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integumentary system > treatments > Flashcards

treatments Flashcards

1
Q

Rehabilitation goals for burns (NOT wound management goals)

A

Overall goal:

  1. Limit ROM loss
  2. reduce edema
  3. prevent contractures through positioning and splinting
  4. prevent / reduce complications from immobilization
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2
Q

anti contracture positioning for burns: Anterior neck

A

common deformity = flexion
stress hyperextension
position with cervical orthosis (plastic)

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3
Q

anti contracture positioning for burns: shoulder

A

common deformity = adduction & IR
stress abduction, flexion and ER
position with axillary splint / airplane splint

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4
Q

anti contracture positioning for burns: elbow

A

common deformity = flexion and pronation
stress extension and supination
position with posterior arm splint

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5
Q

anti contracture positioning for burns: hand

A

common deformity = claw hand (intrinsic minus position )
stress wrist extension, MP Flexion, IP extension, thumb abduction
position in intrinsic plus position with resting hand splint

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6
Q

anti contracture positioning for burns: hip

A

common deformity =flexion and adduction

stress hip extension, abduction with neutral rotation

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7
Q

anti contracture positioning for burns: knee

A

common deformity = flexion

stress extension with posterior knee splint

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8
Q

anti contracture positioning for burns: ankle

A

common deformity = plantar flexion

stress dorsiflexion with neutral inv/ev with splint or plastic AFO

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9
Q

Post acute rehab for grafts following burns

A
  • continue passive ROM, increasing active ROM
  • progressive strengthening
  • minimize edema
  • scar management (including desensitization and pressure garments for minimizing hypertrophic or keloids)
  • progressive ambulation for CV benefits
  • training ADLs and functional mob
  • manage chronic pain
  • education and emotional support
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10
Q

how long to wait until exercise can be continued after graft placement

A

3-5 days - allow some tissue healing and solidification of grafts

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11
Q

stage 1 pressure ulcer treatment

A

vigorous pressure, friction and moisture alleviating measures required

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12
Q

stage 2 pressure ulcer treatment

A

if no infection, appropriate dressing that occludes the wound from environment
similar pressure, friction, and moisture alleviating measures for stage 1 pressure ulcer

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13
Q

stage 3 pressure ulcer treatment

A

often requires debridement of necrotic tissues, dressings and advanced pressure alleviating measurs

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14
Q

stage 4 pressure ulcer treatments

A

debridement
appropriate dressings
advanced pressure alleviating measures required
surgery with grafts often required

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15
Q

arterial insufficiency treatment

A

bed rest w/ head of bed elevated , avoid leg elevation
cease smoking
wound care
protective environment- appropriate shoe size, seamless socks
wound VAC often helpful
ABI of 0.5 or below indicates medical intervention such as surgery or medication

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16
Q

venous insufficiency treatments

A 
elevation and compression of wound to control edema 
Unna Boot 
custom fitted stockings 
intermittent compression therapy 
active exercise w/ support garments 
compression stockings for long term mngt
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17
Q

diabetic foot ulcer treatments

A

standard ulcer treatment - debridement of necrotic tissues, promote moist wound healing
OFFLOAD ulcer from abnormal pressures
- total contact cast (contraindicated if infected)
- change weight bearing status to NWB
rocker bottom shoe

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18
Q

herpes zoster treatments

A

no curative agent
anti viral drugs
symptom treatment for pain and itching

** Heat and ultrasound contraindicated!!

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19
Q

cellulitis treatment

A

antibiotics
elevation of limb
cool, wet dressings

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20
Q

lupus erythematosus treatment

A

no cure
topical treatment (corticosteroids)
salicylates

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21
Q

epidermal burn healing

A

protection of epithelial cells critical

protect wound with moisture (Creams) important since loss of sebaceous glands results in drying and cracking

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22
Q

dermal burn healing

A

cause of scar formation since injured tissue replaced by connective tissue

23
Q

emergent burn care / management

A

immersion in cold water
if < half the body cold compress may be used
cover burn with sterile cloth/bandage
NO OINTMENTS/CREAMS

24
Q

purpose of wound vac (negative pressure wound therapy)

A 
maintain moist wound environment
control edema
increase localized blood flow
reduce infectious materials
increases granular tissue formation and capillary blood flow
enhances epithelial cell migration
25
Q

purpose of wound debridement

A
  1. removal of necrotic tissue or infected tissue that is interfering with wound healing
  2. allows examination of wound/ulcer
  3. decreases bacterial concentration in wound
  4. decreases spread of infection
26
Q

selective debridement

A

removal of nonviable tissue from wound

sharp, enzymatic, autolytic

27
Q

sharp debridement

A

use of scalpel, scissors, r forceps to selectively remove necrotic tissue/ debris from wound

often used with large amounts of necrotic tissue

28
Q

enzymatic debridement

A

topical application of enzymatic preparation to necrotic tissue

used with infected and non infected wounds w/ necrotic tissue

slow to establish clean wound bed and should be removed once devitalized tissue is removed

29
Q

autolytic debridement

A

use of bodys own mechanisms to remove non viable tissue

use of transparent films, hydrocolloids, hydrogels, and alginates

establishes moist wound environment and can be used with any amount of necrotic tissue but requires longer healing time

DO NOT USE ON INFECTED TISSUE

30
Q

non selective debridement

A

removal of both viable and non viable tissue from wound

“mechanical debridement”

wet to dry dressings
wound irrigation
hydrotherapy

31
Q

wet to dry dressings

A

most often used to debride wounds with moderate amounts of exudate and necrotic tissue
use sparingly on wounds with necrotic and viable tissue since granulation tissue can be traumatized

32
Q

wound irrigation

A

removes necrotic tissue from wound bed with pressurized fluids (Pulsed lavage)

most desirable for infected wounds and wounds with loose debris

33
Q

hydrotherapy

A

whirlpool tank
softens and loosens necrotic tissues

horrible side effects, don’t ever use this with your patients Emily

34
Q

contraindications of wound vac

A

malignancy within wound
insufficient vascularity to sustain wound healing
large amounts of necrotic tissue with eschar present
untreated osteomyelitis
fistulas to organs
exposed arteries or veins
uncontrolled pain

35
Q

hydrocolloid dressing indications

A

partial and full-thickness wounds

effective with granular or necrotic wounds

36
Q

hydrocolloid dressing advantages

A 
provides moist environment
enables autolytic debridement
protection from microbial contamination
moderate absorption
no secondary dressing
waterproof surface
37
Q

contraindications for hydrocolloid dressing

A

infected wounds

38
Q

hydrogel indications

A

superficial or partial thickness wounds (abrasions, blisters, pressure ulcers) that have minimal drainage

39
Q

hydrogel advantages

A 
moist environment for wound healing 
autolytic debridement
reduce pressure and dec pain
minimally adheres to wound 
can couple with US
40
Q

foam dressing indications

A

partial and full thickness tears with various levels of exudate
can be used as secondary dressing over hydrogels

41
Q

foam dressing advantages

A 
moist environment for wound healing
adhesive and non adhesive forms
prophylactic protection and cushioning
autolytic debridement 
moderate absorption
42
Q

transparent film indications

A

superficial or partial thickness wounds with minimal drainage

43
Q

transparent film advantages

A 
moist environement for wound healing 
autolytic debridement 
visualization of wound
resistant to shear and frictional forces
cost effective over time
44
Q

transparent film contraindication

A

infected wounds

45
Q

guaze indications

A

infected or non infected wounds of any size

46
Q

gauze advantages

A

readily available and cost effective short term dressings
can be used alone or in combo with topical agents
can modify # of layers to accommodate for changing wound status

47
Q

alginates indications

A

partial or full thickness draining wounds such as pressure ulcers or venous insufficiency ulcers

often used w/ infected wounds because of high exudate

48
Q

alginate advantages

A 
high absorptive capacity
enables autolytic debridement 
protection from microbial contamination
use on infected or non infected wounds
non adhering to wound
49
Q

alginate contraindications

A

cannot be used on wounds with exposed tendon, capsule or bone

50
Q

Primary intention wound healing

A

Acute wounds with minimal tissue loss
Smooth clean edges reapproximated with staples/sutures, etc
Minimal scarring and heals quickly

51
Q

Secondary intention healing

A

Wound heals on its own without superficial closure
Requires wound care frequently
Larger scarring
Wounds with large tissue loss, necrotic, irregular and non viable tissue margins

52
Q

Tertiary intention healing

A

Delayed primary intention healing
Wounds at risk for sepsis or dehiscence are temp left open and once risk factors are dec wound is closed by primary intention.

53
Q

Risk factors for wound sepsis or dehiscence

A

Significant edema
Contamination from debris
High risk for infection
Questionable vascular integrity

54
Q

Wound vac indications

A

Chronic or acute wounds unable to be closed by primary intention such as

  • dehisced surgical wounds
  • full thickness wounds
  • partial thickness burns
  • heavily draining granular wounds
  • flaps, grafts
  • most ulcer types

integumentary system (3 decks)

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