Practical #2 Flashcards
Neuropathic Wounds Pain
Lack of pain complaint due to neuropathy
Possible paresthesias
Neuropathic Wounds Position
Plantar foot
Plantar aspect of metatarsal heads
Plantar aspect of midfoot if Charcot deformity
May occur under calluses
May occur in areas of pressure/friction from inappropriate footwear
Neuropathic Wounds Presentation
Round, punched-out lesions
Callused rim
Minimal drainage unless infected
Eschar or necrotic material uncommon unless infected
Neuropathic Wounds Periwound
Skin is dry, cracked Callus present Structural deformities Claw toes Rocker-bottom foot/Charcot deformity Prior amputation
Neuropathic Wounds Pulses and Temp
both normal
Neuropathic Tests and Measures
Sensory integrity
Sensation to light touch
Sensation to vibration
Neuropathic Education
Daily foot checks
Neuropathic PT Inteventions
Offloading
Neuropathic in clinic
Estim
Arterial Pain
Pain, often severe, increased with elevation
Arterial Position
Primarily lower extremity Commonly toes, lateral malleolus, anterior leg Rarely above the knee Trauma key precipitating factor Distal toes Dorsal foot Areas of trauma
Arterial Presentation
Round, regular May conform to precipitating trauma Pale granulation tissue if present Possible necrotic tissue/black eschar/ Gangrene Minimal or no bleeding/drainage
Arterial Periwound
Thin, shiny, anhydrous skin Loss of hair growth Thickened, yellow nails Pale, dusky, cyanotic skin Possible muscle atrophy Possible dependent rubor Loss of hair growth Thickened, yellow nails Pale, dusky, cyanotic Black eschar
Arterial Pulses and Temperature
decreased in both
pulses can be absent
Arterial Tests and Measures
ABI
TBI
TCPO2
Arterial Education
Protect feet and legs from
trauma, chemicals, excessive heat and cold
Arterial PT Interventions
Aerobic Exercise
Arterial in clinic
Estim
Venous Pain
Mild to moderate
Decreased with elevation/compression
Venous Position
Medial malleolus
Medial lower leg
Areas of trauma
Venous Presentation
Irregular shape
Red, ruddy wound bed
Fibrous, glossy coating
Copious drainage
Venous Periwound
Edema
Cellulitis, dermatitis
Hemosideran deposition
Lipodermatosclerosis
Venous Pulses and Temperature
Normal
Normal to mild warmth
Venous Tests and Measures
ABI
Venous Education
Etiology
Calf Muscle Pump
Venous PT Intervention
Elevation
Venous in Clinic
Compression
Pressure Pain
Category I pressure ulcers may be tender instead of painful
Patients with neurological deficits may not perceive pain
Patients who are unable to communicate may demonstrate pain by grimacing, withdrawal, or moaning
Pressure Ulcer Position
Majority on lower half of body over boney prominence
95% of pressure ulcers located over sacrum, greater trochanter, ischial tuberosity, posterior calcaneous, lateral malleolus
Areas of outside pressure:
casts, tubing, shoes
Pressure Presentation
Patients with full-thickness pressure ulcers more likely to have multiple ulcers
Pressure Periwound
Nonblanchable erythema
Mottled
Ring of inflammation around ulcer
Dermatitis
Pressure Pulses
Usually not applicable due to proximal ulcer location
Usually normal unless concomitant PVD
Pressure Temperature
Increased in areas of reactive hyperemia
Decreased in areas of ischemia
Pressure tests and measures
Pressure ulcer staging
Pressure ulcer education
Control pressure and shear forces
Positioning/offloading/pressure relief/turn schedule
Importance of proper support surfaces (mattress/cushion)
Pressure PT Inteventions
Assist with mobility, transfers, and weight shifts
Flexibility exercise to minimize contractures
Gait training
Transfers and bed mobility
Emphasize minimizing friction and shear
Pressure ulcer in clinic
Estim
Pressure Ulcer Stage I:
Intact skin with non-blanchable redness of a localized area
Pressure Ulcer Stage II:
Partial thickness loss of dermis. Presents as a shallow open ulcer with a red pink wound bed without slough
Pressure Ulcer Stage III
Full thickness tissue loss
Subcutaneous fat may be visible but bone, tendon or muscle not exposed
Pressure Ulcer Stage IV:
Full thickness tissue loss with exposed tendon or muscle
Estim Frequency:
80–115 Hz
Estim Intensity
75–200 V
Estim interpulse
50–100 microseconds
Estim time
45-60 mins
3–7 day/wk for 30 min/day
