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Fall 2024: Integumentary Systems > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

T or F? Negative Pressure Wound Therapy (NPWT) cleans the wound

A

False, it only drains the exudate (and promotes granulation formation)

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2
Q

Describe Negative Pressure Wound Therapy (NPWT)

A

Purpose: Enhance healing and promote wound closure

Used for acute, sub-acute, and chronic wound management (Wound must be debrided so it is free of eschar and slough)

Indications: Post-surgical wounds, wounds with exposed deep tissue, skin grafts, traumatic wounds

Contraindications: Necrotic tissue or dry wounds, bleeding, osteomyelitis, individuals on anticoagulants (blood thinners)

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3
Q

In regards to target pressure using NPWT for acute ulcers and chronic ulcers, which pressures should be used?

A

Acute traumatic / pressure ulcers
- Black Foam: 125mmHg
- Soft Foam: 125-175mmHg

Chronic Ulcers
- Black Foam: 50-75mmHg
- Soft Foam: 125mmHg

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4
Q

When should NPWT be dicontinued?

A

Large amounts of blood, patient is unable to tolerate pain/pressure, no progress, signs of new infection

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5
Q

Describe pulsed lavage

A

Used for cleansing/debridement of the wound (can also help soften the tissue if high PSI is used, ultimately making debridement easier)

  • 1x per day, At least 3x per week (should be done more if the wound is not granulating), should be discontinued when treatment goals have been met

Indications: eschar tissue that needs to be softened before debridement, tunnels, skin graft prep

Contraindication: Exposed arteries/veins/nerves/tendons/bone, active bleeding, facial wounds, vascular bypass graft sites/flaps

Precautions: Insensate areas (loss of sensation), patients on anticoagulants (blood thinners), wounds near major vessels

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6
Q

What are biofilms?

A

Communities of microorganisms attached to the wound surface

(can create a barrier to wound healing)

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7
Q

Which pressure should be used with pulsed lavage when using it to clean or debride a wound?

A

Cleaning: 4-7psi

Debridement: 8/10-15psi

(use low pressure for tunneling)

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8
Q

T or F? Suction for NPWT stimulates granulation tissue production

A

True

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9
Q

Differentiate between closed and open pulsed lavage

A

Open Pulsed Lavage: Done in a medical facility, full PPE is mandatory, wound debris sprays from the wound

Closed Pulsed Lavage: Can be done in the patient’s home or somewhere casual due to the utilization of a bag. This bag collected all debris and prevents splashing from the wound

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10
Q

Describe HBOT

A

Hyperbaric Oxygen Therapy

An oxygen chamber/bed that has the following benefits:
- Increases oxygen concentration gradient (hyperoxia) in the blood
- May reduce bacterial growth
- Enhance angiogenesis, collagen, granulation tissue formation, epithelialization, and wound contraction
- May reduce edema

Oxygen Pressure must be >40mmHg for “normal wound healing” to occur… <40mmHg is considered wound hypoxia

Indications: Gas gangrene, peripheral ischemia, skin grafts, osteomyelitis, thermal burns

Contraindications: Untreated pneumothorax, COPD/asthma, pregnancy, claustrophobia, arterial insufficiency

Duration: 90-120 minutes per session, 2-3x per week, 10-60 sessions total

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11
Q

Describe laser therapy

A

A machine that uses light waves that has the following benefits:
- Provides cells with photons, then the cells turn energy into ATP
- Increases respiratory chain activity
- Promotes cell repair/reproduction through stimulation of ATP
- Enables cell proliferation

Precautions: Decreased sensation, steroid injection

Contraindications: Pregnancy, malignancy, growth plates in children, gangrene (wagner 4/5), individuals with epilepsy

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12
Q

What are the 4 customizable settings with laser therapy?

A
  1. Wavelength (nm):
    • Distance between two peaks of a wave
  2. Power (mW):
    • The rate at which energy is produced
  3. Energy (J/cm^2):
    • The amount of energy delivered per unit area
  4. Continuous or pulsed:
    • Whether or not the laser is always on (continuous), or pulsed (sometimes on, sometimes off)
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13
Q

T or F? Length and Power determine the depth of the probe (light)

A

True

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14
Q

T or F? Power=Probe

A

True

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15
Q

What are the parameters for acute and chronic wounds using laser therapy

A

ACUTE WOUNDS
Dosage: 8j/cm^2
Frequency: 700Hz
Application: In and around wound bed and peri-wound

CHRONIC WOUNDS
Dosage: 1-6j/cm^2
Frequency: Continuous
Application: In and around wound bed and peri-wound

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16
Q

What are some examples of resistance to estim?

A

Fat, Hair, Dirty skin

17
Q

What are the 4 debridement techniques?

A
  • Autolytic (body’s natural enzymes break down the dead tissue)
  • Enzymatic (uses chemical agents to remove the dead tissue)
  • Biological (maggots consume the dead tissue)
  • Surgical (debridement using scalpel, scissors, etc.)
18
Q

Describe E-stim (for wound healing)

A

Typically a monopolar pad placement with negative lead on or around the wound. If placed on the wound, use gauze (soaked with saline) underneath as it will prevent burning

Indications: Muscle re-ed, pain control, wound healing, edema/swelling control

Contraindications: Pacemaker, skin cancer, malignancy, osteomyelitis, thrombosis

19
Q

Distinguish which types of nerves are recruited by the 3 following phase duration ranges of estim…

20-100, 200-400, 400-1000

A

20-100: Sensory nerves
200-400: Motor nerves
400-1000: Noxious nerves

20
Q

What are the parameters for wound healing estim?

A

High volt (twin spiked monophasic)

> 100 volts (intensity)

<100 usecs (phase duration)

1-120 Hz frequency

21
Q

Differentiate between a cathode and an anode

A

Cathode: Negative electrode (pad)… typically used for granulation and epithelialization

Anode: Positive electrode (pad)… typically used for autolytic debridement

22
Q

What other type of Estim has a polarity?

a) Biphasic symmetrical
b) Biphasic asymmetrical
c) Direct Current
d) Russian
e) IFC

A

c. Direct current

23
Q

In a monopolar pad setup, the dispersive and active pad need to be placed how far apart?

A

15cm

24
Q

Describe ultrasound

A

Measured in megahertz (MHz)… 1MHz goes deeper but takes longer to heat, 3MHz is more superficial but is quicker to heat

must be a protective layer between gel and wound

Indications: For clean or infected wounds that have not responded well to other treatments (only use non-thermal US on wounds, thermal on scar tissue)

Contraindications: Malignancy, pregnancy, laminectomy, fx site, osteomyelitis

25
Q

T or F? Use continuous (laser) for chronic wounds

A

True

26
Q

What are the contraindications for HBOT?

A

“PLACE” mnemonic

  • Pregnancy
  • Lung issues
  • Arterial TCOM <40
  • Claustrophobia
  • Ear/sinus issues
27
Q

What are the contraindications for pulse lavage?

A

“FABLE” mnemonic

  • Face
  • Active bleeding
  • Bypass grafts
  • Latex allergy
  • Exposed bone, tendon
28
Q

What are the contraindications for sharp debridement?

A

“GO PITAS”

  • Gangrene
  • Osteomyelitis
  • PAD/arterial insufficiency <.9
  • Immunocompromised
  • Thrombocytopenic
  • Anticoagulants
  • Stage 3-4 w/tunneling
29
Q

What are the contraindications for NPWT?

A

“FB Domains” mnemonic

  • Fistulas
  • Blood vessels
  • Dry
  • Osteomyelitis
  • Malignancy
  • Active bleed
  • Infection
  • Necrosis
  • Starved/malnourished Albumin <3.5
30
Q

What are the contraindications for Estim?

A

“B SUCTION” mnemonic

  • Blood flow compromised
  • Seizures
  • Unstable fracture
  • Chest/cancer
  • Titanium okay, all other metals no
  • Implants
  • Osteomyelitis
  • Neck
31
Q

What are the precautions for Estim?

A

“SSSSOCCC” mnemonic

  • Seizure hx
  • Sensation deficits
  • Surgical sites
  • Skin conditions
  • Obesity
  • Cognitive deficits
  • Cancer hx
  • Cardiac issues
32
Q

What are the contraindications for laser?

A

“CHEEP EGG” mnemonic

  • Cancer
  • Hemorrhage
  • Eyes
  • Endocrine
  • Pregnancy
  • Epilepsy
  • Gangrene
  • Growth plate
33
Q

What are the contraindications for compression?

A

CC Ideas

  • Claustrophobia
  • Complex regional pain syndrome
  • Infection
  • DVT
  • Edema of the cardiopulm system
  • ABI <.7
  • Spasticity
34
Q

What are the contraindications for ultrasound?

A

“O SAD” mnemonic

  • Osteomyelitis
  • Severe arterial insufficiency
  • DVT
35
Q

What are the mnemonics or HBOT, Pulse Lavage, Sharp Debridement, NPWT, Estim, Laser, Ultrasound

A

HBOT: “PLACE”

Pulse Lavage: “FABLE”

Sharp Debridement: “GO PITAS”

NPWT: “FB DOMAINS”

Estim: B SUCTION

Laser: CHEEP EGG

Ultrasound: O SAD

36
Q

What are the parameters for estim on wounds?

A

High volt, twin spiked monophasic, >100 volts (intensity), <100usecs (phase duration), 1-120Hz (frequency)

Should be done daily (5-7 days per week), and for 45-60 minutes per session

37
Q

T or F? When using estim, the cathode (negative pad) is used for granulation/epithelialization while the anode (positive pad) is used for debridement

A

True

38
Q

T or F? transparent films are not used on estim, just ultrasound and laser

A

True

Fall 2024: Integumentary Systems (11 decks)

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