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822: Integumentary > Electrotherapeutic Modalities, Physical Agents, and Mechanical Modalities > Flashcards

Electrotherapeutic Modalities, Physical Agents, and Mechanical Modalities Flashcards

1
Q

What are 7 modalities and physical agents than can be used to enhance wound healing?

A
  • Wound irrigation
  • Whirlpool
  • Pulsed lavage
  • Electrical stimulation
  • Ultrasound
  • Negative pressure wound therapy
  • Hyperbaric oxygen
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2
Q

What can be defined as the use of fluid to remove loosely adhered debris, bacteria, exudate, draining residue and residual topical agents?

A

Wound Irrigation

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3
Q

What are 3 advantages to wound irrigation?

A
  • Facilitates debridement
  • Assists with achieving and maintaining a moist wound environment
  • Enhances wound healing
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4
Q

Irrigation after whirlpool removes _ times more bacteria than whirlpool alone

A

4

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5
Q

Wound irrigation is an acceptable intervention for all types of wounds and is the only direct wound intervention for what type of wound?

A

healing granular wounds

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6
Q

In what type of wound is irrigation contraindicated?

A

Wounds with active, profuse bleeding

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7
Q

Wound irrigation should use _-__ psi of pressure

A

4-15

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8
Q

Recent recommendations for irrigation suggest that pressures between __-__ psi are most effective for preventing infection

A

10-15

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9
Q

What are 6 advantages to wound irrigation?

A
  • simple
  • quick
  • inexpensive
  • effective
  • can use for wound in any location
  • can be used in any setting
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10
Q

What is the main disadvantage to wound irrigation?

A

Irrigant runoff may soil bed lines or patient clothing, which may result in the clinician using less irrigant solution than necessary, making the treatment less effective

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11
Q

What are 3 alternatives to wound irrigation?

A
  • Soak wound with saline-moistened gauze
  • whirlpool
  • pulsed lavage
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12
Q

Whirlpool is a form of _______ (selective/nonselective) mechanical debridement

A

nonselective

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13
Q

What are the 7 main purposes of whirlpool?

A
  • debrides loosely adherent devitalized tissues, foreign debris, and surface bacteria
  • softens necrotic tissue and eschar
  • hydrates the wound bed and promotes moist wound healing
  • promotes circulation
  • associated with decreased patient pain complaint during wound care procedures
  • eases ROM for patients with burn injuries
  • can help soak off adherent wound dressings
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14
Q

Whirlpool is indicated in what 4 types of wounds?

A
  • infected wounds
  • nondraining wounds
  • wounds with thick eschar
  • wounds with loosely necrotic tissue or thick exudate
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15
Q

Whirlpool is contraindicated in what 4 types of wounds?

A
  • Clean, granulating, or epithelializing wounds
  • Edematous, draining, or macerated wounds
  • Wounds with tunneling, undermining, skinfolds that can’t be effectively irrigated
  • Active bleeding wounds
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16
Q

What should you be cautious of when treating arterial insufficiency ulcers with whirlpool?

A

lower the temperature

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17
Q

In what type of patients is whirlpool contraindicated?

A
  • patients with edema or lymphedema
  • incontinent patients
  • patients who are hydrophobic, confused, combative, with seizures
  • patients with multiple open wounds
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18
Q

__% of burn units using whirlpool therapy use the immersion method

A

81

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19
Q

Small whirlpools should be filled with water between __ to __ degrees Fahrenheit. Larger whirlpools need to be slightly warmer, but should never exceed ___ degrees

A

92-98

102

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20
Q

Whirlpool treatments should be completed in __-__ minutes

A

10-20

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21
Q

What are 3 advantages to whirlpool treatment?

A
  • provides a comfortable environment to perform ROM exercises
  • promotes moist wound healing
  • available in most clinical settings
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22
Q

What are 4 disadvantages to whirlpool treatment?

A
  • the irrigation pressure cannot be calibrated
  • there is potential for maceration, edema, and cross-contamination
  • time intensive for setup and cleanup
  • expensive
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23
Q

What can be defined as the delivery of wound irrigant under pressure by an electrically powered device?

A

Pulsed Lavage

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24
Q

What are the 4 positive effects of pulsed lavage?

A
  • Irrigates wound bed with precisely calibrated pressure
  • Assist with obtaining/maintaining moist wound environment
  • Facilitates debridement
  • May enhance granulation tissue formation, epithelialization, and tissue perfusion
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25
Q

In what type of wounds is pulsed lavage indicated?

A
  • arterial insufficiency wounds
  • venous insufficiency wounds
  • diabetic ulcers
  • pressure ulcers
  • small burns
  • surgical wounds
  • wounds with tunneling/undermining
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26
Q

When is pulsed lavage contraindicated?

A
  • in wounds with exposed arteries, nerves, tendons, capsules, or bone
  • on facial wounds
  • recent grafts or surgical procedures
  • wounds that are actively bleeding
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27
Q

Patients with a _____ allergy should not be treated with pulsed lavage

A

latex

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28
Q

What are 3 situations in which pulsed lavage should be used with caution?

A
  • patients taking anticoagulants because of the potential for hemorrhage
  • insensate patients to decrease the risk of unperceived trauma
  • patients with deep tunneling wounds to prevent damage from the probing wound tip
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29
Q

If the pulsed lavage pressure is greater than 15 psi what is the risk?

A

increased bacteria penetration into wound tissues

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30
Q

Depending on the wound size and severity there should be anywhere around ____-____ mL of irrigant in the irrigant reservoir and should be between ___-___ degrees Fahrenheit.

A

1000-3000

102-106

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31
Q

What is the appropriate PPE requirement while performing pulsed lavage and why?

A

Everyone in the room is required to wear PPE in order to protect them from splash injury and aerosolization

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32
Q

In order to prevent cross-contamination what are the environmental requirements while performing pulsed lavage?

A
  • room with four walls and a door
  • cover IV sites/open areas not being treated
  • wipe down all horizontal surfaces
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33
Q

What are the 6 advantages of pulsed lavage treatment?

A
  • encourages thorough irrigation
  • can be used in any setting and on a wound in any location
  • quick
  • low risk of cross-contamination
  • decreased pain
  • ergonomical
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34
Q

What are the 4 disadvantages of pulsed lavage treatment?

A
  • messy
  • expense
  • not appropriate for large wounds
  • some parts are “one-time use”
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35
Q

It has been shown that electrical stimulation can increase the rate of wound healing by ___% compared to standard care

A

144

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36
Q

Typical wound care electrical stimulation uses ____ volt pulse current

A

high

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37
Q

What are the 7 purported ways in which electrical stimulation is thought to facilitate wound healing?

A
  • restores the current of injury
  • causes galvanotaxis
  • stimulates cells
  • increases blood flow
  • increases bactericidal abilities
  • reduces edema
  • facilitates debridement
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38
Q

Normally, the epidermis is electro____ with respect to the dermis creating a skin “battery”. A break in skin integrity disrupts this battery making the wound electro____ compared to the surrounding tissues

A

negative

positive

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39
Q

What is galvanotaxis?

A

the stimulation of cells to move along an electrical current

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40
Q

Electrical stimulation-mediated angiogenesis may be mediated by what activation of what?

A

vascular endothelial growth factor (VEGF)

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41
Q

Does the antibacterial effect seem to be greatest under the anode or cathode?

A

cathode (negative electrode)

42
Q

______ stimulation is believed to facilitate autolytic debridement

A

Negative/Cathodal

43
Q

Electrical stimulation is indicated as an adjunct to would healing for what type of wound?

A

chronic or recalcitrant wounds that are clean or infected, granular or necrotic

44
Q

According to the Center for Medicare and Medicaid Services electrical stimulation should be considered in patients with stage __ or __ pressure ulcers that fail to respond after 30 days of standard care

A

III or IV

45
Q

What are the 4 contraindications to using electrical stimulation as an adjunct to wound healing?

A
  • simple, uncomplicated wounds
  • untreated osteomyelitis
  • not in combination with topical agents containing heavy metals
  • wounds that are actively bleeding
46
Q

In what type of patients should electrical stimulation be used cautiously?

A

Patients with sensory neuropathy

47
Q

What are the 3 techniques for applying electrical stimulation to facilitate wound healing?

A
  • direct
  • immersion
  • periwound
48
Q

Describe the direct technique

A

A saline or hydrogel moistened gauze is placed within the wound bed and covered with a carbon electrode.
The return electrode should be placed approximately 15-20 cm proximally or on the opposite body surface

49
Q

If there is a decline in wound status or if there is no improvement after _ weeks electrical stimulation, alternative interventions must be considered.

A

2

50
Q

In what type of patient is the immersion technique best used for?

A

Patients with multiple and or foot ulcers

51
Q

Describe the immersion technique

A

The wound is placed in a nonmetal basin filled with water. The treatment electrode is then placed contact side down within the basin, essentially making the entire water-filled area the treatment electrode.

52
Q

What are the advantages to the periwound technique?

A
  • the wound dressings can be kept in place

- decreased potential for wound contamination

53
Q

E-Stim Parameters

Frequency: __-___Hz

A

80-115

54
Q

E-Stim Parameters

Intesnity: __-___ Volts

A

75-200

comfortable parenthesia (submotor)

55
Q

E-Stim Parameters

Interpulse Interval: __-___ microseconds

A

50-100

56
Q

Is the anode or cathode used to decrease wound infection?

A

cathode

57
Q

Is the anode or cathode used to restore the normal current of injury, promote granulation tissue formation, and enhance epithelialization?

A

anode

58
Q

Due to the varying effects of e-stim polarity when should the cathode be used?

A

the first several days of treatment because it may reduce bioburden (even in wounds that are not infected)

59
Q

How long should e-stim treatment sessions be?

A

45-60 minutes or as little as 30 minutes if performed BID

60
Q

How many times per week should e-stim be performed in IP and in OP?

A

IP: once or twice daily

OP: 3 times per week

61
Q

What are the 4 advantages to e-stim?

A
  • research supports its efficacy
  • can be used in any setting due to its portability
  • painless
  • less setup and cleanup time than whirlpool
62
Q

What are the 3 disadvantages to e-stim?

A
  • time consuming
  • increased risk of wound contamination
  • not appropriate for large, extensive burn wounds
63
Q

What are 2 alternatives to electrical stimulation?

A
  • ultrasound

- hyperbaric oxygen

64
Q

There appears to be sufficient evidence that states ultrasound is helpful in facilitating healing in _______ wounds

A

recalcitrant/chronic

65
Q

What are the proposed effects of ultrasound?

A
  • enhances all 3 phases of wound healing
  • enhances wound contraction
  • improves scar pliability
66
Q

What 3 things does ultrasound increase during the wound healing process?

A
  • collagen deposition
  • granulation tissue formation
  • angiogenesis
67
Q

Noncontact low frequency (25-40 kHz) ultrasound in combination with saline mist can help to do what 2 things?

A
  • debride wounds with adherent fibrin

- decrease bioburden within chronic wounds

68
Q

What are the 4 contraindications to ultrasound for wound healing?

A
  • untreated osteomyelitis
  • wounds with active profuse bleeding
  • severe AI
  • DVT
69
Q

What are the 3 application techniques for ultrasound?

A
  • direct
  • immersion
  • periwound
70
Q

Describe the application of direct ultrasound

A

Deep wounds should be filled with amorphous hydrogel or normal saline to allow for the transmission of energy into the wound bed.
The wound must be covered with a barrier to prevent contamination from the conductive gel.
Apply ultrasound gel over the barrier.

71
Q

What type of barrier transmits the greatest amount of ultrasound energy?

A

sheet hydrogels

72
Q

True or False

It is appropriate to use varying barriers when treating wounds with ultrasound.

A

False

They should use the same type of barrier to ensure a consistent treatment dosage

73
Q

When performing immersion ultrasound how should the sound head be held in respect to the wound?

A

0.5 to 1.0 cm away from the surface of the wound and periwound

74
Q

Ultrasound Parameters

Frequency: __ MHz for superficial wounds and __ MHz for deep wounds

A
  1. 0

1. 0

75
Q

Ultrasound Parameters

Intensity: __-__ W/cm squared

A

0.5-1.0

no greater than 1.5 for remodeling closed wounds

76
Q

Ultrasound Parameters

Pulse Rate: __-__%

A

20-25%

77
Q

The treatment area for ultrasound should be divided into zones equal to __ times the area of the sound head.

A

1.5

78
Q

Each ultrasound treatment zone should be treated for _ minutes initially, increased to 30 second intervals until reaching _ minutes of treatment per zone.

A

2

3

79
Q

How many times per week should ultrasound be performed in acute wounds and in chronic wounds?

A

acute: once or twice daily
chronic: 3 times per week

80
Q

Noncontact low-frequency ultrasound Parameters

Frequency: __-__ kHz

A

25-40

81
Q

Noncontact low-frequency ultrasound Parameters

Treatment Time: __-__ seconds per cm squared with a minimum of _ minutes for wounds less than 15 cm

A

20-60

4

82
Q

What are the 5 advantages to using ultrasound as an adjunct for wound healing?

A
  • can be used in any setting
  • quick
  • less setup and cleanup time
  • does not hyperhydrate
  • does not require dependent positioning
83
Q

What are the 4 disadvantages to using ultrasound as an adjunct for wound healing?

A
  • not as much research support
  • not appropriate for large wounds
  • may be painful or difficult to perform
  • increased risk of contamination
84
Q

What are the 8 proposed effects of negative pressure wound therapy?

A
  • increase local blood flow
  • decrease wound/periwound edema
  • increase granulation tissue formation
  • increase angiogenesis
  • increase epithelialization
  • decrease wound bioburden
  • promote cell proliferation
  • maintain moist, warm wound environment
85
Q

What are 3 examples in which NPWT can be used on a wound?

A
  • postsurgical wounds and grafts
  • wounds with exposed deep tissue or hardware
  • traumatic wounds
86
Q

In what type of wounds is NPWT contraindicated?

A
  • dry wounds
  • necrotic wounds
  • wounds in body cavities
  • wounds over malignancies
  • in the presence of exposed blood vessels
  • untreated osteomyelitis
87
Q

Caution should be used with applying NPWT to what type of patient?

A

patients on anticoagulants or with wounds that are actively bleeding

88
Q

What is black polyurethane foam used to do?

A

enhance granulation tissue formation and wound contraction

89
Q

What is white PVA foam used to do?

A

enhance epithelialization

90
Q

How much pressure is applied during NPWT?

A

50–175 mm Hg

125 mmHg is optimal

91
Q

How long is the NPWT dressing left in place?

A

12-72 hours

92
Q

What are the 3 advantages to using NPWT?

A
  • may cost less over time
  • can be used in any setting
  • helps maintain a warm, moist wound environment
93
Q

What are the 7 disadvantages to using NPWT?

A
  • no standard for use
  • possibly painful
  • may hinder patient mobility
  • noisy
  • challenging to obtain an air-tight seal
  • may cause skin damage and ulceration due to negative pressure
  • expensive
94
Q

Tissue partial pressure of oxygen must be greater than __ mm Hg for normal healing

A

40

95
Q

What are the 4 ways in which hyperbaric oxygen may enhance wound healing?

A
  • increases the oxygen concentration gradient
  • reduces bacterial growth
  • increases angiogenesis, granulation tissue formation, epithelialization, and wound contraction
  • reduces edema
96
Q

What are the 7 indications for hyperbaric oxygen?

A
  • gas gangrene
  • peripheral ischemia
  • crush injury
  • Wagner grade 3 or higher
  • progressive necrotizing fasciitis
  • osteomyelitis
  • osteoradionecrosis
97
Q

What are the 6 contraindications to hyperbaric oxygen?

A
  • DVT
  • congestive heart failure
  • claustrophobia
  • pregnancy
  • severe AI
  • noncomplicated wounds
98
Q

When patients are in a hyperbaric oxygen treatment they are breating 100% at __-__ atm

A

2.0-2.5

99
Q

If wound size does not decrease by 50% after __ hyperbaric oxygen treatments, the wound is unlikely to respond to this modality.

A

10

100
Q

What is the main advantage of systemic HBO?

A

the TCOM test can be used to help the HCP determine the potential for improvement with therapy

101
Q

What are 2 disadvantages to using hyperbaric oxygen?

A
  • extremely high cost

- extensive treatment time

822: Integumentary (16 decks)

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