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Chapter 8: Integ Final Exam > Modalities > Flashcards

Modalities Flashcards

1
Q

Removes loosely adhered debris, bacteria, exudate, dressing residue and topical agents.

Facilitates debridement

Promotes moist wound healing

A

Wound irrigation

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2
Q

Wound irrigation is indicated for

A

all wound wound types

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3
Q

Wound irrigation is contraindicated for

A

Wounds with active profuse bleeding

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4
Q

What is the optimal irrigation pressure

A

4-15 PSI

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5
Q

Optimal irrigation pressure is equivalent to ___ml syringe with a ___guage angiocatheter or ______ on the lowest setting (of 6 psi)

A

35ml
19 guage
waterpik

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6
Q

Alternatives to irrigation that can have the same effect are

A
  1. Soaking wound with saline moistened gauze
  2. Whirpool
  3. Pulsed lavage
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7
Q

Whirlpool is considered what type of debridement method?

A

Non-selective mechanical debridement, good method for removing a lot of necrotic tissue.

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8
Q

Immersion Technique for whirlpools should never exceed what temperature

A

102, small whirpools range 92-98, large whirlpools never go over 102

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9
Q

The purpose of this modality is similar to irrigation but also promotes circulation, decreases pain, and makes ROM exercises easier

A

Whirlpool

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10
Q

This modality is indicated for
infected non draining wounds
wounds with thick Eschar or exudate
wounds with loosely adherent, necrotic tissue or debris

A

Whirlpool

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11
Q

Contraindications for this particular modality include:

  1. clean/granulating wounds
  2. Draining macerated wounds
  3. Tunneling, underminning skinfolds that can be effectively irrigated
  4. Active bleeding
  5. For AIs that need to be treated at low temps (precaution)
  6. Precautions: be aware of patients that are hydrophobic, confused and combative when using this modality.
A

WHIRLPOOL

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12
Q

What is the treatment time for immersion whirlpool and what should patients be encouraged to perform?

A

10-20 min, patients should be encouraged to perform AROM activities during treatment.

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13
Q

T/F irrigating wounds immediately after whirlpool treatment has been shown to remove 4x as much bacteria as whirlpool alone

A

T

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14
Q

What is the frequency usually prescribed for immersion technique whirlpool?

A

2x/day for acute burns

3x/wk for less serve outpatient wounds.

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15
Q

Describe Showering Technique for whirlpool?

A

Patient extremity positioned over empty whirlpool, and sprayed with water 92-98 degrees F.

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16
Q

Whirlpool technique can include adding chemical additives to help reduce infection and cross contamination however why aren’t these additives typically used

A

they tend to be cytotoxic to human cells and puts patient at risk for delayed wound healing, contraindicated for chemical wounds

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17
Q

What are the alternatives to Whirlpool?

A

wound irrigation, soaking with saline-moistened gauze, pulsed lavage

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18
Q

The purpose of this modality is to irrigate wound bed with precisely calibrated pressure as well as promoting a moist wound environment and facilitating debridement

A

Pulsed lavage

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19
Q

This modality is indicated for wounds with cavities, tracts such as undermining, tunneling, and wounds that are infected. Wounds that require thorough irrigation or debridement.

A

Pulsed lavage

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20
Q

It is contraindicated to use this modality on wounds with exposed deep tissue, facial wounds, recent surgical procedures, latex allergy/sensitivity

A

Pulsed Lavage

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21
Q

What precautions should a prationer be aware of when using pulsed lavage?

A
  • note wounds with new granulation
  • if a patient is on anticoagulants
  • deep tunneling wounds
  • insensitivity
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22
Q

What does pulse lavage do when used with concurrent suction?

A

applies negative pressure to wound bed, removes irrigant/pathogens, enhances granulation

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23
Q

Describe the method of Saline Irrigation with pulse lavage

A

5-10 min, 4-5 psi, done everyday twice a day

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24
Q

Describe the method for general pulse lavage?

A

4-15 psi irrigation, warm 1-3L of irrigant to 102-106 F
time 15-30 min
wear PPE

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25
Q

To prevent cross contamination when using pulsed lavage what should the practioner do?

A

Administer treatment in a room with 4 walls
cover IV sites and open areas not being treated
wipe down all horizontal surfaces

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26
Q

Name the three electrical stimulation techniques that most research supports to enhance wound healing

A

Hi Volt pulsed current
Low intensity DC
Microcurrent Stim

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27
Q

What are the 7 ways e-stim facilitates wound healing?

A
  1. Restores current of injury-(restores skin battery, epidermis is electro neg and the wound is electro positive, e stim mimics the normal current of injury and stimulates wound healing)
  2. Causes galvanotaxis-stimulation of cells to move along electrical gradient, attracts macros, neutros, etc)
  3. Stimulates cells–>general increase in cell proliferation and ehnaces cellular function
  4. Increases blood flow
  5. Increases bactericidal abilities–through attraction of macros and neutros
  6. Reduces Edema-reducing microvascular perm
  7. Facilitates Debridement -autolytic, esecially if cathode is applied.
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28
Q

Hi-volt pulsed current is indicated for

A

chronic or recalcitrant wounds or CMMS category III/IV that fail to respond after 30 days of standard care. Pressure ulcers, diatbetic ulcers, surgical wounds

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29
Q

What are the precautions for Hi-Volt/estim

A

untreated osteomyletis (contra), VIs, neoplastic cells and DVTs, patients with sensory neuropathy. Should not be used in combo with topical agents containing heavy metal ions

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30
Q

Parameters for Hi-Volt

A

100-105 pps, pulsed, 5x a week can use positive or negative

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31
Q

If a patient is prone to abnormal scar formation what modality would be good to use

A

e-stim

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32
Q

Cathode is indicated to use for

A

infected wounds, and to reduce bioburden

33
Q

Anode is indicated to use

A

to promote granulation and epithelization

34
Q

Typical E-stim Method

A

Frequency: 80-115 Hz
Intensity: 75-200 V, submotor
Use which ever polarity would best address wound
45-60 min, 3-7 days per week, or 30 min 2x day

35
Q

Enough evidence supports this modality to use on poorly healing wounds

A

Ultrasound

36
Q

Parameters for Direct and Immersion Techniques for ultrasound

A
  1. Superficial wounds: 3 mhz
  2. Deep wounds: 1 mHz
  3. Pulsed at 20-25%
  4. Intensity: 0.5-1.0 W/cm,
    continous 1.5 w/cm2 –>for remodeling dehised wounds.
  5. Tx area divided into area equal to 1.5x the size of the sound head each zone treated for 2-3 min.
37
Q

Acute wounds will be treated ___/day

Chronic wounds will be treated___/week

38
Q

Low frequency ultrasound in combo with saline mist can assist with

A

debridement of fibrin and reduces wound bioburden (25-40)

39
Q

This modality enhances all 3 phases of wound healing. Increases collagen deposition, granulation tissue formation, angiogensis, enhances wound contraction and improves scar pilability.

A

Ultrasound

40
Q

Ultrasound is indicated for what type of wounds

A
  1. traumatic
  2. chronic or recalicitrant wounds
  3. post surgical wounds and grafts
  4. wounds with exposed deep tissue or hardward
41
Q

What are the contraindications for ultraounds

A
  1. Necrotic wounds-Direct technique may not be effective
  2. Body cavity wounds
  3. Active bleeding
  4. severe AI
  5. DVT
  6. untreated osteo
  7. exposed blood vessels
  8. use caution with patients on anticoagulants.
42
Q

List all the methods for ultrasound

A
  1. Direct
  2. periwound
  3. Immersion
  4. noncontact low-frequency
43
Q

T/F You can use other dressings with Negative Pressure wound therapy

44
Q

This modality is indicated for chronic wounds, post surgical wounds and grafts. Commonly used on pressure ulcers, diabetic ulcers traumatic or dehised wounds

45
Q

What are the alternatives to Ultrasound

A

E-stim, NPWT, topical growth factor, scar remodeling using parrafin, soft tissue mobs, silicone dressings and other debridement options.

46
Q

This modality increases local blood flow, capillary filling and lymphatic flow, may help approximate wound edges, demonstrates bactericial effects, allows for moist wound closure.

47
Q

T/F there is insufficient evidence that NPWT is better than standard care

48
Q

What are the contraindications for NPWT?

A
  1. Necrotic wounds
  2. Body cavity wounds
  3. Untreated Osteo
  4. Exposed blood vessels
  5. Caution with patients on anticoagulants
49
Q

Method and Parameters for NPWT

A
  1. cut foam to fit within the wound
  2. Irrigate and debride as needed, tissue should be free from necrotic tissue, but can use if less than 20% non-viable tissue is being treated with enzymatic or sharp debridement
  3. protect periwound
  4. place tubing within bed and connect canister
  5. cover with firm drape to create air-tight seal, semiperm film drape
  6. Paramters:
    50-175 mmHg at constant or intermittent
  7. Time 12-72 hours
50
Q

Hyperbaric Oxygen is defined as

A

100% oxygen mono or multiplace chamber administed at >1.5atm

51
Q

What does the tissue oxygen pressure need to be for normal wound healing

52
Q

T/F HBO administration requires a physician on site.

53
Q

This modality tends to increase the oxygen concentration gradient, promotes revascularization, collagen synthesis, bactericial effects and reduces edema.

54
Q

What are the two absolute contras to HBO?

A

DVT and CHF

55
Q

What are the precautions to HBO?

A
  1. Claustrophobia
  2. COPD
  3. Pregnancy
  4. Severe AI
  5. Isehmic wounds
56
Q

Which modality may help prevent the loss of a limb

57
Q

Tracutaneous oxygen monitoring is used to while patients are undergoing HBO for what reason

A

to help predict tx efficiacy

58
Q

Describe method for HBo

A
  1. 100% oxygen at 1.5-2.5 atm
  2. treatment time: 90-120 min
  3. Frequency: 2x/day -3x/week
  4. Treatment length: 10-60 sessions
59
Q

If ___% decrease in wound surface area is not noted after ____HBO treatment sessions, the wound is unlikely to respond to this modality.

60
Q

This modality may facilitate healing in VI/AI ulcers, pressure ulcers, neuropathic ulcers

61
Q

Short term treatment UVC is used to

A

reduce bioburden in critically colonized category III/IV pressure ulcers.

62
Q

UVC wavelength

63
Q

At what wavelength is UV used to treat psoriasis

A

280-400 nm

64
Q

How deep does UVC penetrate?

A

0.1mm of skin, which only into the epidermis.

65
Q

Bactericidal effects of UVB or UVC that reduceds wound bioburden occur at what wavelength

66
Q

UVA wavelength

UVB wavelength

A
  1. 320-400 nm

2. 290-320 nm

67
Q

List the Ultraviolet effects

A
  1. Increases cell turnover
  2. ehances cell proliferation
  3. Growth Factor release
  4. Granulation
  5. ehances capillary blood floow
  6. Increases vascular permeability
  7. Ehances Ca absortpiton and conversion of provitamin D to previtmain D
68
Q

T/F There is limited research that low-intensity laser therapy (HeNe), (GaAIAs) and (GaAs) lasers are effective in treating Vi/pressure/neuropathic ulcers

69
Q

T/F low-intensity laser therapy is not currently reimbursed by medicare.

70
Q

MIRE delivers near-infrared energy at ____wavelength to skin through flexible diode pads

71
Q

MIRE supposedly used to improve blood flow to treat areas by up to

72
Q

MIRE has shown slight improvement in treating

A

diabetic neuropathy

73
Q

T/F MIRE is not currently recommended

74
Q

Granular Non draining wounds what are your treatment options

A
  1. Pulsed lavage with suction
  2. E stim
  3. US
  4. HBO
75
Q

Granular, Draining wound what are your treatment options

A
  1. Pulsed lavage with suction
  2. Whirlpool
  3. E-stim
  4. US
  5. Low frequency US
  6. HBO
76
Q

Necrotic, Nondraining wounds what are your treatment options

A
  1. Whirlpool
  2. Pulsed lavage with suction
  3. e-Stim
  4. Low frequency US
  5. HBO
77
Q

Necrotic, draining wounds what are you treatment options

A 
Whirlpool
Pulsed lavage with suction
E stim
Ultrasound to periwound
Low frequency US
HBO
78
Q

Closed wound with red, raised scar limiting ROM

A

continous ultrasound, with thermal effects there is a 5-7 min window of time that you can do scare mobs after

Chapter 8: Integ Final Exam (1 decks)

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