Ch 48 skin integrity & wound care Flashcards
1
Q
, the largest organ in the body, is a protective barrier against disease-causing organisms and a sensory organ for pain, temperature, and touch
A
Skin
2
Q
skin has two layers: the
A
epidermis and the dermis
3
Q
epidermis and the dermis separated by a membrane, often referred to as the
A
dermal-epidermal junction.
4
Q
is the thin outermost layer of the epidermis
A
stratum corneum
5
Q
consists of flattened, dead, keratinized cells
A
stratum corneum
6
Q
cells originate from the innermost epidermal layer, commonly called the
A
basal layer
7
Q
divide, proliferate, and migrate toward the epidermal surface
-After they reach the stratum corneum, they flatten and die
A
Cells in the basal layer
8
Q
protects underlying cells and tissues from dehydration and prevents entrance of certain chemical agents
A
thin stratum corneum
9
Q
allows evaporation of water from the skin and permits absorption of certain topical medications.
A
stratum corneum
10
Q
, the inner layer of the skin, provides tensile strength; mechanical support; and protection for the underlying muscles, bones, and organs
A
dermis
11
Q
Collagen (a tough, fibrous protein), blood vessels, and nerves are found in the dermal layer
A
dermis
12
Q
, which are responsible for collagen formation, are the only distinctive cell type within the dermis
A
Fibroblasts (dermis)
13
Q
such as reduced skin elasticity, decreased collagen, and thinning of underlying muscle and tissues cause the older adult’s skin to be easily torn in response to mechanical trauma, especially shearing forces
A
Age-related changes
14
Q
Existing medical conditions and polypharmacy are factors that interfere with wound healing. Aging causes a diminished inflammatory response, resulting in slow epithelialization and wound healing
A
Age-related changes
15
Q
decrease in subcutaneous padding over bony prominences, where impaired skin integrity and injury to other tissues are most likely to occur
A
Age-related changes
16
Q
patient experiencing decreased mobility, decreased sensory perception, fecal or urinary incontinence, and/or poor nutrition is
A
risk for pressure injury development.
17
Q
- Older adults, those who have experienced trauma
- Those with spinal-cord injuries (SCI)
- Those who have sustained a fractured hip
- Those in long-term homes or community care, the acutely ill, or those in a hospice setting
- Individuals with diabetes
- Patients in critical care settings
A
people at risk for pressure injuries
18
Q
Prolonged, intense pressure affects cellular metabolism by decreasing or obliterating blood flow, resulting in tissue ischemia and ultimately tissue death.
A
affects cellular metablolism
19
Q
is the major element in the cause of pressure injuries.
A
Pressure
20
Q
Current theory suggests that skin and soft tissue damage can begin at the surface and progress inward or begin at the muscle and progress outward, depending on causation
A
skin theory
21
Q
Top-down damage (superficial) is thought to be caused by superficial shear or friction, presenting as red skin
A
(stage 1 pressure injury)
22
Q
damage is believed to be caused by several pressure-related factors: (1) pressure intensity, (2) pressure duration, and (3) tissue tolerance.
A
Bottom-up (deep)
23
Q
as the minimal amount of pressure required to collapse a capillary (e.g., when the pressure exceeds the normal capillary pressure range of 15 to 32 mm Hg)
A
capillary closing pressure (pressure intensity)
24
Q
when the pressure applied over a capillary exceeds the normal capillary pressure and the vessel is occluded for a prolonged period of time,
A
tissue ischemia can occur
25
if the pressure is relieved and the blood flow returns, the
skin turns red
26
clinical presentation of obstructed blood flow occurs when evaluating areas of pressure. After a period of tissue ischemia, if the pressure is relieved and the blood flow returns, the skin turns red. The effect of this redness is vasodilation (blood vessel expansion), called
hyperemia (redness)
27
erythema returns when you remove your finger, the hyperemia is transient and is an attempt to overcome the ischemic episode, thus called
blanchable hyperemia (no longterm damage)
28
the erythematous area does not blanch (nonblanchable erythema) when you apply pressure, deep tissue damage is probable.
nonblanchable erythema
29
occurs when the normal red tones of the light-skinned patient are absent
Blanching
30
When checking for pressure injuries in patients with darkly pigmented skin, dark skin may not show the blanch response. Inspect suspected pressure-related skin alterations with an adjacent or opposite area of the body for comparison
check blanching w/ dark pigmented skin
31
assessment of changes in skin tissue, consistency (firm vs. boggy [less than normal stiffness or mushy] when palpated), sensation (pain), edema, and warmer or cooler temperature
Skin inspection should include
32
do not confuse the normal hyperpigmentation of Mongolian spots that are seen on the sacrum of African, Native American, and Asian patients with cyanosis
Mongolian spots in AA
33
Assess for changes in sensation, temperature, or tissue consistency, which may precede visual skin changes
-examine w/ least pigmentation ex: under arms
skin assessment in dark pigmented skin (do NoT rely only on visual inspection)
34
localized area of skin may be purple/blue or violet instead of red. Purple or maroon discoloration may indicate deep tissue injury.
deep tissue damage
35
may occur with induration of more than 15 mm in diameter, and skin may appear taut and shiny
Edema
36
pressure duration include evaluating the amount of pressure
(checking skin for nonblanching hyperemia)
37
determining the amount of time that a patient tolerates pressure
(checking to be sure after relieving pressure that the affected area blanches).
38
extrinsic factors of shear, friction, and moisture affect the ability of the skin to
tolerate pressure
39
Systemic factors such as poor nutrition, aging, hydration status, and low blood pressure affect the tolerance of the tissue to externally applied pressure.
systemic factors affecting tolerance of tissue
40
Patients who are comatose, confused or disoriented; those who have expressive aphasia or the inability to verbalize; and those with changing levels of consciousness are
unable to protect themselves from pressure injury
41
causes occurs at the deeper fascial level of the tissues over the bony prominence
damage that shear cause
42
death of cells or tissue thru disease or injury
necrosis
43
effects dermal area
shear
44
effects epidermis area
| -sheet burn- denuded skin (upper part) appears red & painful
friction
45
occurs in patients who are restless, in those who have uncontrollable movements such as spastic conditions,
friction
46
is defined as inflammation and erosion to the skin caused by prolonged exposure to various sources of moisture, including wound drainage, urine or stool, perspiration, wound exudate, mucus or saliva (
moisture-associated skin damage (MASD)
47
classifies pressure injuries
staging system
48
dead tissue separating from living tissue
slough
49
dead tissue that falls off
eschar
50
commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel
-Partial-thickness skin loss with exposed dermis
Stage 2 pressure ulcer
51
If slough or eschar obscures the extent of tissue loss, this is an
Unstageable Pressure Injury.
52
This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface.
Deep-Tissue Pressure Injury
53
If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full-thickness pressure injury
(Unstageable, Stage 3, or Stage 4).
54
is a disruption of the integrity and function of tissues in the body
wound
55
tissue layers involved and their capacity 1241for regeneration determine the mechanism for repair for any wound
repair of wound
56
are shallow in depth, moist, and painful, and the wound base generally appears red.
Partial-thickness wounds
57
extends into the subcutaneous layer, can be painful, and the depth and tissue type varies, depending on body location
full-thickness wound
58
partial-thickness wound heals by
regeneration
59
by forming new tissue, a process that can take longer than the healing of a partial-thickness wound
full-thickness wound heals
60
clean surgical incision is an example of a
wound with little tissue loss
61
surgical incision
heals by primary intention
62
contrast, a wound involving loss of tissue such as a burn, stage II pressure injury, or severe laceration
heals by secondary intention
63
wound healed by regenerating ex: partial-thickness
epidermal
64
ex: scrape or abrasion
partial thickness
65
full thickness
stage 3&4
66
wound: inflammatory response, epithelial proliferation (reproduction) and migration, and reestablishment of the epidermal layers.
3 components are involved in the healing process of a partial-thickness
67
causes the inflammatory response, which in turn causes redness and swelling to the area with a moderate amount of serous exudate
Tissue trauma
68
wound that is kept moist can resurface in 4 days, whereas one left open to air can resurface within 6 to 7 days
wound moist (partial thickness)
69
4 phases occur in full-thickness wound repair are
hemostasis, inflammatory, proliferative, and maturation.
70
primary-acting white blood cell is the neutrophil, which begins to ingest bacteria and small debris.
inflammation to heal (neutrophil,)
71
filling of a wound with granulation tissue, wound contraction, and wound 1242resurfacing by epithelialization
proliferative phase (full thickness healing)
72
usually results from systemic factors such as age, anemia, hypoproteinemia, and zinc deficiency.
Impairment of healing during proliferative phase
73
by looking for distention or swelling of the affected body part, a change in the type and amount of drainage from a surgical drain, or signs of hypovolemic shock
detect internal hemorrhaging
74
is a localized collection of blood underneath the tissues.
hematoma
75
appears as swelling, change in color, sensation, or warmth that often takes on a bluish discoloration
hematoma
76
can include erythema; increased amount of wound drainage; change in appearance of the wound drainage (thick, color change, presence of odor); and periwound warmth, pain, or edema.
-fever and an increase in white blood cell count
local clinical signs of wound infection
77
occur within 30 days of surgery; risk factors include hyperglycemia, smoking, untreated peripheral vascular disease, obesity, age, and emergency surgery
- fever, tenderness, and pain at the wound site and an elevated white blood cell count
- edges of the wound will appear inflamed. If drainage is present, it is odorous and purulent, which causes a yellow, green, or brown color, depending on the causative organism
Surgical site infections
78
show signs of infection early, within 2 to 3 days
contaminated or traumatic wounds
79
Clear, watery plasma
Serous
80
Thick, yellow, green, tan, or brown
Purulent
81
Pale, pink, watery; mixture of clear and red fluid
Serosanguineous
82
Bright red; indicates active bleeding
Sanguineous
83
is the partial or total separation of wound layers
Dehiscence
84
poor nutritional status, infection, or underlying diseases such as diabetes mellitus or peripheral vascular disease) is at risk for dehiscence.
-obese
risk for Dehiscence
85
abdominal surgical wounds and occurs after a sudden strain such as coughing, vomiting, or sitting up in bed
-serosanguineous drainage from a wound in the first few days after surgery
indication of Dehiscence
86
(protrusion of visceral organs through a wound opening)
evisceration
87
place sterile gauze soaked in sterile saline over the extruding tissues to reduce chances of bacterial invasion and drying of the tissues
implementation of evisceration
88
is the most widely used risk-assessment tool for pressure injuries and is in the WOCN guidelines as being a valid tool to use for pressure injury risk assessment
Braden Scale
89
sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
Braden Scale contains 6 subscales
90
total score ranges from 6 to 23; a lower total score indicates a higher risk for pressure injury development
- 18 score is cut off not at risk for adult
- onset of risk of intensive care pt is 13
Braden Scale score
91
no longer receive reimbursement for care related to stage 3 and 4 pressure injuries that occur during a hospitalization
Reimbursement for hospitals
92
is a protein formed from amino acids acquired by fibroblasts from protein ingested in food.
Collagen
93
is necessary for synthesis of collagen
Vitamin C
94
reduces the negative effects of steroids on wound healing
Vitamin A
95
for epithelialization and collagen synthesis
zinc
96
for collagen fiber linking
copper pg 1243
97
provide the energy source needed to support the cellular activity of wound healing.
Calories
98
needs especially are increased and are essential for tissue repair and growth.
Protein
99
A balanced intake of various nutrients (i.e., protein, fat, carbohydrates, vitamins, and minerals) is
critical to support wound healing
100
because it reflects not only what the patient has recently ingested but also what the body has absorbed, digested, and metabolized
best measure of nutritional status is prealbumin
101
are biochemical indicators of malnutrition
Serum proteins
102
, which leads to additional tissue destruction
proinflammatory cytokines
103
is present include the presence of purulent drainage; change in odor, volume, or character of wound drainage; redness in the surrounding tissue; fever; or pain.
wound infection (signs & symptoms)
104
decrease in the functioning of macrophages leads to a delayed inflammatory response, delayed collagen synthesis, and slower epithelialization.
physiological changes associated with aging affect all phases of wound healing.
105
Body image changes often impose a great stress on a patient’s adaptive mechanisms. They also influence self-concept and sexuality
psychosocial impact of wounds
106
include: location, the presence of scars, stitches, drains (often needed for weeks or months), odor from drainage, and temporary or permanent prosthetic devices.
Factors that affect a patient’s perception of a wound
107
is an occurrence in which erythema and/or other manifestation of cutaneous abnormality (including but not limited to vesicle, bulla, erosion, or skin tear) persists 30 minutes or more after removal of the adhesive.
Medical adhesive–related pressure injury
108
Skin stripping, or tape burns, from
adhesives is the most commonly reported injury;
109
is red, moist tissue composed of new blood vessels, the presence of which indicates progression toward healing
Granulation tissue
110
Soft yellow or white tissue is characteristic of slough (stringy substance attached to wound bed), and it must eventually be removed by a qualified clinician or by an appropriate wound dressing before the wound is able to heal.
slough
111
Black, brown, tan or necrotic tissue is eschar, which also needs to be removed before healing can occur.
eschar
112
to measure wound width and length.
disposable wound-measuring device
113
Measure depth (wound) by using a
cotton-tipped applicator in the wound bed
114
Frequent exposure to urine and fecal contents increases patients’ risk for
incontinence-associated dermatitis (IAD)
115
exposure to gastric and pancreatic drainage has the
highest risk for skin breakdown
116
is superficial with little bleeding and is considered a partial-thickness wound.
-appears “weepy” because of plasma leakage from damaged capillaries
abrasion
117
sometimes may bleed more profusely (especially if the patient is taking anticoagulants or other blood thinners), depending on the depth and location of the wound
laceration
118
bleed in relation to the depth, size, and location of the wound
- small, circular wound with the edges coming together toward the center.
- main danger= infection & internal bleeding
Puncture wounds
119
provide a means for fluid or blood that accumulates within a wound bed to drain out of the body
Drains
120
lies under a dressing; at the time of placement a pin or clip is placed through the drain to prevent it from slipping farther into a wound
Penrose drain
121
is a liquid tissue adhesive that forms a strong bond across approximated wound edges, allowing normal healing to occur below
Dermabond
122
(1) skin care and management of incontinence;
(2) mechanical loading and support devices, which include proper positioning and the use of therapeutic surfaces;
(3) education
3 major areas of nursing interventions for prevention of pressure injuries are
123
can sometimes be better managed with proper diet and medications
Bowel incontinence
124
is treated with behavioral techniques, medication, and surgery. Behavioral techniques help patients learn ways to control their bladder and sphincter muscles.
Urinary incontinence
125
- reduce friction and shear.
- Use for moderate- to high-risk patients
- Not indicated for those with existing stage 3 or 4 pressure injuries
- Hot and may trap moisture
Foam Overlay (type mattress)
126
- Use for high-risk patients
- make procedures (e.g., dressing changes, CPR) difficult
- Patient transfers out of bed are difficult.
Water Overlay (type mattress)
127
- Use for moderate- to high-risk patients
- patients who are wheelchair dependent
- Multiple-patient use
Gel Overlay (type mattress)
128
- Use for moderate- to high-risk patients
- Use for patients who can reposition themselves
- downside- Damaged by punctures from needles and sharps
Nonpowered Air-Filled Overlay(type mattress)
129
- managing the heat and humidity (microclimate) of the skin
- moderate- to high-risk patients
- Deflates to facilitate transfer and CPR
- req battery or electrical outlet
- moist control
Low-Air-Loss Overlay
130
- Use for high-risk patients
- patients with stage 3 or 4 pressure injuries or burns
- Becomes firm for CPR or other treatments when device is turned “off”
- May facilitate management of copious (heal by secondary intention) wound drainage or incontinence
- May not be wide enough for use with obese patients or patients with contractures
- cant lie prone= suffocate
Air-Fluidized Bed (type bed)
131
- Contraindicated in patients with unstable spinal column
- used for those who cannot be repositioned frequently, or those who have skin breakdown
- Easy transfer in and out of bed but slippery
Low-Air-Loss Bed (type bed)
132
- Provides continuous passive motion to promote mobilization of pulmonary secretions
- Used primarily to facilitate pulmonary hygiene in patients with acute respiratory conditions
- not be used when the patient is hemodynamically unstable
- Reduces pulmonary complications associated with restricted mobility
- Does not reduce shear or moisture
- Cannot be used with cervical or skeletal traction
Kinetic Therapy
133
which should prevent positioning directly over the bony prominence
recommend a 30-degree lateral position
134
require close monitoring (every 4-8 hours;
Acute wounds (monitoring)
135
assessment occurs less frequently
Chronic wound (monitoring)
136
- addresses 15 wound characteristics.
- You score individual items and calculate the sum total, providing an overall indication of wound status.
- scoring helps to evaluate whether the goals of the wound management are effective.
Bates-Jensen Wound Assessment Tool (BWAT)
137
only with noncytotoxic wound cleaners such as normal saline or commercial wound cleaners
Clean pressure injuries (ONLY WITH NONCYTOTOXIC)
138
is to use a 19-gauge angiocatheter and a 35-mL syringe, which delivers saline to a pressure injury at 8 psi
ensure an irrigation pressure within the correct range
139
is the removal of nonviable, necrotic tissue
Debridement
140
include mechanical, autolytic, chemical, and sharp/surgical.
Methods of debridement
141
is the removal of dead tissue via lysis of necrotic tissue by the white blood cells and natural enzymes of the body
Autolytic debridement(Methods of debridement)
142
with the use of a topical enzyme preparation, Dakin’s solution, or sterile maggots
chemical debridement (Methods of debridement)
143
breaks down and loosens dead tissue in a wound
Dakin’s solution ( chemical debridement)
144
used in wound because ingest the dead tissue.
Sterile maggots ( chemical debridement)
145
is the removal of devitalized tissue with a scalpel, scissors, or other sharp instrument.
-usually indicated when the patient has signs of cellulitis or sepsis.
```
Surgical debridement (Methods of debridement)
QUICKEST METHOD
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146
are wound irrigation (high-pressure irrigation and pulsatile high-pressure lavage) and whirlpool treatments
mechanical debridement (Methods of debridement)
147
is used initially to autolytically debride (liquefy the tissue using body moisture) a necrotic wound.
transparent film dressing
148
is to place a folded thin blanket or pillow over an abdominal wound so that a patient can splint the area during coughing
prevent surgical wound dehiscence
149
promotes collagen synthesis, capillary wall integrity, fibroblast function, and immunological function.
Vitamin C promotes
150
, first rinse the wound with normal saline and lightly cover the area with a dressing.
cleaning abrasions, minor lacerations, and small puncture wounds
151
, only brush away surface contaminants and concentrate on hemostasis
laceration is bleeding profusely (cleaning)
152
place the moist dressing (contact dressing) over the wound bed, cover with a clean gauze, and allow the contact layer to dry. In this case the contact dressing is allowed to dry so that it sticks to underlying tissue and debrides the wound during removal
-recommended for debridement in a necrotic wound
debridement is nonselective
153
dressings pulls excess drainage into the dressing and away from the wound
woven gauze
154
occur at the face and head region, and the ears specifically
-MOST COMMON ex oxygen tubing and masks
MDRPIs (medical device–related pressure injury)
155
adheres to undamaged skin, does not need a secondary dressing, and permits viewing of the wound.
-ideal for small superficial wounds such as a stage 1 pressure injury or a partial-thickness wound.
transparent dressing
156
as a secondary dressing and for autolytic debridement of small wounds.
-does not need a secondary dressing,
film dressing
157
are dressings with complex formulations of colloids and adhesive components.
- support healing in clean granulating wounds and autolytically debride necrotic wounds
- can be left in place for 3 to 5 days
- slowly liquefies necrotic debris
- useful on shallow-to–moderately deep dermal injuries.
- contraindicated for use in full-thickness and infected wounds
- cannot absorb drainage from heavily draining wounds
Hydrocolloid dressings
158
are gauze or sheet dressings impregnated with water or glycerin-based amorphous gel
- hydrates wounds and absorbs small amounts of exudate
- indicated for use in partial-thickness and full-thickness wounds, deep wounds with some exudate, necrotic wounds, burns, and radiation-damaged skin
- debride necrotic tissue by softening the necrotic area.
- disadvantage is that some hydrogels require a secondary dressing and you must take care to prevent periwound maceration.
Hydrogel dressings
159
are for wounds with large amounts of exudate and those that need packing
-foam absorb drainage
Foam and alginate dressings
160
are manufactured from seaweed and come in sheet and rope form.
- alginate forms a soft gel when in contact with wound fluid
- for wounds with an excessive amount of drainage and do not cause trauma when removed from the wound
- Do not use these in dry wounds, and they require a secondary dressing.
Calcium alginate dressings
161
, which combine two different dressing types into one dressing.
composite dressings
162
(add dressings without removing the original one)
“reinforce dressing prn”
163
you will use clean medical aseptic technique for a dressing change
chronic nonsurgical wounds
164
is the application of subatmospheric (negative) pressure to a wound through suction to facilitate healing and collect wound fluid
- used for 24 hours to 5 days
- enhances the adherence of split-thickness skin grafts
- airtight seal must be maintained
NPWT(negative-pressure wound therapy )
165
is a device that helps in wound closure by applying localized negative pressure to draw the edges of a wound together
- remove fluid from area surrounding wound, reducing edema and improving
vacuum-assisted closure (V.A.C.)
166
adheres well to the surface of the skin
Common adhesive tape
167
compresses closely around pressure bandages and permits more movement of a body part.
elastic adhesive tape
168
open, deep wounds; wounds involving an inaccessible body part such as the ear canal; or when cleaning sensitive body parts such as the conjunctival lining of the eye.
- use 35-mL syringe with a 19-gauge soft angiocatheter to deliver solution
Irrigation should be used for following body areas
169
is a clear gel or paste applied to the edges of clean small wounds to hold the edges of the wound togethe
- peels off 5-7 days
- avoid touching the glue for 24 hours, to try to keep the wound dry for the first 5 days,
- avoid soaking the wound
- not used over joints, the hand, or the groin area
Skin glue (alternate for sutures)
170
are threads or metal used to sew body tissues together
Sutures
171
- silk, steel, cotton, linen, wire, nylon, and Dacron. (nonabsorbable)
- types sutures can be absorbed: PDS, Vicryl, and Monocryl
types sutures
172
, as the name implies, is a series of sutures with only two knots, one at the beginning and one at the end of the suture line.
Continuous suturing
173
are placed more deeply than skin sutures
Retention sutures
174
are convenient portable units that connect to tubular drains lying within a wound bed and exert a safe, constant low-pressure vacuum to remove and collect drainage
Drainage evacuators
175
are lightweight and inexpensive, mold easily around contours of the body, and permit air circulation to prevent skin maceration
Gauze bandages
176
conform well to body parts but are also for exerting pressure.
Elastic bandages
177
are bandages that are made of large pieces of material to fit a specific body part. Most binders are made of elastic or cotton
-ex: abdominal binder and a breast binder
Binders
178
support arms with muscular sprains or fractures.
Slings
179
secure or support dressings over irregularly shaped body parts.
Rolls of bandage
180
increasing muscle and ligament flexibility; promoting relaxation and healing; and relieving spasm, joint stiffness, and pain
Moist heat applications therapeutically beneficial
181
acute phase of a musculoskeletal injury and during and after childbirth, surgery, and superficial thrombophlebitis
- applications include warm compresses and commercial moist heat packs, warm baths, soaks, and sitz baths
Moist heat indications
182
is also used to reduce pain and increase healing by increasing blood flow in tissues and can be used at a low level for a longer period with little chance of tissue injury
Dry heat
183
is designed to treat the localized inflammatory response of an injured body part that presents as edema, hemorrhage, muscle spasm, or pain
- improvement joint therapy
- pain and swelling, inhibiting muscle spasm, and reducing muscle tension
- used immediately after soft tissue and musculoskeletal injuries such as sprains or strains;
Cold therapy
184
when a patient has an acute, localized inflammation such as appendicitis because the heat could cause the appendix to rupture.
-do NOT cover an active area bleeding w/ warm application= continuous bleeding
Warm applications are contraindicated
185
cardiovascular problems, it is unwise to apply heat to large parts of the body because the resulting massive vasodilation disrupts blood supply to vital organs
Warm applications are contraindicated
186
- if the site of injury is already edematous. It further retards circulation to the area and prevents absorption of the interstitial fluid. If a patient has impaired circulation (e.g., arteriosclerosis), it further reduces blood supply to the affected area.
- Cold therapy is also contraindicated in the presence of neuropathy, because the patient is unable to perceive temperature change and damage resulting from temperature extremes.
- contraindication for cold therapy is shivering
Cold therapy is contraindicated
187
occur through heat-loss mechanisms (sweating and vasodilation) or mechanisms promoting heat conservation (vasoconstriction and piloerection) and heat production (shivering)
Systemic responses to heat & cold
188
occur through stimulation of temperature-sensitive nerve endings within the skin.
Local responses to heat and cold
