Modalities Flashcards
What is Complete decongestive therapy?
It is a generalized term for 2 phases of treatment. These phases are composed on Phase 1- Treatment phase (MLD, Compression bandages, exercise, Meticulous skin care) and Phase 2- Self Management phase (Continuous bandaging or compression, exercise, skin care, MLD as needed)
What is Manual Lymph Drainage?
Improves lymphatic flow by guiding around blockages for removal. Lie supine with affected side elevated Central areas and uninvolved proximal nodes are cleared first Light and gentle stroke DISTAL TO PROXIMAL starting at the most proximal aspect of extremity first. (Move fluid towards abdomen)
What are the 2 kinds of compression?
Short stretch bandages (Comprilan) and Long Stretch Bandages (ACE) Short stretch High working pressure, low resting pressure. Stretches 60% of resting length. Long stretch bandages low working pressure with high resting pressure. Cuts off lymph flow
Importance of compression…
50% of edema reduction is equated to proper compression post MLD. Bandages are primarily used in CDT phase 1 but will mostly be used only at night in phase 2. Graded compression (distal>proximal) In Phase 1 use prefab because limb will be changing sizes. In Phase 2, use custom
Pneumatic compression
NORMAL RANGE 20-60psi (30-40mmHg UE, 40-50mmHg LE) DANGER ZONE is 70-100mmHg that will damage lymph vessels in as few as 3-5 minutes
What are exercise guidelines for patients with Lymphedema?
NEVER perform without compression DO NOT DO isometric holds, overhead resistance, and heavy weight AVOID eccentric based exercises, DOMS, and high impact. Always exercise the proximal musculature first and trunk comes before extremity. Gradual progression Always monitor girth of affected extremities during exercises
Stages of edema?
1+=2mm quick rebound
2+=2-4mm and up to 15 sec rebound
3+=4-6mm and up to 30 sec rebound
4+=6-8mm and greater than 30 sec rebound
Ankle Brachial Index
>1.2 Falsely elevated, arterial disease, diabetes
- 95-1.19 Normal
- 75-0.94- Mild arterial disease+intermittent claud
- 50-0.74- Moderate arterial disease, pain at rest
<0.5- Severe arterial disease
What is Buerger’s Test used for?
Arterial Sufficiency.
Assesses for when the foot becomes when lying down in a supine position.
Up to 90 degrees- Remains pink in color-NORMAL
15-30 degrees (for 30-60 sec) becomes pale- POSITIVE for Ischemic leg
<20 degrees- becomes pale (SEVERE ischemia)
What is the rubor of dependency test?
Assesses for arterial insufficiency
Color at the sole of the foot during elevation
When patient is in supine, patient’s leg is brought to 60 degrees for 1 min
Sole should remain pink- but insufficiency= progresses to purple-red or bright red
Also put patient in sitting or dependent position, for color to return to normal, that is a normal result. Color to BRIGHT RED INDICATES AI.
Capillary Refill Test
Squeeze and blanch the toe for 5 seconds. Release the pressure and count the seconds.
Normal= Equal or less than 3 seconds
Compression with Insufficiency?
No compression when ABI is <0.5
OR
VERY LIGHT compression (12-25mmHg for moderate insufficiency)- close involvement of practitioner
Interventions for AI?
Smoking cessation- FIRST THING YOU ADDRESS on NPTE
Regular and Graded Exercise (Basic ACSM guidlines), 3/4 claudication pain scale, 40-60% HRR, 15 min per day progress 5 min biweekly
Weight Control
For wounds- Hydrogels, wet to dry dressings, foam
What are venous insufficiency interventions?
Most important therapeutic measure for venous leg ulcers is COMPRESSION. Then mobility exercise, positioning, avoidance of aggravating positions or activities
With mixed arterial/venous disease, the most severe pathology is treated first
Compression includes short stretch bandaging too, but with 20-40mmHg**
Venous Wounds Interventions?
Hydrogels - Foam - Calcium Alginates - Silver Impregnated gauze (infection)
Wagner Ulcer Classification Scale?
Neuropathic ulcers are staged using Wagner’s.
Grade 0- Preulcerative lesion, healed ulcers, presence of bony deformity
Grade 1- Superficial Ulcer without subcutaneous tissue involvement
Grade 2- Penetration through sub Q tissue. Exposing bone, ligament, etc
Grade 3- Osteitis, abscess, or osteomyelitis
Grade 4- Gangrene of digit
Grade 5- Gangrene of foot requiring disarticulation
Skin Cancer Grading System?
ABCD
ASYMMETRY- Uneven edges, lopsided in shape, one half unlike the other
BORDER- irregularity,irregular edges, scalloped or poorly defined edges
COLOR- black, shades of brown, white, blue
DIAMETER- Larger than a pencil eraser
Treatment principles for burns:
Basic treatment principles of burn wounds are directed at: 1. Managing or preventing infections 2. Wound closure 3. Ensuring mobility* 4. Preparing patient for surgery*
Treatment principles for burns: Superficial Thickness
Application of a moisturizer
Provide an environment that encourages re-epithelialization
Healing 2-5 days
Treatment principles for burns: Superficial Partial and Deep Thickness
Prepare patient for primary intention (approximation) by - debriding necrotic or non-viable tissue (blisters?) - tap water can be used to keep the wound clean - If there is concern about infection, we can use antimicrobial or antibacterial ointments/creams
-Cover the wound with mesh gauze impregnated with petroleum jelly with a secondary plain gauze dressing (adaptive wound).
Treatment principles for burns: Full thickness
Debridement happens in surgical rooms NOT by PTs.
Prepare patient for surgery by - Controlling/Preventing infection - First wounds are cleaned using anti-microbial (decrease bacterial load) - Using ointments such as Silver Sulfadiazine covered with gauze dressing
Treatment principles for Subdermal burns
Apply moisture with wound healing procedures until surgical coverage of wound is completed.
- Petroleum Jelly - Hydrogels - moisture-retentive - Silver impregnated gauze dressings
PT Goals - Keep wound moist - Maintain mobility/function - Prevent Infection
What are types of ointments that help with burns?
Silver sulfadiazine (Silver Surfer) - Used for infected burns - Burns up to 3rd degree - Topical Antibacterial - Fight infections - Does NOT treat necrotic tissue
Sulfamylon (Mafenide Acetate) - Used for infected burns & thermal burns - Topical Antibacterial - Fight infections - Treats necrotic tissue*
Bactracin
Goals of dressings for surgical treatments:
Prevent: - Shear - Displacement - Infection - Development of hematoma or seroma
- Dressed with soaked gauze that is irrigated frequently to keep a moist wound bed - A splint is incorporated to allow the graft to adhere properly to the wound bed. - Compression bandages are also used as well to prevent hematoma (RBC filled fluid sac) or seroma (WBC filled fluid sac)
Contraindications for Volumetrics
DO NOT USE WITH OPEN WOUNDS
How do you measure girth with a patient with severe LE edema?
circumferential measurements every centimeter, starting at the floor or weight-bearing surface and progressing to the groin.
Is surgical debridement for a non infected, chronic wound appropriate?
Yes. Surgical debridement uses sterile sharp instruments to remove debris and necrotic tissue, as well as viable tissue beyond the wound This converts a chronic wound into an acute wound. The bleeding base afterward is thought to stimulate release of growth factors to speed healing. It is also appropriate for infected wounds in order to make sure there is complete removal of the infection. It is done in an operating room or outpatient setting and is not within the scope of practice for a physical therapist. It is contraindicated in patients with poor vascular supply.
