Compression, hydro-, diathermy Flashcards
Actue Edema
Usually localized response to a known injury
Rapid onset
Warmth and redness
Acute edema tx
ASAP after injury
RICE
Venous edema
Slow progressive
Mod warmth
Dusky, brown hyperpigmenation
Increased pain as day progresses
Venous edema
Tx
Compression
Elevation
Lyphemeda
Soft and pitting or hard
Slow progressive
Mild warmth
Less freq assoc with pain and color changes
limb feels full, heavy
asymmetrical
shiny skin
loss of skin folds
Lyphedema tx
Education
Compression
Manul lymphatic drainage
Systemic Edema
Result os kidney, liver, heart disease
fever is possible
Systemic edema tx
Medical management
Toxic Edema
d/t RXN (bees sting, allergies)
Acute
Localized
Itchy, painful
Redness
Toxic edema tx
Medical management
Elevation Purpose
Allows gravity to assit in the flow of fluids
Decreases the hyrdostatic pressure in tissue
Elevation contraindications
Poor arterial supply
Ischemic limb
Compression Purpose
Increase hydrostatic pressure
Decrease of fluid movement out of the capillaries
Increase absorption of fluid by veins and lymphatic bessels
Compression indications
Control peripheral edema
prevent DVT
Shape residual limb after amputation
Facilitate the healing of veous ulcers
Post surgery lymphedema
Prevent/treat hyrpertrophic scarring
Compression methods
Bandages
- Elastic bandages
- Amount of stretch during app (high or low)
- Number of layers applied
- Condition of bandage (old or new)
Athletic Tape
Intermittenet compression machines
Inflated Sleeves
Parameter
Pressure does not go higher than diastolic
UE - 30-60 mm Hg
LE - 40-80 mm Hg
Lymphedema: use lower pressures
On/Off
Usuallt Pt tolerance
Edema of DVT prevention
- 80-100s on/ 25-50s off
residual limb reduction
- 40-60s on/10-15s off
Start with 3:1, then adjust to pt tolerance
1-4 hr 1-4x wk
Inflation sleeve
Contraindications
CHF and pulmonary edema (assoc with CHF)
Active skin infection
Acute trauma
Acute or unstable fx
Recent thrombophelbitis
DVT
Pulmonary emboli
Obstruction of lymph vessels
Obstruction of venous return
Systemic edema
Atrial insufficiency
Arterial revascularization
Stroke
Inflations sleeve Precautions
Impaired sensation/mentation
Uncontrolled HTN
Cancer
Rcent stroke
Around superficial veins
Edema measuring
Circumferential tape measuring
Volumetric measurement (water displacement)
Hydrotherapy
Goals
Use of water for specific therapeutic golas
Superficial heating and cooling
Wound care
- debridement; promote circulation
Unload weight bearing joints
Provide resistance for movement
Mechanical stimulation
- pain relief; desensitization
Water Properties
Thermal conductivity
- Heat transfers from higher to lower temps
- Conduction
- Convection if water is moving (faster flow = faster transfer
Bouyancy
- Decrease weight. influenced by amount of body immersed
- 50% ASIS
- 33% Xyphoid
- 10% Clavicular
Viscosity
- Friction resistance
- Faster = more resistance
Hydrostatic pressure
- Pressure applied by the water
- Deeper the water, the more compression
Effects of immersion
Muscles
- Strengthening
- Increase resting muscle blood flow
- Increase O2, waste removal
Cardiovascular
* Due to hydrostatic pressure:
- Enhance venous return
- Increase cardiac output
Respiratory
* Increase work of breathing
- increase venous return + increase resistance to chest expansion (due to water on chest)
- Increased moisture may have benefits
Renal
* Increase urine production and urinary Na and K
- Due to increase venous return
Psynchological
* Invigorating and relaxing
Immersion Contraindications
Bleeding
Maceration around the wound
Cardiac instability
Infectious conditions that can be spread by water
Bowel incontinence
Severe epilepsy
Immunosupressed patients
Actue inflammation
PVD
Existing fever
Immersion Precautions
Impaired thermal sensation
Confusion
Recent skin grafts
Pregnancy
MS
Poor thermo regulation
Immersion adverse RXN
Drowning
Burns, fainting, bleeding
Hyponatremia (burn pt)
Infection
Aggravation of edema
Asthma exacerbation
Increased weakness
Water Temperature
32-79: Cold, acute inflammation, min pain and edema
79-92: cool/tepid, decrease spasticity
92-96: Neutral, circulatory disorders
96-98: Warm, open wound, debridement
99-104: Hot, Arthritis, ROM/Pain
104-110: Very hot
Contrast bath
Alt immersion of body part in hot and cold
Promote pain relief, gain effects of heat
Hot water 3-4 mins
cold water 1 min
5-6 x total 20-30 mins
Diasadvantage: limb is in dependant position, unconfortable, messy
Diathermy
High frequency electromagnetic waves used to heat deep tissue
Short wave frequency: 27.12 MHz
Thermal, non thermal effects
Diathermy
Non-thermal effects
Repolarization of cells
Acceleration of cell growth and division
re-establishment of sodium pump
Increase micro vascular perfusion
Improve cell function
Increase WBC in a wound
Diathermy
Thermal effects
Conversion
Same as any heating modality (heats deeper without contact)
Tissue with least resistance = best current flow. High electrolyte balance heats best
Diathermy
Indications
Heting for stretching
Heating skin or joint when other heat apps are not tolerated
Deep heating >2 cm
Over a large area
Areas of mod fat and deep muscle
Treatment area is irregular
Diathermy Contraindications/precautions
Pacemaker, neurostimulator, defibrillator
Metal implants
Pregnancy
Malignancy
Presence of fever
Site of infection
Epiphyseal plates in children
Testes of eyes
Insulim pump
Acute inflam cond
Impaired circulation/sensation
Fluid filled organs
Hemorrhage
HNP
Joint effusion
Diathermy Adverse RXN
Burns soft tissue
Excessive heating of adipose tissue
Superficial burn where moisture collects
Diathermy Applications
Inductive coils (magnetic field)
Capacitative plates (electrical field)
Inductive Coils
Alt current flows flowing through coils producing a magnetic field
Curents cause tissue to oscillate. Causes friction, increasing tissue temp
Strength of current depends on strngth of magnetic field and conductivity of the tissues
Cables - coils wrapped around limb
Drums - one or two
Capacitative Plates
HIgh frequency alt current. one plate to another through pt.
current flow causes oscillation of cahrged particles increasing temp
Heat generated depends on strength and density of current
Greatest heat generated in tissue with greatest conductivity
Superficial heat
Magnatron condensor
microwave diathermy
High freq, alt current
Small focused tx area
most superficial (burn potential)
Reflectio occurs (can cause bone burning)
