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UM - Integumentary > Biophysical Agents > Flashcards

Biophysical Agents Flashcards

1
Q

What are the primary ways NPWT promotes wound healing?

A
  • removal of wound fluid
  • local circulation improved
  • mechanical stimulation of cells
  • occlusion of the wound from environ contaminants (48-72 hrs)
  • Inflammatory mediators and bacteria are removed
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2
Q

When should the wound be reassessed (officially) for signs of healing during negative pressure wound therapy?

A

2 weeks

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3
Q

What is the average length of treatment for negative pressure wound therapy?

A

4-6 weeks

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4
Q

How often should a NPWT dressing be changed?

A

Every 48 hours or 12-24 if infected, but check the seal every 2 hours

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5
Q

Indications for NPWT

A
  • acute and chronic wounds
  • acute traumatic & sx wounds healing by primary and secondary intention
  • burns
  • skin grafts
  • chronic wounds associated w/venous insuff, diabetes, pressure, arterial (caution)
  • palliative care
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6
Q

Precautions for NPWT

A
  • anticoag & low platelet count
  • fistulas
  • over bone/tendon/organs
  • avoid circumferential occlusive sheeting due to risk of ischemia
  • monitor: over bony prominences, bleeding, & notify physician if drainage is sanguineous or if > 2 canisters filled in a 24 hr period
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7
Q

Contraindications NPWT

A
  • wounds > 30% slough or necrotic tissue
  • untreated osteomyelitis
  • gross infection
  • lack of hemostasis
  • malignancy in treatment area
  • blood dyscrasia
  • over exposed vessels/organs/grafts
  • any wound with a negative initial response
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8
Q

Signs of wound deterioration

A
  • inc. periwound erythema
  • periwound skin hypoxia
  • repeated need for sharp/sx debridement
  • inc. drainage or bleeding
  • new infection/necrosis
  • increased pain
  • increased wound size
  • new undermining/sinuses
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9
Q

What are the main components of NPWT

A
  • suction device
  • wound filler (foam or gauze)
  • occlusive sheet cover
  • tubing
  • collection canister
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10
Q

Advantages of NPWT

A
  • enhances wound healing
  • continuous coverage wounds
  • comfortable
  • maintains optimal moist environment
  • infrequent dressing changes
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11
Q

Disadvantages NPWT

A
  • more expensive
  • patient stuck to suction unit
  • could cause skin irritation
  • time consuming set up
  • does not substitute hydrotherapy
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12
Q

What is the most common mode of delivery for NPWT - especially initially

A

continuous

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13
Q

What pressure is optimal for granulation tissue formation (NPWT)

A

125 mmHg

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14
Q

What ramping increment is used for NPWT pressure?

A

25 mmHg for pt comfort, wound response, treatment goals

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15
Q

How long should you wait to change NPWT dressings if it was over a fresh skin graft?

A

3-5 days to make sure the graft is stable first

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16
Q

When do you DC NPWT

A
  • goals met
  • granulation of wound bed even w/skin surface
  • no benefit has been seen in 24 hrs
  • signs of wound deterioration
  • new infection
  • pt intolerance
  • sanguineous drainage fills canister in 1 hr or > 2 in 24 hrs
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17
Q

NPWT Application steps

A
  1. prep wound bed
  2. prep periwound w/topical moisture barrier/nonadherent gauze
  3. non-adherent protective leayer
    - wound filler
  4. occlusive sheeting 3-5cm past wound edge
  5. drain
    7 connect tubing
  6. set parameters
  7. turn on suction & confirm seal
  8. education
  9. document type and # of foam at each time
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18
Q

What are the wound healing benefits of US?

A
  • inc local blood flow
  • dec bioburden
  • enhance all 3 phases of wound healing
  • debridement
  • pain reduction
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19
Q

US Theory

A
  • cavitation (vibration of bubbles to cause compression forces)
    -microstreaming (unidirectional mvmt of tissue fluids causing mechanical stim to surrounding cells)
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20
Q

When is cavitation stable vs unstable?

A

Stable: bubbles change size
Unstable: bubbles grow and then burst causing free radical foration

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21
Q

Indications for US

A
  • traumatic wounds
  • burns
  • skin teras
  • P injuries
  • venous insufficiency
  • diabetic foot ulcers
  • inflammatory wounds
  • split-thickness donor sites
  • debridement
  • pain reduction
  • infection
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22
Q

What does US do in the inflamatory phase?

A
  • degranulates mast cells to release histamine to attract neutrophils and monocytes to the injured area
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23
Q

What does US do in the proliferative phase

A
  • stimulates fibroblasts to secrete collagen to accelerate wound contraction and increase strength of tissue
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24
Q

Precautions/Contra for US

A
  • over epiphyseal plates
  • over breast implants
  • malignant tumor
  • near a fetus
  • laminectomy
  • jt cement
  • plastics for prosthetics
  • pacemaker
  • eyes
  • carotid sinus
  • over the heart
  • absence of sensation
  • acute inflam
  • arterial insuff
  • DVT
  • osteomyelitis
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25
Q

Therapeutic use of high vs low frequency US

A
  • High: tissue healing, repair & pain reduction
  • Low: noncontact = tissue repair, wound cleansing, & pain reduction; contact = debridement
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26
Q

How to do direct application of high frequency US on a superficial/superficial partial thickness wound

A
  • apply hydrogel sheet over wound
  • apply US gel on sheet
  • do US over hydrogel sheet
27
Q

How to do direct application of high frequency US on a deep partial thickness/full thickness wound

A
  • fill wound with hydrogel and remove air bubbles
  • cover with film or hydrogel
  • apply US gel on top
  • US over it
28
Q

How to do direct application of high frequency US over tunnels, tracts, undermining

A
  • irrigate tunnels
  • fill all open wound spaces w/hydrogel
  • sonate over intact skin over targeted areas
29
Q

Benefits of Low-f US

A
  • cellular changes
  • fluid mobilization
  • dec. wound pain
  • inc. cellular permeability
  • bacterial killing
  • relatively painless debridement
30
Q

What is hyperbaric O2 Therapy

A

A patient inside a chamber breathes 100% O2 intermittently at a pressure higher than sea-level (b/t 2 & 3 ATA)

31
Q

What are the physiologic effects of hyperbaric oxygenation

A
  • vasoconstriction to tissues
  • O2 delivery in the presence of arterial occlusion (Inc o2 of plasma can compensate to give O2 to tissue distal to occlusion)
  • collagen deposition
  • immune response
  • mediate cytokine activity
  • angiogenesis in irradiated tissues
32
Q

How does hyperbaric O2 therapy help diabetic foot ulcers

A
  • dec risk of major amputation and improve chance of healing at 1 yr
33
Q

How does hyperbaric O2 therapy help arterial insufficiency ulcers

A
  • lead to fibroblast prolif, collagen synthesis, angiogenesis and production of granulation tissue
34
Q

Precautions of Hyperbaric O2

A
  • COPD
  • hx of spontaneous pneumothorax
  • high fever
  • optic neuritis
  • claustrophobia & pregnancy
  • HF
  • uncontrolled HTN
  • seizure disorders
35
Q

Adverse effects of O2 under pressure

A
  • middle-ear barotrauma
  • sinus squeeze
  • pulmonary barotrauma
  • exacerbation of HF
  • CNS: Cataracts or myopia
  • claustrophobia
36
Q

Why would you use UVC

A

UVC has a bactericidal effect causing cell death of bacteria and viruses

37
Q

Contraindications for UVC

A
  • acute eczema, dermatitis, or psoriasis
  • cancer
  • cardiac dis
  • diabetes
  • eyes
  • hepatic dis
  • herpes simplex
  • hyperthyroidism
  • pulm tuberculosis
  • renal disease
  • SLE
38
Q

Precautions for UVC

A
  • generalized fever
  • malignant wounds for palliative care
  • photosensitivity
  • recent x-ray or other radiation
  • hx of skin cancers
39
Q

How to apply UVC

A
  • protect eyes (pt and clinician)
  • block surrounding skin completely
  • hold UVC parallel and 1 inch from wound bed
  • only need 30-60 sec of treatment
40
Q

UVC parameters

A
  • time: 30-60 sec (180 s max)
  • 1 inch and parallel to wound bed
  • daily for 5 days, then repeat if necessary
41
Q

What is the whirlpool?

A

Non-selective hydrotherapy that can remove loosely adhered debris, bacteria, exudate, dressing residue, and topical agents

42
Q

What is the APTA stance on whirlpools in wound care

A

Do not use them - they can predispose patients to bacterial cross contamination and damage fragile tissue

43
Q

How long does a typical PLWS session last

A

15 to 30 minutes

44
Q

is PLWS positive or negative pressure therapy?

A

Both in one

45
Q

What does PLWS do (theory)

A
  • wound cleansing
  • debridement of slough
  • loosen nonviable tissue
  • reduce surface bacteria
  • increase local perfusion
  • stimulation of granulation tissue
46
Q

What are the cellular effects of PLWS

A
  • compression-decompression cycles on the tissues that mechanically dislodge bacteria/nonviable tissue/debris from the wound bed
  • promotes tissue granulation
  • facilitates local increased vasodilation
47
Q

What is the safe psi according the the AHCPR for PLWS

A

4 to 16 psi

48
Q

Indications for PLWS

A
  • critically colonized wounds
  • presence of: infection, necrotic tissue, mucinous exudate, undermining/tunnels/tracks
  • traumatic wounds w/foreign debris
  • open amputation sites
  • stage III and IV pressure ulcers
49
Q

Precautions PLWS

A
  • anticoagulants/active bleeding
  • poorly visualized wound spaces
  • near: fistulas, visible wound beds, recent byprass grafts, LVAD drain lines
  • over exposed bone or tendon
  • facial wounds
  • hypothermia (if using cool fluid irrigation)
50
Q

What is the normal saline & temp for PLWS

A
  • 0.9% at 37-38 degrees celcius
51
Q

Frequency of PLWS

A
  • daily: infected, heavily draining
  • 2-3x/week OP w/mod-heavy drainage
  • 1x/week OP w/min drainage and no infection
52
Q

What are some infection considerations when doing PLWS

A
  • bacteria can go up to 8 feet away from treatment site
  • risk for fluid aerosolization and transport of bacteria
  • cover all surfaces and lines/ports/other wounds & then disinfect after
  • mask for pt and clinician
53
Q

PPE for PLWS

A
  • waterproof gown
  • gloves
  • face mask + splash shield or goggles
  • hair cover
  • shoe covers
54
Q

T or F: irrigation collection canisters can be cleaned out and re-used after PLWS

A

FALSE - they are single use and should go in a biohazard waste container

55
Q

How should patient be positioned for PLWS?

A

comfortable w/draping and waterproof drape underneath and laying so that excess irrigation from one area does not go to another open wound

56
Q

Indications for E-stim

A
  • Pressure, arterial, venous, and diabetic ulcers
  • clean wounds w/decreased or stalled healing
57
Q

Precautions for E-stim

A
  • child < 3 yo
  • skin irritation or burns under electrodes
  • when sensation is impaired or absent
  • skin irritation from ion shifts
58
Q

Contraindications E-stim

A
  • over known malignancy
  • osteomyelitis
  • metal
  • electrical implant
  • anterior/upper chest (heart) or so that current will flow through anterior neck/upper chest
  • developing fetus
  • active bleeding
  • transcerebral
59
Q

How much can ES increase wound healing by?

A

as much as 22% per week

60
Q

Which phases of healing do you want to use negative electrodes?
positive?

A
  • negative: proliferation (& inflammation if infection present)
  • positive: epithelialization, remodeling, & inflammation (no infection)
61
Q

What is direct electrode placement vs indirect?

A
  • direct one: monopolar is in the wound bed w/a dispersive electrode
  • indirect: straddles the wound w/bipolar application and a dispersive electrode
62
Q

If you are doing debridement and e-stim, in which order should it be completed?

A
  • debride then do e-stim
63
Q

Depth of current penetration (increase/decrease) as distance between electrodes increases?

A
  • Increases

UM - Integumentary (6 decks)

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