treatments Flashcards
Rehabilitation goals for burns (NOT wound management goals)
Overall goal:
- Limit ROM loss
- reduce edema
- prevent contractures through positioning and splinting
- prevent / reduce complications from immobilization
anti contracture positioning for burns: Anterior neck
common deformity = flexion
stress hyperextension
position with cervical orthosis (plastic)
anti contracture positioning for burns: shoulder
common deformity = adduction & IR
stress abduction, flexion and ER
position with axillary splint / airplane splint
anti contracture positioning for burns: elbow
common deformity = flexion and pronation
stress extension and supination
position with posterior arm splint
anti contracture positioning for burns: hand
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
anti contracture positioning for burns: hip
common deformity =flexion and adduction
stress hip extension, abduction with neutral rotation
anti contracture positioning for burns: knee
common deformity = flexion
stress extension with posterior knee splint
anti contracture positioning for burns: ankle
common deformity = plantar flexion
stress dorsiflexion with neutral inv/ev with splint or plastic AFO
Post acute rehab for grafts following burns
- 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
how long to wait until exercise can be continued after graft placement
3-5 days - allow some tissue healing and solidification of grafts
stage 1 pressure ulcer treatment
vigorous pressure, friction and moisture alleviating measures required
stage 2 pressure ulcer treatment
if no infection, appropriate dressing that occludes the wound from environment
similar pressure, friction, and moisture alleviating measures for stage 1 pressure ulcer
stage 3 pressure ulcer treatment
often requires debridement of necrotic tissues, dressings and advanced pressure alleviating measurs
stage 4 pressure ulcer treatments
debridement
appropriate dressings
advanced pressure alleviating measures required
surgery with grafts often required
arterial insufficiency treatment
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
venous insufficiency treatments
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
diabetic foot ulcer treatments
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
herpes zoster treatments
no curative agent
anti viral drugs
symptom treatment for pain and itching
** Heat and ultrasound contraindicated!!
cellulitis treatment
antibiotics
elevation of limb
cool, wet dressings
lupus erythematosus treatment
no cure
topical treatment (corticosteroids)
salicylates
epidermal burn healing
protection of epithelial cells critical
protect wound with moisture (Creams) important since loss of sebaceous glands results in drying and cracking
dermal burn healing
cause of scar formation since injured tissue replaced by connective tissue
emergent burn care / management
immersion in cold water
if < half the body cold compress may be used
cover burn with sterile cloth/bandage
NO OINTMENTS/CREAMS
purpose of wound vac (negative pressure wound therapy)
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
purpose of wound debridement
- removal of necrotic tissue or infected tissue that is interfering with wound healing
- allows examination of wound/ulcer
- decreases bacterial concentration in wound
- decreases spread of infection
selective debridement
removal of nonviable tissue from wound
sharp, enzymatic, autolytic
sharp debridement
use of scalpel, scissors, r forceps to selectively remove necrotic tissue/ debris from wound
often used with large amounts of necrotic tissue
enzymatic debridement
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
autolytic debridement
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
non selective debridement
removal of both viable and non viable tissue from wound
“mechanical debridement”
wet to dry dressings
wound irrigation
hydrotherapy
wet to dry dressings
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
wound irrigation
removes necrotic tissue from wound bed with pressurized fluids (Pulsed lavage)
most desirable for infected wounds and wounds with loose debris
hydrotherapy
whirlpool tank
softens and loosens necrotic tissues
horrible side effects, don’t ever use this with your patients Emily
contraindications of wound vac
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
hydrocolloid dressing indications
partial and full-thickness wounds
effective with granular or necrotic wounds
hydrocolloid dressing advantages
provides moist environment enables autolytic debridement protection from microbial contamination moderate absorption no secondary dressing waterproof surface
contraindications for hydrocolloid dressing
infected wounds
hydrogel indications
superficial or partial thickness wounds (abrasions, blisters, pressure ulcers) that have minimal drainage
hydrogel advantages
moist environment for wound healing autolytic debridement reduce pressure and dec pain minimally adheres to wound can couple with US
foam dressing indications
partial and full thickness tears with various levels of exudate
can be used as secondary dressing over hydrogels
foam dressing advantages
moist environment for wound healing adhesive and non adhesive forms prophylactic protection and cushioning autolytic debridement moderate absorption
transparent film indications
superficial or partial thickness wounds with minimal drainage
transparent film advantages
moist environement for wound healing autolytic debridement visualization of wound resistant to shear and frictional forces cost effective over time
transparent film contraindication
infected wounds
guaze indications
infected or non infected wounds of any size
gauze advantages
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
alginates indications
partial or full thickness draining wounds such as pressure ulcers or venous insufficiency ulcers
often used w/ infected wounds because of high exudate
alginate advantages
high absorptive capacity enables autolytic debridement protection from microbial contamination use on infected or non infected wounds non adhering to wound
alginate contraindications
cannot be used on wounds with exposed tendon, capsule or bone
Primary intention wound healing
Acute wounds with minimal tissue loss
Smooth clean edges reapproximated with staples/sutures, etc
Minimal scarring and heals quickly
Secondary intention healing
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
Tertiary intention healing
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.
Risk factors for wound sepsis or dehiscence
Significant edema
Contamination from debris
High risk for infection
Questionable vascular integrity
Wound vac indications
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
