treatments

Question 1

Rehabilitation goals for burns (NOT wound management goals)

Answer 1

Overall goal:

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

Question 2

anti contracture positioning for burns: Anterior neck

Answer 2

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

Question 3

anti contracture positioning for burns: shoulder

Answer 3

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

Question 4

anti contracture positioning for burns: elbow

Answer 4

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

Question 5

anti contracture positioning for burns: hand

Answer 5

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

Question 6

anti contracture positioning for burns: hip

Answer 6

common deformity =flexion and adduction

stress hip extension, abduction with neutral rotation

Question 7

anti contracture positioning for burns: knee

Answer 7

common deformity = flexion

stress extension with posterior knee splint

Question 8

anti contracture positioning for burns: ankle

Answer 8

common deformity = plantar flexion

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

Question 9

Post acute rehab for grafts following burns

Answer 9

• 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

Question 10

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

Answer 10

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

Question 11

stage 1 pressure ulcer treatment

Answer 11

vigorous pressure, friction and moisture alleviating measures required

Question 12

stage 2 pressure ulcer treatment

Answer 12

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

Question 13

stage 3 pressure ulcer treatment

Answer 13

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

Question 14

stage 4 pressure ulcer treatments

Answer 14

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

Question 15

arterial insufficiency treatment

Answer 15

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

Question 16

venous insufficiency treatments

Answer 16

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

Question 17

diabetic foot ulcer treatments

Answer 17

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

Question 18

herpes zoster treatments

Answer 18

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

** Heat and ultrasound contraindicated!!

Question 19

cellulitis treatment

Answer 19

antibiotics
elevation of limb
cool, wet dressings

Question 20

lupus erythematosus treatment

Answer 20

no cure
topical treatment (corticosteroids)
salicylates

Question 21

epidermal burn healing

Answer 21

protection of epithelial cells critical

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

Question 22

dermal burn healing

Answer 22

cause of scar formation since injured tissue replaced by connective tissue

Question 23

emergent burn care / management

Answer 23

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

Question 24

purpose of wound vac (negative pressure wound therapy)

Answer 24

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

Question 25

purpose of wound debridement

Answer 25

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

Question 26

selective debridement

Answer 26

removal of nonviable tissue from wound sharp, enzymatic, autolytic

Question 27

sharp debridement

Answer 27

use of scalpel, scissors, r forceps to selectively remove necrotic tissue/ debris from wound often used with large amounts of necrotic tissue

Question 28

enzymatic debridement

Answer 28

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

Question 29

autolytic debridement

Answer 29

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

Question 30

non selective debridement

Answer 30

removal of both viable and non viable tissue from wound "mechanical debridement" wet to dry dressings wound irrigation hydrotherapy

Question 31

wet to dry dressings

Answer 31

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

Question 32

wound irrigation

Answer 32

removes necrotic tissue from wound bed with pressurized fluids (Pulsed lavage) most desirable for infected wounds and wounds with loose debris

Question 33

hydrotherapy

Answer 33

whirlpool tank softens and loosens necrotic tissues horrible side effects, don't ever use this with your patients Emily

Question 34

contraindications of wound vac

Answer 34

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

Question 35

hydrocolloid dressing indications

Answer 35

partial and full-thickness wounds | effective with granular or necrotic wounds

Question 36

hydrocolloid dressing advantages

Answer 36

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

Question 37

contraindications for hydrocolloid dressing

Answer 37

infected wounds

Question 38

hydrogel indications

Answer 38

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

Question 39

hydrogel advantages

Answer 39

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

Question 40

foam dressing indications

Answer 40

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

Question 41

foam dressing advantages

Answer 41

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

Question 42

transparent film indications

Answer 42

superficial or partial thickness wounds with minimal drainage

Question 43

transparent film advantages

Answer 43

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

Question 44

transparent film contraindication

Answer 44

infected wounds

Question 45

guaze indications

Answer 45

infected or non infected wounds of any size

Question 46

gauze advantages

Answer 46

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

Question 47

alginates indications

Answer 47

partial or full thickness draining wounds such as pressure ulcers or venous insufficiency ulcers often used w/ infected wounds because of high exudate

Question 48

alginate advantages

Answer 48

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

Question 49

alginate contraindications

Answer 49

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

Question 50

Primary intention wound healing

Answer 50

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

Question 51

Secondary intention healing

Answer 51

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

Question 52

Tertiary intention healing

Answer 52

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.

Question 53

Risk factors for wound sepsis or dehiscence

Answer 53

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

Question 54

Wound vac indications

Answer 54

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