Modalities In Wound Care

Question 1

Which 2 modalities are used for cleaning

Answer 1

pulsed lavage and whirlpool

Question 2

which modalities are used for healing

Answer 2

estim, wound vac, pulsed lavage, MIST ultrasound, hyperbaric oxygen

Question 3

what occurs during the acute phase of healing

Answer 3

trauma
vasoconstriciton
increased vessel permeability

Question 4

what occurs during the proliferative phase

Answer 4

granulation tissue forms
angiogenesis occurs
epithelial cells migrate across the wound bed

Question 5

what occurs during the maturation phases

Answer 5

type III collagen remodelded to type I collagen

tissue strength increases to up to 80% pre-injury state

Question 6

mechanism of action for estim

Answer 6

the current of injury is used to increase circulation and oxygenation
facilitates phagocytosis
attracts fibroblasts and epithelial cels to control infection

Question 7

what is estim indicated for

Answer 7

just about any chronic wound

chronic means that it hasn’t healed after 30 days

Question 8

contraindications for estim

Answer 8

placement of electrodes over the heart, gentials, carotid sinus
cardiac pacemeaker
malignancy
osteomyelitis

Question 9

what is the charge of the skin

Answer 9

the skin is electronegative because sweat accumulates on the skin with Cl- left on the surface

Question 10

what is the charge of the wound bed

Answer 10

electropositive in relation to the surrounding tissue
when skin breaks a current is started and all the neutrophils and fibroblasts that are negative are attracted to the positive wound to promote healing

Question 11

how long do we wait until using estim and why

Answer 11

wait 30 days because this is when the natural current of injury disappears

Question 12

procedure for estim

Answer 12

rotate every 3 days between negative and positive and start with the NEGATIVE electrode

Question 13

What is pulsed lavage

Answer 13

hydrotherapy that uses pulsed, pressurized saline to cleanse and debride a wound, suction removes saline and matter from the wound

Question 14

mechanism of action for pulsed lavage

Answer 14

removal of necrotic tissue and suction promote granulation

Question 15

indications for pulsed lavage

Answer 15

just about anything (pressure, arterial, venous, nerptahic, traumatic and surgical wounds)

Question 16

when is whirlpool more efficient than pulsed lavage

Answer 16

for wounds that are too large

Question 17

advantages of pulsed lavage

Answer 17

quicker set up time
decreased risk of cross contamination and maceration
cost-effective
access to sinus tracts and tunnels**

Question 18

what is whirlpool indicated for

Answer 18

arterial insufficiency
diabetic ulcers
necrotic wounds
ischemic wounds that need more circulation

Question 19

contraindications for whirlpool

Answer 19

clean wounds
new skin grafts
****venous wounds/edematous wounds****
febrile conditions
incontinence
renal failure
dry gangrene

Question 20

mechanism of action of whirlpool

Answer 20

warm water vasodilates superficial blood vessels, the increased circulation removes metabolites and brings leukocytes for cleaning
water also allows for mechanical and autolytic debridement
granulation tissue is stimulated from agitation of the water
exudate is rinsed by the water
warm water also offers pain relief and sedation

Question 21

mechanism of ultrasound

Answer 21

vibration causes mast cells to release histamine which attracts monocytes and neutrophls

Question 22

when is ultrasound indicated

Answer 22

for all types of wounds

Question 23

contraindications of ultrasound

Answer 23

pregnancy
malignancy
ossificans
acute infection

Question 24

disadvantage of ultrasound

Answer 24

not effective and not well supported by research

Question 25

mechanism of action for hyperbaric oxygen

Answer 25

increases tissue oxygenatoin, collagen deposition, angiogenesis while decreasing anaerobic bacteria and excess MMP’s in chronic wounds

Question 26

what is HBO therapy indicated for

Answer 26

wounds that aren’t healing well

commonly diabetic ulcers

Question 27

contraindications for HBO therapy

Answer 27

untreated pneumothorax

taking any medications for cancer treatment

Question 28

what is the advantage to HBO therapy

Answer 28

evidence has showed decreased incidence of LE amputations when used on diabetic ulcers

Question 29

mechanism of action for NPWT

Answer 29

promotes granulation, increases blood supply and draws in the wound via suction

Question 30

what is NPWT indicated for

Answer 30

chronic wounds
trauma
partial thickness
dehisced wounds
diabetic and pressure ulcers

Question 31

contraindications for NPWT

Answer 31

malignancy
untreated osteomyelitis
exposed vessels or organs
necrotic tissue with eschar