Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Integ > Lecture 5b - TIME and wound bed prep > Flashcards

Lecture 5b - TIME and wound bed prep Flashcards

1
Q

What does TIME stand for?

A

Tissue
Infection or Inflammation
Moisture
Edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tissue from “TIME”

A

Debridement & modalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Infection or Inflammation from “TIME”

A

Treat local or systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Moisture from “TIME”

A

Treat with barriers, lotions, and dressings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Edges from “TIME”

A

Treat with barriers, dressings debridement & modalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What level of evidence does e-stim have?

A

Level A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some indications for e-stim for wounds?

A
  • Pressure ulcers
  • Venous insufficiency ulcers
  • Arterial ulcers
  • Diabetic neuropathy ulcers
  • Burns
  • Dehisced surgical wounds
  • Chronic wounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are benefits of e-stim for wound care?

A
  • Restores current of injury
  • Causes galvanotaxis
  • Stimulates cells
  • Increases blood flow
  • Increases bactericidal abilities
  • Facilitates debridement
  • Reduces edema
  • Reduces pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the charge typically found in edema?

A

(-) charge so when using High-Volt to push, put the (-) electrode on/near the edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What charge does the epidermis have?

A

Electronegative (-) charge, SO when we have a break in the skin, there is a disruption so a wound has a (+) charge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common e-stim treatment for wounds?

A

HVPC

Parameters
* Frequency: 80-125 Hz
* Interpulse interval: 50-100 ms
* Intensity: 75-100 V
* Time: 45-60 minutes

Inpatient tx: 1-2x/day
Outpatient tx: 3x/wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 3 e-stim methods?

A
  1. Direct technique (saline-soaked gauze; other electrode is 15-20 cm away; most common)
  2. Immersion technique (in water; consider risk for contamination or infection)
  3. Periwound technique (around wound, decrease contamination, don’t have to remove dressing)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some roles of the cathode (-)?

A
  • Attracts: neutrophil, fibroblast
  • Promote epithelial growth & organization
  • Vasoconstrictor
  • Denatures protein
  • Aids in preventing post-ischemic lipid production
  • Attracts macrophages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Do you start with the cathode or anode for treatment?

A

Begin with cathode for a few days, then switch to anode usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some roles of the anode(+)?

A
  • Attracts: neutrophil, macrophage
  • Fight infection
  • Decrease edema
  • Lyse necrotic tissue - debridement
  • Increase blood flow
  • Stimulate granular tissue growth
  • Angiogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the contraindications for e-stim?

A
  • Simple, uncomplicated wounds
  • Evidence of osteomyelitis
  • Cancer related wounds
  • Using any metal (silver) dressing or cream
  • Active bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In addition to enhancing all 3 phases of healing, what does Ultrasound do?

A
  • Reduce inflammation
  • Enhance granulation tissue
  • Increase wound tensile strength
  • Improve scar pliability
18
Q

What are indications for Ultrasound?

A
  • Chronic wounds
  • Pressure wounds
  • Venous insufficiency
  • Acute trauma
  • Recent surgery
19
Q

What are 2 ways Ultrasound may produce cellular changes?

A
  1. Cavitation
  2. Microstreaming
20
Q

What is Cavitation?

A
  • production & vibration of micron sized gas-filled bubbles
  • as bubbles move & condense, they are condensed before moving on
  • the movement and compression of bubbles can cause changes in cellular activities of the tissues
21
Q

What is microstreaming?

A

AKA acoustic streaming

  • unidirectional movement of fluids along cell membrane or bubbles bc of pressure wave associated with US
  • may increase permeability in cell membrane or vascular wall
22
Q

What are the 3 Ultrasound methods?

A
  1. Direct technique (fill deep wound with hydrogel/saline; cover wound with barrier then use coupling medium over barrier) nah
  2. Periwound technique (less effective but don’t have to move dressing; good for painful wounds)
  3. Immersion technique (immerse wound and sound head underwater; think about positioning)
23
Q

Review Ultrasound Basics

A

Superficial: 3 MHz
Deep: 1 MHz

Non-thermal pulsed at 30-35% with low intensity of 0.5-1.0 W/cm^2 for healing

To remodel scar tissue, remove contractures, or improve ROM use thermal setting of 1.5 W/cm^2

Treatment time: 2-3 min for 3-7x/week

24
Q
A
25
Q

What is Non-Contact Low Frequency US (UltraMIST)?

A

Advertised for:

  • active cell stimulation
  • decreased bioburden
  • increased blood flow
  • cleansing & gentle debridement
26
Q

Pros/Cons of Non-Contact Low Frequency US…

A

Pros:

  • increased microstreaming/acoustic streaming
  • research shows: wound size reduction & increased healing rates

Cons:

  • Need specific device = expensive
  • Wear PPE
27
Q

What are contra-indications for Ultrasound?

A
  • Simple, uncomplicated wounds
  • Osteomyelitis
  • Active profuse bleeding
  • Untreated infection
  • Severe AI
  • Acute DVT
28
Q

How does Hyperbaric Oxygen (HBO) work?

A
  • administration of 100% medical-grade O2 at >1.5 atmospheres absolute pressure which increases the O2 dissolved within the plasma by ~14 fold
  • need specialized clinic
29
Q

What are 4 benefits of HBO?

A
  1. Increase concentration gradient for O2 (improve O2 ability to diffuse & HgB ability to carry O2)
  2. Increase ability of WBC to kill bacteria
  3. Stimulate angiogenesis, collagen synthesis, granulation tissue formation, epithelialization, and wound contraction
  4. Reduce edema
30
Q

Indications for HBO?

A
  • if periwound hypoxia is present with transcutaneous O2 monitoring testing on room air AND increases at least 10-15 mmHG breathing 100% O2
  • gas gangrene, progressive necrotizing infection
31
Q

What level of significant hypoxia is not appropriate for HBO?

A

<30 mm Hg is not appropriate for HBO

32
Q

What are contraindications for HBO?

A
  • Metallic or electric implants
  • Certain types of dressings
  • DVT
  • COPD
  • untreated CHF
  • claustrophobia
  • untreated pneumothorax
  • severe AI requiring amputation
33
Q

Thoughts on Topical HBO?

A
  • more controversial than regular HBO
  • done at the patient’s home
34
Q

What is the most effective type of Ultraviolet?

A

UVC is most effective; can use on infected wounds or to decrease bioburden on chronic wounds

35
Q

What can UVB do?

A

Induce inflammation & stimulate epithelialization

36
Q

For ultraviolet, what is the best depth of treatment?

A

< 100-200 um (micrometers)

37
Q

What protective measures do you need to take for ultraviolet?

A
  • wear protective eyewear
  • Protect the periwound with petroleum jelly/lotion SPF 30 +
  • Hold the light perpendicular during treatment at a distance of 1 inch
38
Q

How often do you use ultraviolet treatment?

A

daily for 30 seconds for 5 days

Exposure time to kill 99.9% of S. Aureus & MRSA: 5 seconds

39
Q

How does laser therapy work?

A
  • Operates at intensities too low to damage living tissues
  • not well supported in research
40
Q

Laser Cellular Effects

A

a lot of things

to name a few…

  • Increased cellular proliferation
  • Increased mitochondrial production of ATP
  • Increased fibroblast proliferation
  • Enhanced epithelialization rates & improved tissue tensile strength
  • Increase GF release
41
Q

Do I exercise?

A

Yes! Exercise can improve wound healing

42
Q

How do we dose exercise?

A
  • Moderate failure
  • Cardio
  • more blood flow = faster healing

Integ (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions