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Integumentary > Modalities Used in Wound Care > Flashcards

Modalities Used in Wound Care Flashcards

1
Q

List some modalities used in wound care.

A

Hydrotherapy, E-stim, Hyperbaric oxygen, compression, Negative wound therapy, ultrasound

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2
Q

What are the benefits of whirlpool treatment?

A 
softens adherent necrotic tissue
increases blood flow and metabolic rate
proliferation and granulation tissue and epithelial cells
exudate removal to decrease infection
wound cleansing
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3
Q

What are the negatives of whirlpool treatment?

A

Maceration, dependent position, potential for burns, cytotoxic additives

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4
Q

What are the contraindications for whirlpool treatment?

A 
CHF/LE edema
pulmonary disease
acute phlebitis
lethargy
gangrene
renal failure
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5
Q

What are the treatment parameters for hydrotherapy?

A

92-96 degrees F

10-15 minutes

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6
Q

Why do you use pulsed lavage with suction?

A

Used for cleansing and debridement (cleaning wound and removal of toxic residuals)

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7
Q

What are the treatment parameters for pulsed lavage?

A

10-15 minutes

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8
Q

What are the precautions and considerations of pulsed lavage?

A

Precautions: tissue damage can occur if pressure is too high
Considerations: can be done at bedside, can be expensive

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9
Q

How does electrical stimulation affect wounds?

A

stimulates fibroblasts to enhance collagen and DNA synthesis
increases number of receptor sites for growth factors
alters the direction of fibroblast migration, activates cells in the wound site, improves tissue perfusion, decreases edema
increases cutaneous oxygen transport
controls infection
stimulates wound contraction and scar healing

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10
Q

What are the indications to use e-stim?

A

pressure ulcers stage 1-4, diabetic ulcers, venous ulcers, traumatic wounds, surgical wounds, ischemic wounds, donor sites, flaps, burn wounds

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11
Q

What are contraindications for e-stim treatment?

A

osteomyelitis, pregnancy, malignancy, pacemaker, over the carotid sinus or across heart, laryngeal musculature, along regions of phrenic nerve, over topical substance containing metal ions, over povidine iodine or mercurochrome

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12
Q

Can you apply e-stim directly to the wound or periwound?

A

Yes

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13
Q

Will medicare pay for e-stim as your very first wound care treatment?

A

No.

Only after the wound is not progressing following traditional treatment for 30 days

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14
Q

What are the settings for e-stim?

A

Pulse width: 20-200 microseconds

Pulse frequency: to 100 pulses per second

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15
Q

What are the different characteristics of polarity for e-stim?

A

Cathode (-): used during the inflammatory phase for bacteriostatic effect and to dissolve necrotic tissue
Anode (+): used during the proliferative phase to accelerate wound healing, increase fibroblastic formation, increase epithelialization, stimulate protein and DNA synthesis

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16
Q

What is the timing of use for e-stim? (days)

A

In the proliferation phase you use the cathode for 1-5 days, then change to the anode until healed
In the maturation phase you alternate between the cathode (3 days) and the anode (3 days)

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17
Q

What are the parameters for e-stim treatment?

A

45-60 minutes
5-7 times per week
Voltage/Intensity: 100-150 volts

18
Q

What are the effects of hyperbaric oxygenation?

A

Hyperoxygenation and decreases edema
toxin inhibition, antibiotic synergy
restores body’s defense against infection, increases the rate of killing some common bacteria, inhibits growth of anaerobic organisms
angiogenesis

19
Q

What are the indications of hyperbaric oxygenation?

A

acute burns, chronic wounds, radiation induced injury, necrotizing infection, sepsis, chronic osteomyelitis, carbon monoxide poisoning
Must be well debrided

20
Q

What are the contraindications of HBOT?

A

claustrophobia, pneumothorax, COPD, seizure disorders, upper respiratory infection, optic neuritis, malignant tumors, acidosis, drugs (steroids, alcohol, nicotine)

21
Q

What are the treatment guidelines for HBOT?

A

2.0 ATA oxygen x 90 minutes

5x/week for 4 weeks = 20 sessions

22
Q

What are the goals of negative pressure wound therapy (NPWT)?

A

increase blood flow, decrease bacteria colonies, able to measure and assess wound fluid, increase granular tissue base, contraction of wound, epitheliazation

23
Q

What are the indications for NPWT?

A

acute wounds, PTW/FTW from burns, surgical wounds/incisions and dehiscence, diabetic wounds, venous/arterial wounds, pressure ulcers, graphs/flaps, enteric fistulas

24
Q

What are the contraindications for NPWT?

A

necrotic tissue with eschar, malignancy, untreated osteomyelitis, exposed blood vessels or organs, non-enteric or unexplored fistulas, acute bleeding

25
Q

What are the settings for NPWT?

A 
Dressings are changes every 48-72 hrs
Must be ON for 22-24 hrs
Pressure between 75 mmHg and 150 mmHg
intermittent versus continuous
white foam, black foam, silver foam
26
Q

How long does someone receive NPWT, and when is it discontinued?

A

treatment usually lasts 4-6 weeks

should be discontinued when goals are met, no progress in healing for 1-2 weeks, patient is non-compliant

27
Q

What are the indications of ineffective VAC therapy?

A

Minimal changes in wound size, deterioration of the wound, changes in wound color, wound appears white, excessively moist or macerated, wound odor

28
Q

What are the indications for intermittent/pneumatic compression?

A

primary/congenital lymphedema, secondary lymphedema from lymph node resection after cancer, chronic venous insufficiency, venous stasis, venous ulcers, reduce and control peripheral edema

29
Q

What are contraindications of compression therapy?

A

phlebitis, CHF, PE, DVT, increase of venous/lymphatic return is not desired, caution in using on extremity with lack of sensation to pain

30
Q

What are the settings for compression therapy?

A

Daily to BID tx
30-60 minutes per tx
pressure from 0-80 mmHg (set 20 below diastolic BP)
monitor BP pre and post therapy

31
Q

Why do we use a Unna boot?

A

used in AMBULATORY patients to aid the calf muscle pump

32
Q

What are the layers of the unna boot?

A

first layer is gauze impregnated with zinc oxide, glycerine, and calamine, outer layer is gauze and/or self-adherent or compressive bandage

33
Q

What are the treatment parameters of the unna boot (time, precautions)?

A

Leave it on for ~ 1 week

Do not get it wet

34
Q

What is MIST ultrasound?

A

A non-contact US which administers continuous US energy via an atomized saline solution
Used for cleansing and debridement

35
Q

What does Ultrasound (US) do physiologically?

A

accelerates acute inflammatory phase, stimulates fibroblasts to secrete collagen, provides heat to deeper tissue prior to stretch, accelerates wound contraction, promotes strong, more elastic scars, increases blood flow

36
Q

What are contraindications to US?

A

thrombophlebitis, actute infection, pregnancy, malignancy, over the eye, hemophiliacs not covered by factor replacement, concurrent or post radiation, over bony prominence

37
Q

What are the indications for US use?

A

colonized wounds, arterial/venous wounds, diabetic foot ulcers, chronic leg ulcers, pressure ulcers, burns, acute wounds, post operative wounds, sickle cell ulcers

38
Q

What are the parameters for US treatment?

A

Use a hydrogel dressing or sterile saline

1-2 minutes for area 1.5x the size of applicator

39
Q

What are the settings for US treatment?

A 
Frequency: 3 MHz
Duty cycle: 20%
Intensity: <.5 watts (thermal)
Duration: 1-2 minutes per zone
TxFreq: 1-2 times per day until inflammation subsides, then decrease to 2-3x/wk
40
Q

How are leeches used?

A

used to diminish venous congestion with reattachment surgery
saliva of leeches has anticoagulant properties
feed for 20 minutes at a time

41
Q

How are maggots used?

A

selectively debride necrotic tissue

48-72 hours, 2 times per week

Integumentary (3 decks)

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