherent necrotic tissue
 Increase blood flow and metabolic rate
 Proliferation of granulation tissue and epithelial cells
 Exudate removal to decrease infection
 Wound Cleansing

Whirlpool

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Detrimental effects of whirlpool therapy

Maceration
Dependent position
Potential for burns
Cytotoxic additives

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Contraindications for whirlpool (6)

CHF/LE edema
Lung disease
Acute phlebitis 
Lethargy 
Gangrene
Renal failure

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Hydrotherapy temperature

92-96 deg F

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Hydrotherapy treatment time

10-15 min

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 Suction, adjustable pump, hand piece, tip

 Used for cleansing and debridement

Pulses lavage with suction

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Treatment time for pulsed lavage

10-15 min

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Indications for pulsed lavage

Clean wound

Remove toxic residuals

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Precaution of pulsed lavage

Tissue damage if the pressure is too high

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2 considerations for pulsed lavage

Can be done at bedside

It’s expensive

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What type of therapy is HPVC

Electrical stimulation

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How does HPVC work?

Stimulates fibroblasts to enhance collagen and DNA synthesis

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Increases number of receptor sites for growth factors

HPVC

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 Alters the direction of fibroblast migration,
activates cells in the wound site, improves tissue perfusion, decreases edema
 Increases cutaneous oxygen transport
 Controls infection
 Stimulates wound contraction and scar healing

HPVC

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Indications for HPVC (4)

Pressure ulcers stage 3-4

Diabetic, venous and arterial ulcers

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Contraindications for HPVC (Estim) (9)

 Osteomyelitis
 Pregnancy
 Malignancy
 Pacemaker
 Over carotid sinus or across heart
 Laryngeal musculature
 Along regions of phrenic nerve
 Over topical substances containing metal ions (remove silver dressings!)
 Over povidine iodine or mercurochrome

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Medicare will only pay or EStim if wound is not progressing after ?

30 days of traditional wound care

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In proliferation phase, whats the setting you would use?

(-) polarity for 1-5 days and then change it to (+) until it heals

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What are the setting for the maturation phase?

Alternate every 3 days between - to +

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Duration in min?

45-60 min

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Frequency?

5-7x/week

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Intensity/voltage?

100-150 volts

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Where do you apply the electrode?

Directly over the wound

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Do what for deeper wounds?

Increase distance b/w electrode and dispersive

Do what for more shallow wounds?

Decrease distance b/w electrode and dispersive

 Intermittent administration of 100% oxygen inhaled | at a pressure greater than sea level

Hyperbaric oxygen therapy

Effects of hyperbaric oxygen therapy

Hyperoxygenation and decreases edema

Two effects of HBOT

Toxin inhibition, antibiotic synergy and angiogenesis

restoresthe body’s defense against infection; increases the rate of killing some common bacteria; inhibits the growth of anaerobic organisms

Toxin inhibition, antibiotic synergy

increases partial pressure ofthe oxygen tension to allow formation of the collagen matrix and angiogenesis

Angiogenesis

Indications for hyperbaric oxygen (7)

```  Acute burns  Chronic wounds  Radiation induced injury  Necrotizing infection  Sepsis  Chronic osteomyelitis  Carbon monoxide poisoning ```

Major Contraindications for HBOT (4)

 Claustrophobia  Pneumothorax  COPD  Malignant tumors

What does NPWT stand for?

Negative pressure wound therapy

Goals for NPWT? (6)

```  Increase blood flow  Decrease bacteria colonies  Able to measure and assess wound fluid  Increases granular tissue base  Contraction of wound  Epithelialization ```

Indications for NPWT (8)

```  Acute wounds  PTW/FTW from burns  Surgical wounds/incisions and dehiscence  Diabetic wounds  Venous/arterial wounds  Pressure ulcers  Grafts/flaps  Enteric fistulas ```

Major Contraindications for NPWT (4)

 Necrotic tissue with eschar/ NO SLOUGH  Malignancy  Exposed blood vessels or organs  Non-enteric or unexplored fistulas

Indicators of Ineffective V.A.C. Therapy (5) | WHEN ITS NOT WORKING:

```  Minimal changes in wound size  Deterioration of the wound  Changes in wound color  Wound appears white, excessively moistor macerated  Wound odors ```

Intermittent/Pneumatic Compression indications (4)

```  Primary/Congenital Lymphedema  Secondary Lymphedema from lymph node resection after cancer  Chronic venous insufficiency, venous stasis,venous ulcers  Reduce and control peripheral edema ```

Contraindications for intermittent/pneumatic compression (6)

```  Phlebitis  CHF  PE  Suspected DVT  Increase of venous/lymphatic return is notdesired  decreased sensation ```

Semi-rigid dressing  Useful in ambulatory patients to aid the calf muscle pump mechanism (used on lower leg only)

Unna boot

gauze impregnated with zinc oxide, glycerine, and calamine

First Unna boot layer

gauze and/or self-adherent or compressive bandage

Second Unna boot layer

 A mechanical vibration delivered at afrequency above the range of human hearing

Ultrasound

Two delivery methods of ultrasound

Contact and no contact

noncontact US which administers | continuous US energy via an atomized saline solution. Used for cleansing and debridement

MIST therapy’s system by Celleration

What does ultrasound do? (6)

 Accelerates acute inflammatory phase  Stimulates fibroblasts to secrete collagen  Provides heat to deeper tissue prior to stretch  Accelerates wound contraction  Promotes strong, more elastic scars  Increases blood flow

Contraindications for ultrasound (8)

```  Thrombophlebitis  Acute infection  Pregnancy  Malignancy  Over the eye  Hemophiliacs not covered by factor replacement  Concurrent or post radiation  Over bony prominence ```

Ultrasound indications (9)

```  Colonized wounds  Arterial & venous wounds  Diabetic foot ulcers  Chronic leg ulcers  Pressure ulcers  Burns  Acute wounds  Post operative wounds  Sickle cell ulcers ```

What does ultrasound use to transmit US energy?

Gel or sterile saline

Used to diminish venous congestion with reattachment surgery

Leeches

Saliva of leeches has?

Anticoagulant properties

Selectively debride necrotic tissue

Maggots

Increases tissue temperature causing an increase in blood flow

Electromagnetic Therapy (Diathermy)

Use electromagnetic therapy (diathermy) with what ulcers?

Arterial, diabetic and pressure ulcers

Contraindications for diathermy (electromagnetic therapy) 3 major ones!!

Pacemaker Defibrillator Any hardware

Contraindication for Unna boot?

Can’t use it on someone with ABI less than 0.7 !!

MIST is used with?

In conjunction with your treatment

Wound vac not used for?

Malignancy If theyre bleeding If theyre not getting better