Orthotics, Skin Issues & Positioning Flashcards
philadelphia spinal orthotic
restricts flex/ext
aspen spinal orthotic
restricts in all 3 planes
miami spinal orthotic
restricts in all 3 planes
cervical collar
not alot of restriction
on at all times
may have to sleep in them
cervicothoracic spinal orthotic
- lower cervical/thoracic
- upper back/cervical support
halo spinal orthotic
absolute restriction
actual spinal cord injuries
hyperextension orthoses
jewett
CASH
HE brace with neck support
TLSO spinal orthotic
support from thoracic down to lumbar spine
what should you do with pillows
float heels
elevate UE
use for sidelying
prevent hip ER in supine
what do you not do with pillows
place under knees
keep neck flexed
whats important to do with speciality beds
inflate maximally during mobility
return to proper setting at end of tx
what can you use to off load the pt
cushions in wheelchair
tilt WC
foam cushion
least amount of pressure
most stability
gel cushion
little more pressure relief
air cushion
best pressure relief
gold standard for off loading for diabetic ulcers
total contact cast
role of PT in wound care
- promote wound healing
- education
- maximize pt mobility
- minimize pain
- recommendations for interdisciplinary care
- recommendations for follow up care
what will you see with arterial insuffiency wounds
- decreased pedal pulse
- intermittent claudication
- anteriolateral foot/ankle, toes
- full thickness - well defined borders
- pale, minimal drainage, often with eschar
- shiny, anhydrous, pale to cyanotic
arterial insufficiency will create what kind of wounds
dry wounds
what will u see with venous insufficiency wounds
- pedal pulse present
- lower limg discomfort
- edema worse in dependent position, less when LE raised
- irregular shape, shallow wound on medial lower leg and malleolus
- mod to copious drainage
- hemosiderin staining and lipodermatosclerotic changes
venous insufficiency will create what kind of wounds
wet wounds
diabetic foot ulcer will look like what
- pedal pulse often absent
- ulcers painless with decreased temp
- at pressure points
- pale wound, nonviable tissue, minimal drainage
- trophic changes
pressure injury
- pulses intact
- on pressure areas
- painful
- varying depth
- stages 1-4
superficial wound stage
- damage to epithelium
- heals rapidly through regeneration of epithelial cells
partial thickness wound stage
- dermal layer
- vessel damage
full thinkness wound stage
- subcutaneous fat and deep
- longest time to heal
- contraction
stage 1 pressure injury
intact
reddened skin that does not lighten when palpated
stage 2 pressure injury
partial thickness when exposed
viable dermis
no slough, eschar
stage 3 pressure injury
full thickness with exposed subQ
may include epibole, tunneling, undermining
slough and eschar
stage 4 pressure injury
full thickness exposed muscle, tendon, ligament, fascia, cartilage, bone
epibole, tunneling, undermining
slough, escar
unstageable pressure injury
slough, escar covers full thickness wound
unable to detect depth
deep tissue pressure injury
intact or nonintact skin appearing as non-blanchable red, maroon or purple in color
phases of wound healing
hemostasis
inflammation
proliferation
remodeling
hemostasis
begins immediately
minimize bleeding and create barrier form contamination
localized vasoconstriction, activation of platelets
inflammation
10-15 min after injury
control bioburden, establish clean wound
localized vasodilation, inc tissue permeability bring exudate to wound
localized response in proportion to injury
proliferation
2-5 days post injury
restoration of vascular integrity, formation of connnective tissue, wound contraction, reepitheliazation
fibroblasts –> granulation tissue
remodeling
up to 2 yrs post injury
immature collagen organized into mature collagen
scar tissue only up to 80% or original tissue strength
lacks elastin, stiffer than original tissue
acute wounds
known cause
moves through phases of healing in reasonable timeframe
achieves successful wound closure
chronic wounds
underlying condition or from negative effect
delayed healing in one or more phases of healing
wound closure not sustained
acute wounds last how long
chronic wounds last how long
4-6 weeks
longer 6 weeks
examples of acute wounds
surgical wounds bites burns abrasions traumatic wounds
examples of chronic wounds
leg/foot ulcers
pressure sores
treatment for acute wound
clean/minor:
severe and contaminated:
- minimal intervention
- surgical debridement
- antimicrobial therapy
- wound lavage
chronic wound treatments
wound dressing antimicrobial agents footwear PT educational strategies optimise tx for co-morbidities
sharp debridement
using a scalpel cutting away non-viable tissue
autolytic debridement
dressing placed and bodies enzymes heal it
enzymatic debridement
certain enzymes added to the dressing that help heal it
mechanical debridement
dressing placed on wound and when pulled off - it pulls all the skin off
ideal wound bed
clean and moist
