Physiology of Healing

Question 1

3 phases of healing

Answer 1

inflammatory response
fibroblastic repair
maturation-remodeling

Question 2

T or F: the body must go through the inflammatory response to heal

Answer 2

T

Question 3

symptoms of inflammation

Answer 3

swelling, pain, warmth, redness, crepitus, loss of function

Question 4

what happens during the inflammatory phase? how long is it?

Answer 4

• the injured area is walled off and leukocytes phagocytize foreign debris
• lasts 2-4 (up to 10) days after injury

Question 5

physiological cause of edema

Answer 5

increased permeability of blood vessels

Question 6

physiological cause of erythema and warmth

Answer 6

increased blood flow

Question 7

what are some factors that influence inflammatory phase?

Answer 7

• medical conditions
• meds
• immobilization
• location of injury
• age
• nutrition
• physical agents

Question 8

acute inflammation

Answer 8

local tissue damage
pain all the time

Question 9

sub-acute inflammation

Answer 9

pain is actively related
can last 4-6 weeks if not managed

Question 10

chronic inflammation

Answer 10

the longer pain lasts, the high the chance of pain being referred away from original location
* sign of impaired healing

Question 11

what happens in the fibroblastic repair (proliferative) phase? how long is it?

Answer 11

• regeneration leads to scar formation and repair of injured tissue
• lasts 4-6 weeks

Question 12

fibroplasia

Answer 12

the formation of fibrous tissue beginning within the first few hours after injury

Question 13

clinical signs of fibroplasia

Answer 13

• inflammation signs subside
• if open wound you will be able to see tissue formation

Question 14

by 6-7 days after injury fibroblasts begin producing _________

Answer 14

collagen

Question 15

T or F: A persistent inflammatory response can lead to abnormal proliferation

Answer 15

T: due to extended fibroplasia and fibrogenesis (hypertrophic and keloid scars may result)

Question 16

what happens in maturation-remodeling phase? how long?

Answer 16

• realignment of collagen fibers along lines of tensile force
• ongoing breakdown/ synthesis of collagen
• may require several years to complete

Question 17

how is scar tissue different than normal tissue

Answer 17

lacks elastin and weaker

Question 18

scar tissue is initially type ___ collagen in a random pattern and once it matures it is type _______ in an organized pattern

Answer 18

3,1
*no elastin like in normal skin

Question 19

what are some local factors associated with delayed healing

Answer 19

moisture
pressure
friction
shear
continued injury
inappropriate management

Question 20

what are some systemic factors associated with delayed healing?

Answer 20

circulation
sensation
inadequate nutrition
age
body habitus
co-morbidities
meds
behavioral risk taking

Question 21

hydrostatic pressure

Answer 21

pressure exerted by a fluid on an immersed body

Question 22

osmotic pressure

Answer 22

pressure that causes diffusion between fluids with different concentrations

Question 23

dependent position

Answer 23

feet lower than the rest of the body

Question 24

subjective questions to ask related to edema

Answer 24

• when did it start
• injury/surgery?
• what makes it better/worse?
• is it always like this?
• both legs or one leg?
• pain?
• are shoes and socks fitting?
• heavy legs?
• tightness in legs?

Question 25

objective measures related to edema

Answer 25

assess skin decreased hair growth decreased pulses erythema/cellulitis thickening of skin ulceration

Question 26

Homan's sign assesses for?

Answer 26

DVT

Question 27

gold standard for DVT assessment?

Answer 27

ultrasound

Question 28

2 indications to take a circumferential measurement

Answer 28

edema atrophy/hypertrophy *could also use volumetrics

Question 29

adverse consequences of edema

Answer 29

- delayed healing - restricted ROM - function limitations - pain - increased infection risk - subcutaneous tissue fibrosis - ulceration

Question 30

when determining treatment for edema what should you determine first?

Answer 30

etiology

Question 31

PRICE treatment

Answer 31

Protect Restricted activity Ice Compression Elevation

Question 32

what does ice (cryotherapy) do?

Answer 32

- decreased metabolism to control secondary hypoxic injury - analgesia - possibly cause vasoconstriction

Question 33

how long should you use ice

Answer 33

20 mins to 1 hour, depending on the agent

Question 34

effects of compression

Answer 34

- controls peripheral edema - manages scar formation - prevents DVT - promotes lymphatic and venous return - shaping of residual limb

Question 35

contraindications for compression

Answer 35

- circulatory obstruction - DVT - heart failure - infection of treated area - malignancy of treated area - unstable or acute fracture - pulmonary edema

Question 36

compression options

Answer 36

- elastic wraps (short or long stretch) - compression garments - intermittent pneumatic compression - cryocuff - deep water submersion

Question 37

indications for intermittent compression

Answer 37

edema, venous insufficiency, prevention of DVT, lymphedema

Question 38

the pressure for intermittent pneumatic compression should be greater than _______. why?

Answer 38

30mmHg this is arterial capillary pressure

Question 39

total treatment time for intermittent pneumatic compression

Answer 39

at home: >1 hour, 2-3 times a day

Question 40

long stretch elastic wraps have a ________ working load and ______ resting load

Answer 40

low high

Question 41

long stretch elastic wraps should be applied in what pattern

Answer 41

figure 8 *from metatarsal heads to tibial plateau

Question 42

should you wear long-stretch elastic wraps at night

Answer 42

no

Question 43

should stretch bandages have a ________- working load and a _______- resting load

Answer 43

high low

Question 44

short stretch bandages are applied how

Answer 44

circumferentially with padding

Question 45

primary use of short stretch bandages

Answer 45

lympedema

Question 46

how long should you elevate legs

Answer 46

30mins to 1 hour at a time *try to get them above your heart

Question 47

kinesiotaping works on what system

Answer 47

lymphatic

Question 48

how do you start the anchor in KT taping for edema?

Answer 48

in direction you want the lymphatics to flow

Question 49

contraindications for kinesiotaping for edema

Answer 49

- fragile or healing skin - over malignant areas - areas cellulitis/infection - allergies to tape

Question 50

is ice and rest appropriate if a patient's edema is due to a medical condition

Answer 50

no

Question 51

treatment options for edema due to a medical condition

Answer 51

- calf muscle pump - elevation - compression