exam 1 questions Flashcards
- What is the purpose of sensibility evaluation? What are you testing?
a. to assess peripheral nervous system
3 types of nerve fibers
-motor-terminate in muscles (nerve fiber, MMT)
-sensory- terminate in skin (ability to tacitly feel)
-sympathetic- part of autonomic nervous system- inc HR, constricts blood vessels.
- What is the normal process for nerve regeneration? What can the client expect to feel?
a. axonal regeneration is 1-5 mm/day or inch per month.
- referred touch- common during regeneration (can’t localize sensation)
- localization improves as hand is used more
- spontaneous sensationns are normal and can be painful– electic, buzzing
- need to retain sensation in some
- paraesthesis- tingling (good)- becomes bad when it becomes too intense.
- What is cellulitis and what will you see clinically to assist you in referring the patient to the physician?
a. typical infection- increasing redness around the wound .
- red streak spreading from the wound toward the heart (lymphangitis)
- What is exudate and transudate?
a. -Pus (cloudy)- fluid from wound- may promote bacterial growth
- water and electrolytes - first fluid out of wound (clear, drainage).
- In what phase do the fibroblasts proliferate the most yet still have low scar strength?
a. phase 2-fibroplasia
4 days to 2-6 wks
- What is a hypertrophic scar?
a. overproduction of collagen (keloid)
genetic. . smoking, drinking, eating all affect scarring.
- What is the one wound-one scar concept?
all tissue is going to scar together, thats why gliding helps separate different layers. “ heal from the outside in”
- What are the phases of healing including physiological and clinical signs?
a. phase 1- inflammation (0-5 days)-
- physiological- blood vessels dialate
- fluid gets away from vascular system to increase edema
-clinical- 5 cardinal signs of inflammation- redness, edema, heat, pain, loss of function
(more edema=thicker bigger scar b/c more protien- not good/aggressive approach).
phase 2- fibroplasia (4 days - 2-6 wks)
physiological- fibroblasts proliferate (most cell scar growth)
-new capillary growth (if you leave it alone it will contract/ wont stretch out/ granulation tissue/ MOBILIZE at this stage)
- wound looks red and granular
-random laydown of cells
-replacement of injured tissue w immature collagen that is devoid of architectural memory.
-increased strength along with collagen lay down for 3 wks
clinical- inflammation decreases slowly
-pain at end range of motion (not normal).
Phase 3- maturation (remodeling) 1 month - years
physiological - fibroblasts activity decreases (well healed)
-remodels according to tension applied- may shorten if left alone
-scar softens and becomes more pliable
-nutrition has effect
-newly formed scar shrinks in all dimensions and squeezes water out to extracellular spaces = collagen more dense – scar becomes more noticable
Clinical- thickened
- increased pain, edema in beginning
- muscle guarding (stiffness, tension)
- stiff after rest
- decrease ROM 24 hrs after doing too much (offending activity).
- What is the therapist’s role in each phase of healing?
a. dressings, monitor, eval, educate, support healthy healing, clean, address, apply wound healing med.
Phase 1- therapy within 1 week = most beneficial and increased outcome - acute phase -let everything heal
Phase 2- therapy is critical in laydown of cells to facilitate gliding of surfaces yet not increase inflmmation (rupture nerves if moving to soon).
Phase 3-
- What are the different types of wound closure?
Primary closure: clean wound done in 2-3 days if sutures stay in for 14 days
Delayed primary closure: too contaminated for primary closure . Closed after a few days.
Secondary intention healing: skin loss, can’t close it and body closes over it.
Soft tissue or skin loss, no closing.
- Explain the three-color concept for wound assessment. How does your intervention differ for each wound color?
Red- characterized by definite borders, granulation tissue,apparent revascularization, indicates oxygenation, granulation progresses from edges to center of wound.
Interventions: maintain humidity by keeping wound covered, by doing this protects wound fluids and new cells. cleanse with sterile saline can be cleaned with running water and mild pump soap on peri wound area if DR. Approves.
Yellow: creamy to canary yellow, Oder,draining pus. Means delayed healing until infection is under control, once under control healing can start. Use sterile saline to clean.
Interventions: wash with soap and water, sterile whirlpools once infection under control, loosen necrotic tissue, wet to dry dressings. IF yellow do not proceed as an OT call DR.
Black:wound is covered with escar-May have all phases of healing underneath,
Interventions: sterile whirlpool,work on gentle cleaning and debriding and ointments to soften.
- What are the areas you can expect to document for wound assessment?
Exudate-fluid from wound, amount , type and Oder as light,moderate, heavy
Drainage can be clear, sanguine outs ( bloody), serosanguineous( blood tinged), purulent( cloudy, pus-yello, green)
Oder, clean wound well with saline before assessing, describe as faint, moderate or strong.
Size:picture with measurements
- What is the expected viability for skin grafts?
a split thickness graft should be viable in 3 -5 days( superficial dermis)
A full thickness graft in 7-10 days ( skin and nerve ending).
Viability: tissue let it be for time period no whirlpool.
- How do you clean areas of the clinic to avoid sharing bacteria and body fluids?
a exam room surfaces should be cleaned with EPA registered hospital disinfectant or a one to one solution of diluted bleach one tbsp of bleach to one quart of h2o. Place infected patients in private rooms, wear gowns and eye protection when body generates splashes or sprays fluids. Wear gloves, hand hygiene between patients and when moving from contaminated site to clean site on patient. Disposal of used dressings. Avoid touching sink facets soap bars,avoid eating, drinking applying cosmetics in patient care area, avoid contact with eyes, hair,nose, face…report incidence with contact of body fluid with patient.
- How would you explain standard precautions to a new employee?
a therapist guidelines: keep nails short, clean and polish free. Avoid wearing jewelry. No artificial nails, any cuts or abrasions should be covered with water proof dressing. Roll up long sleeves before washing hands and wrists.
