Ultimate Review Pt. 3 Flashcards
1
Q
emphysema
A
develops from a long history of chronic bronchitis. alveolar walls present with significant pathology and air spaces are permanently over inflated. pink puffers. expiration is difficult. characterized as centrilobular, panlobular or paraseptal. symptoms include: dyspnea, chronic cough, orthopnea, barrel chest, increased use of accessory muscles, and increased RR.
2
Q
restrictive pulmonary disease
A
lungs fail to fully expand due to a weakened diaphragm, structural inability of chest wall to expand, and a decrease in elasticity of lung tissue. symptoms include: shortness of breath, persistent non-productive cough, increased RR. results in a decrease in all lung volumes.
3
Q
tuberculosis
A
bacterial infection that is transmitted by airborne fashion (coughing, sneezing, speaking). lungs are primarily involved, however TB can occur in kidneys, lymph nodes, and meninges. lesions in the lungs can be seen with x ray. symptoms: fatigue, weight loss, loss of appetite, low grade fever, productive cough, chest discomfort, and dyspnea. treatment includes anti-tb drug therapy. prevention of TB through immunization is recommended for children.
4
Q
pharmacological intervention for pulmonary management
A
bronchodilator agents, inhaled corticosteriod agents, mucolytic agents, expectorant agents, antiasthmatic agents. examples: albuterol, serevent, epnephrine, vanceril, flovent, decadron, mucosil, plumozyne, guafenesin, terpin hydrate, intal, tilade
5
Q
transfers: levels of phys assistance
A
…
6
Q
independent
A
patient does not require any assistance to complete task
7
Q
supervision
A
patient requires therapist to observe throughout completion of task
8
Q
contact guard
A
patient requires therapist to maintain contact with patient to complete task. usually needed to assist of there is a loss of balance
9
Q
min assist
A
patient requires 25% assist from therapist to complete task
10
Q
mod assist
A
patient requires 50% assist from therapist to complete task
11
Q
max assist
A
patient requires 75% assist from therapist to complete task
12
Q
dependent
A
patient is unable to participate and therapist must provide all effort to perform task
13
Q
3 person carry/lift
A
used to transfer patient from a stretcher to a bed or treatment plinth. 3 therapists carry patient in supine position. therapist at head usually gives commands.
14
Q
2 person lift
A
used to transfer a patient btwn two surfaces of different heights or when transferring a patient to the floor.
15
Q
dependent squat pivot transfer
A
used to transfer a patient who cannot stand independently, but can bear some weight thru the trunk and LEs. therapist should position patient at a 45 degree angle to the destination surface. patient places UEs on therapist’s shoulders, but should not pull on therapist’s neck. should position patient at edge of surface, hold patient around hips and under butt, block patients knees in order to avoid buckling. therapist should utilize momentum, straighten his or her legs and raise patient or allow patient to remain squatting, and pivot and slowly lower patient to destination surface.
16
Q
sliding board transfer
A
used for a patient who has some sitting balance and some UE strength and can adequately follow directions. patient should be positioned at edge of w/c or bed and should lean to one side while placing one end of sliding board under proximal thigh. other end should be position on destination surface. use both arms to initiate a push up and scoot across board. therapist should guard in front of patient and assists as needed as patient performs a series of push ups across the board.
17
Q
stand pivot transfer
A
used when a patient is able to stand and bear weight through one or both of LEs. must possess functional balance and ability to pivot.
18
Q
wheelchair facts
A
…
19
Q
adult w/c specs:
A
seat width: 18 inches, set depth: 16 inches, seat height: 20 inches
20
Q
hemi-height w/c
A
decreased seat height (17.5 inches) to allow for propulsion using the unaffected foot
21
Q
rear wheel axles
A
can be positioned 2 inches posteriorly from normal for patients with amputations to increase the BOS and to compensate for diminished weight in front of w/c
22
Q
reclining w/c
A
allow intermittent or constant reclined positioning
23
Q
tilt-in-space w/c
A
allow for reclined position without losing required 90 degrees of knee flexion. entire chair reclines without any anatomical changes in positioning.
24
Q
standard w/c measurements for proper fit
A
seat height/leg length: 19.5 to 20.5 inches. measure from user’s heel to popliteal fold and add 2 inches to allow clearance of foot rest.
25
seat depth
measure from user's bottom along lateral thigh to popliteal fold, then subtract approx 2 inches to avoid pressure from front edge of seat against popliteal space. 16 inches average.
26
seat width
measure the widest aspect of user's bottom or hips and add aprx 2 inches. will provide space for clothing and clearance of trochanters from armrest side panel. approx 18 inches is average.
27
back height
measure from seat of chair to floor of axilla with user's shoulder flexed to 90 and then subtract 4 inches. this will allow final back height to be below inferior angles of scapula. 16-16 1/2 inches average.
28
armrest height
measure from seat of chair to olecranon process with user's elbow flexed to 90 and then add one inch. average usually 9 inches above chair seat.
29
assistive devices
parallel bars, walkers, axillary crutches, lofstrand crutches, canes
30
parallel bars
proper fit includes bar height that allows for 20-25 degrees of elbow flexion while grasping bars approx four to six inches in front of body.
31
walker
can be used with all levels of weight bearing. should allow for 20-25 degrees of elbow flexion. used with 3 point gait pattern
32
axillary crutches
all levels of weight bearing, but requires higher coordination for proper use. 6 inches in front, two inches out (lateral) to patient. crutch height should be adjusted no greater than 3 finger widths from axilla. handgrip height should be adjusted to ulnar styloid process and allow for 20-25 degrees of elbow flexion while grasping.
33
lofstrand (forearm) crutches
20-25 degrees of elbow flexion while holding handgrips with crutches 6 inches in front and 2 inches lateral. arm cuff should be positioned 1 to 1 1/2 inches below olecranon process so it does not interfere with elbow flexion
34
cane
provides minimal stability and support during ambulation, mainly for balance.
35
NWB
non weight bearing
36
TTWB
toe touch weight bearing
37
PWB
partial weight bearing
38
WBAT
weight bearing as tolerated
39
FWB
full weight bearing
40
2 point gait
when patient uses 2 crutches or canes. moves left crutch forward while simultaneously advancing rt lower extremity ad vice versa.
41
3 point gait
walker or crutches. injured lower extremity may have decreased weight bearing. AD is advanced followed by injured LE and then uninjured LE. AD and each LE are considered separate points
42
4 point gait
each advancement of crutch or cane as well as LEs indicates a single point, used one at a time.
43
swing to gait
patient with bilateral trunk and or LE weakness uses crutches or a walker and advances LEs at the same time only to point of AD.
44
swing through
advances LEs thru AD
45
arterial line
monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. used to measure blood pressure or obtain blood samples. considered more accurate than traditional measures of blood pressure and does not require repeated needle punctures
46
external catheter
applied over shaft of penis and is held in place by a padded strap or adhesive tape
47
foley catheter
indwelling urinary tract catheter that has a balloon attachment at one end. balloon which is filled with air or sterile water must be deflated before catheter can be removed
48
suprapubic catheter
indwelling urinary catheter that is surgically inserted directly into patient's bladder. insertion of a suprapubic catheter is performed under general anesthesia
49
swan-ganz catheter
soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site
50
intravenous system
consists of a sterile fluid source, pump, clamp, and catheter to insert into a vein. can be used to infuse fluids, electrolytes, nutrients, and medication. IV lines are most commonly inserted into superficial veins such as basilic, cephalic, or antecubital.
51
nasal cannula
tubing extends into patient's nostrils approx 1 cm. oxgyen therapy can deliver up to 6 L of oxygen per min
52
nasogastric tube
plastic tube inserted thru a nostril that extends into stomach. commonly used for liquid feeding, medication administration or to remove gas from the stomach
53
oximeter
photoelectric device used to determine the oxygen saturation of blood. device is most commonly applied to finger or ear. often used to assess activity tolerance
54
indications for therapeutic modalities
inflammation and repair, pain, restriction in motion, and abnormal tone.
55
phases of tissue healing
inflammation (1-6 days), proliferative phase (day 3-day 20), maturation phase (day 9 - ongoing)
56
inflammation phase of tissue healing
occurs secondary to trauma or disease. required for healing to occur. presents with calor, rubor, tumor, dolor. clot formation and phagocytosis occur
57
proliferative phase
involves connective tissue and epithelial cells. epithelialization, collagen production, wound contracture, and neurovascularization occur
58
maturation phase
longest in duration, progression towards restoration of the prior function of injured tissues, collagen synthesis and lysis balance, collagen fiber orientation
59
keloid scar
can occur during healing process when collagen production greatly exceeds collagen lysis. extends beyond original boundaries of an injury and damages healthy tissues.
60
hypertrophic scar
can occur during healing process when collagen production greatly exceeds collagen lysis. will be raised, but remain within borders of original injury
61
principles of heat transfer
conduction, conversion, convection, evaporation, radiation
62
heat conduction
direct contact btwn 2 materials at different temperatures. ex: hot pack, paraffin, ice massage, cold pack
63
heat convection
air or water moving in a constant motion across body. ex: whirlpool
64
heat conversion
transfer of heat when nonthermal energy is absorbed into tissue and transformed into heat. ex: diathermy and ultrasound
65
heat evaporation
transfer of heat as a liquid absorbs energy and changes from to a vapor. ex: vapocoolant spray
66
heat radiation
direct transfer of heat from a radiation energy source of higher temperature to one of cooler temperature. directly absorbed without the need for a medium. ex: infrared lamp
67
cryotherapy
ex: ice massage, cold pack, cold bath, vapocoolant spray
68
cryotherapy's therapeutic effects
initial decrease of blood flow to treated area, decreased temp, increase pain threshold, decrease metabolism, decrease edema, initial vasoconstriction, decrease nerve conduction velocity, decrease nerve conduction velocity, reduce spasticity of muscle, produce analgesic effects
69
cryotherapy's indications
acute or chronic pain, myofascial pain syndrome, muscle spasm, bursitis, acute or subacute inflammation, musculoskeletal trauma, reduction of spasticity, tendonitis
70
cryotherapy contraindications
compromised circulation, peripheral vascular disease, ischemic tissue, cold hypersensitivity, raynaud's phenomenon, cold urticaria, hypertension, infection, cryoglobinemia
71
stages of perceived symptoms during cryotherapy
intense cold within 3 mins, aching/burning sensation from 4-7 mins, anesthesia to analgesia from 8-15 mins, numbness from 15-30 mins
72
ice massage
5-10 min treatment time
73
cold pack
requires a temp of 23 degrees. apply cold pack wrapped in moistened towel to area for 15 mins. application may extend to 30 mins but requires observation every 10 minutes (for spasticity) can be applied every one to two hours for reduction of inflammation and pain control.
74
cold bath
used for immersion of distal extremities. water temp ranges from 55 to 64 degrees. immersed for 5 to 15 mins to attain desired effects
75
vapocoolant sprays
often used in conjunction with passive stretching. fluori-methane is a commonly used vapocollant spray that is typically applied from prox to distal muscle attachments.
76
superficial heating agents
fluidotherapy, hot pack, infrared lamp, paraffin
77
deep heating agents
diathermy, ultrasound (and phonopheresis)
78
heating therapeutic effects
increase temp, increase blood flow to area, decrease nerve conduction latency, vasodilation, increase muscle elasticity, increase collagen extensibility, decreases tone
79
heating indications
pain control, chronic inflammatory conditions, trigger point, tissue healing, muscle spasm, decreased ROM, densensitization
80
heating contraindications
circulatory impairment, area of malignancy, acute musculoskeletal trauma, bleeding, sensory impairment, thrombophlebities, arterial disease
81
fluidotherapy
container that circulates warm air and small cellulose particles. extremity is placed into container and dry heat is generated thru energy transferred by forced convection. promotes tissue healing and prevention of edema. body part should be placed into unit prior to turning machine on. temp should be set between 111-125 degrees. treatment time usually 20 minutes.
82
hot pack
effects include soft tissue healing, promoting relaxation, decreasing pain and stiffness. must be stored in hot water between 158-167 degrees. requires 6-8 towels around hot pack. require approx 20 minutes to achieve desire effects
83
infrared lamp (IR)
produces superficial heating of tissue through radiant heat. form of heating is usually limited to penetration of less than one to three millimeters. use is declining due to risk of burns during treatment. patient should be positioned approx 20 inches from source. 20 inches in distance should equal 20 minutes of treatment. as distance decreases, intensity will increase and time of total treatment should decrease.
84
paraffin wax
most commonly used superficial heating agent of distal extremities. temp should be between 113-126 degrees. dip patient's hand and wrap with plastic bag with a towel around it to insulate and maintain heating for approx 15-20 mins.
85
diathermy
converts high frequency electromagnetic energy into therapeutic heat. produces vibration of molecules within a specific tissue, generates heat and elevates tissue temperature. main therapeutic effect is enhancement of soft tissue healing. can be delivered in continuous or pulsed mode. pulsed mode is usually used for thermal effects at 27.12 MHz.
86
contraindications for diathermy
low back, abdomen, pelvis of a pregnant woman, internal and external metal objects, eyes, malignant area, intrauterine device, cardiac pacemaker, pain and temp sensory deficits, moist wound dressing, testes, acute inflammation, ischemic tissue
87
diathermy parameters
inductive application: wrap coils around extremity that has been covered by a towel, place drum over treatment area. patient must remain in same position throughout treatment. treatment time varies from 15-30 mins.
88
ultrasound
common deep heating agent that transfers heat through conversion. elevates tissue temp to depths up to 5 cms, and uses inaudible acoustic mechanical vibrations of high frequency to produce thermal and nonthermal effects. crystal transducer converts electrical energy into sound.
89
ultrasound therapeutic effects
thermal: increase extensibility of collagen structure, decrease joint stiffness, pain relief, increase blood flow, decrease muscle spasm
90
ultrasound therapeutic effects (nonthermal)
nonthermal: stimulation of tissue regeneration, pain relief, soft tissue repair, increase blood flow,
91
indications for u/s
soft tissue repair, contracture, bone fracture, trigger point, dermal ulcer, scar tissue, pain, plantar wart, muscle spasm
92
contraindications for u/s
over eyes, over pregnant uterus, over cemented prosthetic joint, impaired circulation, impaired pain or temp sensory deficits, over heart, over testes, over epiphyseal areas in children, infection, over malignancy
93
u/s treatment parameters
place transducer over area before turning on machine (and gel already applied to head). move in small circular pattern over treatment area. maintain contact with skin and stay within treatment area. an area two to three times the size of the transducer typically requires a duration of five minutes of treatment. intensity for continuous u/s is normally set btwn .5 to 2 w/cm2 for thermal effects. pulsed u/s is normally set between .5 to .75 w/cm2 with a 20% duty cycle for nonthermal effects
94
BNR
beam nonuniformity ratio: ratio of intensity of highest peak to average intensity of all peaks. lower BNR, more favorable, since most patients will be less likely to experience hot spots and or discomfort during treatment. BNR values should range btwn 2:1 and 6:1, most devices often fall in 5:1 or 6:1 range.
95
ERA
effective radiating area. area of transducer that transmits u/s energy. always smaller than total size of transducer head.
96
acoustic cavitation
occurs as a result of acoustic energy generated by u/s that develops into microscopic bubbles causing cavities that surround soft tissues. the bubbles expand and contract.
97
2 types of cavitation that occur:
stable cavitation: microscopic bubbles increase and decrease in size but do not burst. triggers microsteaming. transient (unstable) cavitation: microscopic bubbles increase in size over multiple cycles and implode. this causes brief moments of local temperature ad pressure increases in area surrounding those bubbles. process should not occur during therapeutic u/s since intensities required are much higher than 3 w/cm2.
98
microsteaming
minute flow of fluid that takes place around vapor-filled bubbles that oscillate and pulsate
99
acoustic streaming
term for the consistent and circular flow of cellular fluids that results from u/s. responsible for altering cellular activity and the transport of fluids to different portions of the field.
100
phonophoresis
use of u/s for transdermal delivery of medication. u/s enhances the distribution of medication through the skin, provides a high concentration of the drug directly to the treatment site and avoids risks that may be involved with injection of medication. medications regularly used in phonophoresis include anti-inflammatory agents or analgesics. effective with both continuous and pulsed techniques.
101
hydrotherapy
the internal and external use of water in the treatment of disease. transfers heat thru conduction or convection and is administered in tanks of varying sizes. main therapeutic effects: wound care, unloading of weight, and reduction of edema.
102
buoyancy
(archmides): there is an upward force on body when immersed in water equal to amount of water that has been displaced by the body. ability to float in water results from the body possessing a specific gravity less than that of water.
103
hydrostatic pressure
water exerts pressure that is perpendicular to the body and increases in proportion with the depth of immersion
104
resistance
water molecules tend to attract to each other and provide resistance to movement of the body in the water. resistance by water increases in proportion to speed of motion.
105
specific gravity
computation for specific gravity of water is equal to 1. human body varies based on size and somatotype but typically has a specific gravity of less than 1 (average .974). therefore, a personal will generally float when fully submerged in water.
106
specific heat
measure of the ability of a fluid to store heat. calculated as amount of thermal energy required to increase fluid's temp by one unit. water can store 4 times the heat as compared to air. water's thermal conductivity is approx 25 times faster than air at the same temp.
107
total drag force
comprised of profile drag, wave drag and surface drag forces. is a hydromechanic force exerted on a person submerged in water that normally opposes the direction of the body's motion.
108
therapeutic effects of hydrotherapy:
increase blood flow, increase core temp, relaxation, pain relief, vasodilation, decrease abnormal tone, wound/debridement
109
indications for hydrotherapy:
burn care, superficial heating or cooling, edema control, muscle strain, arthritis, desensitization of residual limb with contrast bath, pain management, wound care, decreased ROM, pool therapy/exercise, sprain, joint stiffness, muscle spasm/spasticity
110
contraindication for hydrotherapy:
peripheral vascular disease, gangrene, severe infection, urinary/fecal incontinence, advanced cardiov or pulm disease, buerger's disease w/contrast bath, impaired circulation, renal infection, bleeding surface area, diminished sensation
111
types of hydrotherapy
extremity tank, lowboy tank, highboy tank, hubbard tank, therapeutic pool
112
treatment temps for water
32-79 degrees: acute inflammation of distal extremities, 79-92 degrees: exercise, 92-96: wound care, spasticity, 96-98: cardiopulmonary compromise, treatment of burns, 99-104: pain management, 104-110: chronic rheumatoid or osteoarthritis, increased ROM
113
treatment parameters for whirlpool
treatment time ranges from between 10 and 30 mins. select water temp based on diagnosis and goals and assist pt into comfortable position, monitor vital signs and level of comfort.
114
treatment parameters for pool therapy
general contraindications for superficial or deep heating, including incontinence, open areas, fear of water, confusion, and significant respiratory pathology. recommended populations for pool therapy include patients with arthritis, musculoskeletal injuries, neuro deficits, sci, cva, ms, and selected cardiopulmonary diagnoses. tank must be cleaned after each use with a disinfectant and antibacterial agent.
115
mechanical agent: traction
modality that applies mechanical forces to body to separate joint surfaces and decrease pressure. force can be applied manually by therapist or mechanically by a machine.
116
therapeutic effects of traction
joint distraction, soft tissue stretching, muscle relaxation, reduction of disk protrusion, joint mobility
117
indications for traction
nerve impingement, herniated or protruding disc, subacute joint inflammation, spondylolisthesis, joint hypomobility, paraspinal muscle spasm, degenerative joint disease, osteophyte formation
118
contraindications for traction
when motion is contraindicated, joint instability, tumor, pregnancy, acute inflammatory response, acute sprain, osteoporosis, fracture
119
treatment parameters for traction
treatment time is 5-20 mins. cervical: pt supine with approx 25-35 degrees of neck flexion, should start with a force btwn 10-15 lbs and progress to 7% of pt's body weight as tolerated for separation of vertebrae. lumbar can be supine or prone, and should be set with a force of less than half body weight for initial treatment. traction force of 25-50 lbs is recommended when initiating mechanical lumbar traction. force of up to 50% of body weight is required for actual separation of the vertebrae.
120
compression
physical agent that applies a mechanical force to increase pressure on treated body part. works to keep venous and lymphatic flow from pooling into interstitial space. static compression utilizes bandaging and compression garments to shape residual limbs, control edema, prevent abnormal scar formation, and reduce risk of dvt. intermittent compression with a pneumatic device is used to reduce edema.
121
therapeutic effects of compression
control of peripheral edema, shaping of residual limb, management of scar formation, improve lymphatic and venous return, and prevention of DVT
122
indications for compression
lymphedema, new res limb, risk for DVT, edema, stasis ulcers, hypertrophic scarring
123
contraindications for compression
malignancy of treated area, DVT, unstable or acute fracture, heart failure, infection of treated area, pulm edema, circulatory obstruction
124
treatment parameters
therapist should measure girth and bp. therapist should set parameters based on desire effect. stockinette should be put over extremity and then compression sleeve. 3:1 ratio is generally used for on/off time with inflation btwn 40 to 100 seconds and deflation btwn 10-35 seconds. inflation pressure generally ranges from 30-80 mm Hg and should not exceed patient's diastolic bp. treatment of upper extremities generally requires btwn 30 and 60 mm Hg of inflation pressure while treatment of LEs requires btwn 40 and 80 mm Hg of inflation pressure. treatment time varies for diagnosis, from 2-4 hours and is utilized from 3 x per week to 3 x per day. when treatment time is up, therapist should reassess extremity and remeasure girth and bp
125
UV: ultraviolet light
form of energy that is used therapeutically and absorbed one to two millimeters into the skin. divided into UV-A and UV-B, and UV-C. most effective use of UV is to treat skin disorders
126
therapeutic effects of UV
facilitate healing, exfoliation, Vit D production, increase pigmentation, tanning
127
indications for UV
acne, psoriasis, tetany, Vit D deficiency, chronic ulcer/wound, osteomalacia/rickets, sinusitis
128
contraindications for UV
photosensitive meds, lupus erythematosus, tb, herpes, renal or hepatic pathology, DM, pellagra
129
treatment parameters for UV
therapist must obtain a minimal erythemal dose before treatment (MED). this is the time of exposure needed to produce an area of mild redness btwn 8 and 24 hours after treatment. MED is tested by paper cutouts on forearm and therapist should wear goggles. squares on skin should be exposed in 15 sec increments for 15, 30, 45, 60 and 75 seconds and inspected after an 8 hr period to determine MED. treatment time should increase each consecutive treatment day since skin adapts to the UV exposure.
130
massage
manual therapeutic modality that produces physiologic effects through stroking, rubbing, and pressure.
131
effleurage
light in stroke and produces a reflexive response. performed at beginning and end of massage to allow patient to relax and should be directed towards the heart.
132
friction
incorporates small circular motion over a trigger point or muscle spasm. deep massage technique that penetrates into the depth of a muscle and attempts to reduce edema, loosen adhesions, and relieve muscle spasm. used with chronic inflammation or with overuse injuries
133
petrissage
kneading where muscle is squeezed and rolled under therapist's hands. distal to proximal sequence of kneading over muscle. can be performed with 2 hands over larger muscle groups or with as few as two fingers over smaller muscles.
134
tapotement
provides stimulation through rapid and alternating movements such as tapping, hacking, cupping, and slapping. purpose is to enhance circulation and stimulate peripheral nerve endings
135
vibration
places hands or fingers firmly over area and uses a rapid shaking motion that causes vibration to treatment area. used primarily for relaxation.
136
therapeutic effects of massage
increases lymphatic circulation, removal of metabolic waste, decrease muscle atrophy, decrease anxiety and tension, facilitate healing, stimulate reflexive effects, reduction of edema, loosen adhesions, decrease muscle spasm
137
indications for massage
pain, decreased ROM, edema, adhesions, myositis, lactic acid excess, migraine, trigger point, muscle spasm and cramping, scar tissue, bursitis, tendonitis, intermittent claudication, raynaud's syndrome
138
contraindications for massage
infection, arterioscelrosis, thrombus, cellulitis, acute injury, embolus, cancer.
139
electrotherapy
used for facilitation of skeletal muscle contraction, stimulation of denervated muscle, pain management, to retard muscle atrophy, osteogenesis, driving medications through the skin, and wound management
140
contraindications
cardiac pacemaker, patient with a bladder stimulator, over carotid sinus, seizure disorders, phlebitis, malignancy, over a pregnant uterus, cardiac arrhythmia, osteomyelitis
141
electrode configuration
techniques include: monopolar, bipolar, and quadripolar
142
monopolar
active (smaller) electrode is placed over target area. second dispersive electrode is placed at another site away from the target area. used for wounds, iontophoresis, and treatment of edema
143
bipolar
2 active electrodes are placed over target area. electrodes usually same size. used for muscle weakness, neuromuscular facilitation, spasms, and ROM
144
quadripolar
2 electrodes from 2 separate stimulating circuits are positioned so that the individual currents intersect with each other. utilized with interferential current.
145
electrode size
when using a smaller electrode it is particularly important to understand that since the current density is quite high compared to a larger electrode, the patient will be more susceptible to pain and potential tissue damage.
146
small electrodes
increased current density, increased impedance, decreased current flow
147
large electrodes
decreased current density, decreased impedance, increased current flow
148
estim indications
pain management, urinary incontinence, edema management, osteoarthritic pain, migraines
149
estim contraindication
malignancy, with all types of electrical implants, during first trimester of pregnancy, over lower abdomen/uterus during pregnancy, over anterior transcervical area
150
direct current
also known as galvanic, constant flow of electrons from anode to cathode without interruption. iontophoresis uses direct current
151
alternating current
polarity that changes from positive to negative with change in direction of current flow. biphasic, symmetrical or asymmetrical, and is a waveform that is sinusoidal in shape. used in muscle retraining, spasticity and stimulation of denervated muscle
152
interferential current
combines two high frequency alternating waveforms that are biphasic. used for deep muscle stimulation. attempts to reach deeper tissues using higher frequencies of each waveform along with overall shorter pulse widths. uses a frequency of 50-1250 pps and a pulse width of 50-150 microseconds for pain management; and a frequency of 20-50 pps and pulse width of 100-200 microseconds for muscle contractions
153
russian current
medium frequency polyphasic waveform. alternating current is produced in a 50 burst per second interval with a pulse width range of 50-200 microseconds, and an interburst interval of 10 milliseconds. type of NMES or FES and is believed to augment muscle strengthening by depolarizing both sensory and motor nerve fibers resulting in tetanic contractions that are painless and stronger than those made voluntarily by the patient. electrode should be placed parallel to muscle fibers along line of pull of muscle group.
154
russian stim parameters
average peak current amplitude of 100 mA, 50 bursts per second, with on/off time ration of 10/50. usually is done 10 evoked contractions with a 10 second contraction and a 50 second rest period between each of the 10 contractions.
155
NMES
neuromuscular electrical stimulation: used to facilitate skeletal muscle activity. stim of an innervated muscle occurs when an electrical stimulus of appropriate intensity and duration is administered to the corresponding peripheral nerve. commonly used to facilitate return of controlled functional muscular activity or to maintain postural alignment until recovery occurs.
156
NMES parameters
bipolar electrode placement over muscle. interrupted current is used with a range of 20-40 pulses per second an on time of 6-10 secs followed by off time of approx 50-60 secs. 15-20 mins for several times a day
157
TENS: transcutaneous electrical nerve stimulation
widely used for acute and chronic inflammation. main effects of TENS include pain relief through gate control theory. used for home use and is portable.
158
TENS contraindications
cardiac pacemakers, epilepsy, during 1st trimester
159
TENS Parameters
conventional, acupuncture like, pulse burst, and brief intense (high-intensity)
160
conventional TENS
frequency: 50-100 Hz, duration: 20-100 microseconds, amplitude: 10-30 mA
161
acupuncture like TENS
frequency: 1-4 Hz, 100-200 microseconds, amplitude: 30-80 mA
162
pulse burst
frequency: 70-100 Hz/burst, duration: 40-75 microseconds, amplitude: 30-60 mA
163
brief intense (high intensity)
frequency: 70-100 Hz/burst, duration: 150-200 microseconds, amplitude: 30-60 mA
164
TENS guidelines
electrodes may be placed on sites of nerve roots, trigger points, acupuncture sites or key points of pain and sensitivity. net polarity is normally equal to zero. if waveform is unbalanced, there will be an accumulation of charges that will lead to skin irritation under the electrodes. includes a pulse duration that can vary from 20-400 microseconds; pulse frequency that varies in range from 1-200 Hz, and current amplitude from .1-120 mA.
165
iontophoresis
process by which medications are induced through the skin into the body by means of continuous direct current electrical stimulation. medication is separated into ions based on the polarity of the current.
166
acidic/alkaline reaction
acidic reaction can cause hardening of skin. alkaline reaction can cause skin to soften over time.
167
buffering
technique used to stabilize the pH of skin during ionto by placing buffering agents into electrode pads that cover drug reservoir area within the electrode
168
electrolysis
decomposition of a compound that results from passing an electrical current through it
169
electron exchange
occurs during ionto where there is an exchange btwn ions within solutions and electrodes
170
redox reaction
decomposition of water when electrical current is passed through it. water will be reduced to a net accumulation of hydrogen ions (H+) under anode and hydroxyl ions (OH-) under the cathode.
171
iontophoresis parameters
pt should never lie on top of electrodes. unit should be set to continuous direct current. polarity must be set to same polarity as ion solution. ion solution should be massaged into treatment site or space within electrode. conductive surface area of the negative electrode (cathode) is twice the size of the conductive surface area of the positive electrode (anode) regardless of which on is the active electrode. active electrode must be placed over target area the the dispersive electrode should be placed as far as possible from active electrode. slowly increase intensity towards a max of five milliamperes. treatment should last 15-20 mins. additional time is required for treatment at an intensity of less than five milliamperes.
172
therapeutic ions and charge
positive charge: lidocaine, hydrocortisone, histamine, lithium, magnesium, zinc. negative charge: acetate, dexamethasone, salicylate, iodine, chlorine, tap water (+ and -)
173
hvpc
high voltage pulsed current: twin peak monophasic, pulsed current. produces high electromotive forces. has a phase duration of 5-20 microsecs (fixed in most machines), a short pulse duration that ranges btwn 100-200 microsecs, and voltage greater than 150V to a max of 500V. one large dispersive pad along with one, two or four active electrodes. active electrodes can be positive or negative in polarity based on treatment goals.
174
indications for hvpc
wound management, pain management, soft tissue edema, levator ani syndrome, muscle spasm, muscle weakness, bell's palsy
175
contraindications for hvpc
cardiac pacemakers, over heavy scarring tissues, malignancy, pregnancy
176
hvpc parameters
secure one electrode over wound (using warm sterile gauze and sponge) and other over healthy skin a min of 5 cm from wound itself. polarity should be in reversal mode so that it allows for 50% of treatment with positive polarity. frequency is generally 30-200 pps, amplitude 1-500V, and duration of treatment from 10-60 mins per session. dermal wounds should be treated 5-7 days per week for best results
177
electromyography
science of evaluating motor units (anterior horn cell, axon, neuromuscular junctions and muscle fibers innervated by unit) through use of intramuscular needle electrodes or surface electrodes. potentials include abnormal: spontaneous and voluntary.
178
biofeedback
modality that uses an electromechanical device to provide visual and or auditory feedback. can be utilized to receive information related to motor performance, kinesthetic performance or physiological response. can measure peripheral skin temp, changes in blood volume thru vasodilation and vasoconstriction using finger phototransmission, sweat gland activity, and electrical activity during muscle contraction. electromyographic feedback is the most commonly used biofeedback modality in clinical setting.
179
biofeedback measures:
muscle activity, heart rate, balance, skin temp, bp, posture, abnormal mvmt, normal mvmt
180
types of feedback
myoelectric/electromyographic biofeedback, EMG-BF, position biofeedback, bp biofeedback, respiratory bioFB, sphincter control biofb, temp and blood flow bioFB, electroencephalographic bioFB
181
biofeedback therapeutic effects
muscle relaxation, improve muscle strength, decrease muscle spasm, neuromuscular control, decrease accessory muscle use, decrease pain
182
biofeedback indications
muscle spasm, pain, sci, urinary incontinence, improve neuromuscular control, muscle weakness, hemiplegia, cp, bowel incontinence, promote relaxation
183
biofeedback contraindications
any condition where muscle contraction is detrimental, skin irritation at electrode site
184
biofeedback treatment guidelines
2 active electrodes and 1 ground electrode in a bipolar arrangement best deletes "noise" (noise is any extraneous electrical activity not produced by the contraction of the muscle). surface electrodes with some form of conduction gel are required to adhere to prepared, clean skin. electrodes should be placed parallel to direction of the muscle fibers, set level of sensitivity on device relative to treatment goals: low level sensitivity settings for muscle re-education, high level sensitivity setting for relaxation
185
biofeedback treatment parameters
2 active electrodes should be placed parallel to muscle fibers and close to each other. reference or ground electrode can be placed anywhere on the body, but is often secured between 2 active electrodes. signals are transmitted to a differential amplifier and info is conveyed thru visual and audio feedback. for muscle re-education, should begin with pt performing a max muscle contraction. sensitivity of bfb unit should be set at a low sensitivity setting and adjusted so that the pt can perform reps at a ratio of 2/3rds of max muscle contraction. isometric contractions should continue for 6-10 secs with relaxation in btwn each contraction. treatment duration for a single muscle group is 5-10 mins. treatment for muscle relaxation requires a high sensitivity setting and a similar electrode placement with active electrodes initially positioned close to each other. as patient improves with relaxation, electrodes should be placed further apart and sensitivity setting increased. during this treatment, patient may also benefit from adjunct relaxation techniques such as imagery. treatment duration of 10-15 mins is usually adequate to attain relaxation.
186
gfci:
ground fault circuit interrupter: designed to cut off electrical supply to a piece of equipment if it detects any form of leakage or ground fault.
187
electrotherapy terms
...
188
accommodation
an occurrence where a nerve and muscle membrane's threshold for excitability increases secondary to a stimulation by a pulse that has a slow phase rise time. the quicker the rise time, the less the nerve can accommodate to the impulse.
189
alternating current (biphasic)
alternating current allows for the constant change in flow of ions
190
ampere
unit of measure used to describe rate of current
191
amplitude
magnitude of current. often labeled intensity or voltage.
192
anode
positively charged electrode that attracts negative ions
193
cathode
negatively charged electrode that attracts positive ions
194
biphasic
pulse that moves in one direction, returns to baseline, then in other direction and back to baseline again within a predetermined amount of time.
195
types of biphasic pulse
symmetrical: positive phase is identical to negative phase, asymmetrical: positive phase and negative phase are not identical in shape, balanced: positive phase's electrical charge is equal to negative phase's electrical charge, unbalanced: positive phase and negative phase do not have identical electrical charges
196
burst
interrupted group of pulses that are delivered in a finite series and a predetermined frequency
197
capacitance
property of an insulator that allows for the storage of energy when opposing surfaces of the insulator have an electrical potential difference
198
chronaxie
testing procedure used to measure amount of time required to produce a small muscle contraction at a particular intensity
199
conductance
ease at which a particular material will allow current flow (mho)
200
current
flow electrons from one place to another
201
direct current (monophasic)
constant unidirectional flow of ions. dependent on polarity
202
duration of stimulus/duration of rest
time period of stimulation and time period of rest btwn periods of stimulation.
203
duty cycle
percentage of time that electrical current is on in relation to entire treatment time.
204
electrical impedance
resistance of a tissue to electrical current
205
frequency
determines number of pulses delivered through each channel per second. often labeled "rate"
206
high volt current
characterized by a waveform greater than 150 volts with a short pulse duration. is intermittent and is used for deeper tissue penetration
207
impedance
property of a substance that provides resistance to flow of current by offering an alternate current
208
inductance
how easily a certain material will induce an electromotive force (emf) within a circuit
209
interpulse interval
period of time of electrical inactivity btwn each pulse, usually expressed in microsecs or millisecs
210
ion
positively or negatively charged atome
211
low volt current
waveform of less than 150 volts and is used for neuromuscular stimulation
212
monophasic
pulse that has either a positive or negative polarity and moves in only one direction from a zero baseline and returns to baseline within a predetermined amount of time
213
negative ion
gained one or more electrons and possesses a negative charge
214
ohm's law
current of an electrical current. there is a direct proportional relationship btwn current and voltage and an indirect proportional relationship btwn current and resistance
215
positive ion
lost one or more electrons and possesses a positive charge
216
pulse
pulse is one individual waveform
217
pulse duration
amount of time that it takes to complete all phases of a single pulse. often labeled "pulse width"
218
pulsed current (interrupted)
allows for a non-continuous flow of either alternating or direct current with periods of no electrical activity
219
ramp
refers to number of seconds it takes for amplitude to gradually increase or decrease to the max value set by amplitude control
220
resistance
ability of a material to oppose the flow of ions through it
221
rheobase
minimal intensity used with a long current duration that produces a small muscle contraction
222
volt
unit of measure of electrical power or electromotive force
223
waveform
consistent pattern of a current measured on an oscilloscope
224
clinical application templates executive summaries
...
225
achilles tendon rupture
usually one to two inches above tendinous insertion on calcaneous, greatest btwn 30-50 yrs of age, typically be unable to stand on their toes and tend to exhibit a positive Thompson test
226
adhesive capsulitis
occurs more in middle-aged population, greater incidence in women, arthrogram can assist with dx by detecting decreased volume of fluid within the joint capsule, ROM restriction typically in a capsular pattern (lateral rotation, abduction, medial rotation)
227
amyotrophic lateral sclerosis
risk is higher in males, usually occurs between 40-70, clinical presentation may include both upper and lower motorneuron involvement with weakness occurring in a distal to prox progression, average course of dx is 2-5 yrs with only 20-30% of patients surviving longer than five years
228
ankylosing spondylitis
systemic condition, inflammation of spine and larger peripheral joints, males greater risk btwn 20-40, presentation initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension
229
anterior cruciate ligament sprain
most commonly occurs during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position, females involved in selected sports have higher ligament injury rates, approx 2/3 of time acl is completely torn, there is an associated meniscal tear
230
bicipital tendonitis
increased incidence of injury is associated with selected sports such as baseball pitching, swimming, rowing, gymnastics, and tennis; characterized by subjective reports of a deep ache directly in front and on top of the shoulder made worse with overhead activities or lifting, examination may reveal a positive speed's test or yergason's test
231
carpel tunnel syndrome
incidence is higher in females with most common age being from 35-55, muscle atrophy is often noted in abductor pollicis brevis muscle and later in the thenar muscles; electromyography studies, tinel's sign, and phalen's test can be used to assist with confirming diagnosis
232
cerebral palsy
spastic cp involves upper motor neuron damage; athetoid cp involves damage to cerebellum, cerebellar pathways or both; clinical presentation includes motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance impairments; mental retardation and epilepsy are present in 50-60% of children diagnosed with cp.
233
cva: cerebrovascular accident
types include ischemic (thrombus, embolus, lacunar) and hemorrhagic stroke (intracerebral, subdural, subarachnoid), left CVA may present with weakness or paralysis to rt side, impaired processing, heightened frustration, aphasia, dysphagia, and motor apraxia. right cva may present with weakness or paralysis to left side, poor attention span, impaired awareness and judgment, spatial deficits, memory deficits, emotional lability, and impulsive behavior
234
chf: congestive heart failure
etiologies include arrhythmia, pulm embolism, hypertension, valvular heart disease, myocarditis, unstable angina, renal failure, severe anemia;
235
cystic fibrosis
causes exocrine glands to overproduce thick mucus which causes subsequent obstruction, autosomal recessive genetic disorder located on long arm of chromosome seven, terminal disease but death age has increased to 32 yrs due to early detection and management
236
degenerative spondylolisthesis
caused by weakening of joints that allows for forward slippage of one vertebral segment on one below due to degenerative changes, most common site is L4/L5, william's flexion exercises may be indicated to strengthen abs and reduce lumbar lordosis
237
diabetes mellitus (type 1)
insulin is functionally absent due to destruction of beta cells of pancreas; where insulin would normally be produced. starts in children ages 4 or older, adolescense. symptoms include polyuria, polydipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration
238
down syndrome
clinical presentation: hypotonia, flattened nasal bridge, simian line (palmar crease), epicanthal folds, enlargement of tongue and dd.
239
duchenne muscular dystrophy
x linked recessive trait manifesting in only male offspring while female offspring become carriers. waddling gait, prox muscle weakness, toe walking, pseudohypertrophy of calf and difficulty climbing stairs. rapid progression of this disease with inability to ambulate by ten to 12 yrs of age with death occurring as teenager or less frequently in the 20's.
240
fibromyalgia
nonarticular rheumatic condition with pain caused by tender points within muscles, tendons, and ligaments. pain exists in all 4 quadrants of body and there is pain in at least 11 of 18 standardized tender point sites
241
full thickness burns
burn causes immediate cellular and tissue death and subsequent vascular destruction, eschar forms from necrotic cells and creates a dry and hard layer that requires debridement. absent sensation and pain due to destruction of free nerve endings
242
guillain barre syndrome
motor weakness in a distal to prox progression, sensory impairment, and possible respiratory paralysis. may be an autoimmune response to a previous respiratory infection, flu, immunization or surgery. patients usually have full recovery
243
huntingtons disease
chronic progressive genetic disorder that is fatal within 15 to 20 yrs after clinical manifestation. degeneration and atrophy of basal ganglia (stiatum) and cerebral cortex w/in brain. clinically presents with enlarged ventricles secondary to atrophy of basal ganglia, mental deterioration, speech disturbances and ataxic gait
244
juvenile rheumatoid arthritis
autoimmune disorder found in children less than 16 that occurs when immune cells mistakenly begin to attack the joints and organs causing local and systemic effects. girls more likely than boys. symptoms include joint swelling, pain, stiffness
245
lateral epicondylitis (tennis elbow)
inflammation or degenerative changes at common extensor tendon that attaches to lateral epicondyle of elbow. repeated overuse of wrist extensors. clinical symptoms include difficulty holding or gripping objects and insufficient forearm functional strength
246
integumentary system
consists of dermal and epidermal layers, air follicles, nails, sebaceous glands, sweat glands
247
dermis
true skin: well vascularized, elastic, flexible and tough.
248
epidermis
avascular, consists of outermost layer of skin
249
arterial insufficiency ulcers
occur secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis
250
venous insufficiency ulcers
occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration
251
pressure ulcer
decubitus ulcer: results from sustained or prolonged pressure at levels greater than the level of capillary pressure on the tissue
252
neuropathic ulcer
secondary complication usually associated with a combination of ischemia and neuropathy. most often associated with diabetes. frequently found on plantar surface of foot, often beneath the metatarsal heads. wound has good granulation tissue and little or no drainage. often do not report pain due to altered sensation
253
arterial ulcers
lower one third of leg, toes, web spaces. smooth edges, well defined, lack of granulation tissue, tend to be deep. severe pain, diminished or absent pedal pulses, normal edema, decreased skin temperature, thin and shiny tissue, hair loss, yellow nails. leg elevation increases pain.
254
venous ulcers
proximal to the medial malleolus, irregular shape, shallow, mild to moderate pain, normal pedal pulses, increased edema, normal skin temp, flaky, dry skin, leg elevation lessens pain
255
intervention for arterial insufficiency ulcer
cleansing the ulcer, rest, reducing risk factors, limb protection
256
intervention for venous insufficiency ulcer
cleansing the ulcer, compression to control edema
257
hydrocolloid dressing
gel forming polymer such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. absorb exudate by swelling into a gel like mass and vary from being occlusive to semi permeable. does not attach to actual wound itself and is instead anchored to intact skin surrounding the wound.
258
when to use hydrocolloids
useful for partial and full thickness wounds. can be effective with granular or necrotic wounds
259
advantages to hydrocolloids
moist environment for wound healing, enables autolytic debridement, offers protection from microbial contamination, provides moderate absorption, does not require a secondary dressing, provides a waterproof surface
260
disadvantages to hydrocolloids
may traumatize surrounding intact skin upon removal, may tend to roll in areas of excessive friction, cannot be used on infected wounds
261
hydrogels
consist of varying amounts of water and varying amounts of gel-forming materials such as glycerin, dressings are available in sheet form or amorphous form
262
when to use hydrogels
commonly used on superficial and partial thickness wounds (abrasions, blisters, pressure ulcers) that have minimal drainage. rather than absorb drainage, hydrogels are moisture retentive
263
advantages to hydrogels
provides a moist environment for wound healing, enables autolytic debridement, may reduce pressure and diminish pain, can be used as a coupling agent for ultrasound, minimally adheres to wound
264
disadvantages to hydrogels
potential for dressings to dehydrate, cannot be used on wounds with significant drainage, typically requires a secondary dressing
265
foam dressings
composed from a hydrophilic polyurethane base. hydrophilic at wound contact surface and are hydrophobic on the outer surface. allows exudates to be absorbed into the foam through the hydrophilic layer. most commonly available in sheets or pads with varying degrees of thickness.
266
when to use foam dressings
used to provide protection over partial and full thickness wounds with varying levels of exudate. can be used as secondary dressings over amorphous hydrogels
267
advantages to foam dressings
provides a moist environment for wound healing, available in adhesive and nonadhesive forms, provides prophylactic protection and cushioning, encourages autolytic debridement, provides moderate absorption
268
disadvantages to foam dressings
may tend to roll in areas of excessive friction, adhesive form may traumatize periwound area upon removal, lack of transparency makes inspection of wound difficult
269
transparent film
film dressings are thin membranes made from transparent polyurethane with water resistant adhesives. permeable to vapor and oxygen, but are mostly impermeable to bacteria and water. highly elastic, conform to a variety of body contours, and allow easy visual inspection of the wound since they are transparent.
270
when to use transparent films
useful for superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.
271
advantages to transparent films
provides a moist environment for wound healing, enables autolytic debridement, allows visualization of the wound, resistant to shearing and frictional forces, cost effective over time
272
disadvantages to transparent films
excessive accumulation of exudates can result in periwound maceration, adhesive may traumatize periwound area upon removal, cannot be used on infected wounds
273
gauze dressings
most readily available used in inpatient environment. commonly used on infected or non-infected wounds of any size. can be used for wet to wet, wet to moist, or wet to dry debridement. readily available and cost effective but has a tendency to adhere to wound bed. requires frequent dressing changes. increased infection rate compared to occlusive dressings
274
alginates
consist of calcium salt of alganic acid that is extracted from seaweed. highly permeable and non-occlusive. requires a secondary dressing. based on the interaction of calcium ions in the dressing and the sodium ions in the wound exudate.
275
when to use alginates
typically used on partial and full thickness draining wounds such as pressure wounds or venous insufficiency ulcers, often used on infected wounds due to likelihood excessive drainage.
276
advantages to alginates
high absorptive capacity, enables autolytic debridement, offers protection from microbial contamination, can be used on infected or uninfected wounds, non-adhering to wound
277
disadvantages to alginates
may require frequent dressing changes based on level of exudate, requires a secondary dressing, cannot be used on wound with an exposed tendon, joint capsule or bone
278
occlusion
refers to ability of a dressing to transmit moisture, vapor or gases from wound bed to atmosphere. truly occlusive substance would be completely impermeable, while a truly non-occlusive substance would be completely permeable.
279
most occlusive to non-occlusive
hydrocolloids, hydrogels, semi-permeable foam, semi-permeable film, impregnated gauze, alginates, and traditional gauze
280
most moisture retentive to least moisture retentive
alginates, semi-permeable foam, hydrocolloids, hydrogels, semi-permeable film
281
primary versus secondary dressing
primary - direct contact with wound. secondary - directly over primary dressing to provide protection, absorption, and/or occlusion
282
selective debridement
remove only nonviable tissue from a wound. selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement
283
red-yellow-black tissue
red: protect wound, maintain moist environment, yellow: moist yellow slough. debride necrotic tissue and absorb drainage. black: debride necrotic tissue.
284
sharp debridement
requires use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound. most often used for wounds with large amounts of thick, adherent, necrotic tissue, also for cellulitis or sepsis. most expedient form of removing necrotic tissue. PTs are permitted to perform sharp debridement in the majority of states.
285
enzymatic debridement
topical application of enzymes to surface of necrotic tissue. can be used on infected and non-infected wounds with necrotic tissue. may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques. can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage
286
autolytic debridement
using body's own mechanisms to remove nonviable tissue. methods include transparent films, hydrocolloids, hydrogels and alginates. results in a moist wound environment that permits rehydration of the necrotic tissue and eschar and allows enzymes to digest the nonviable tissue. can be used with any amount of necrotic tissue and is non-invasive and pain free; however takes longer for wound healing to occur. should not be performed on infected wounds.
287
# Revered
develops from a long history of chronic bronchitis. alveolar walls present with significant pathology and air spaces are permanently over inflated. pink puffers. expiration is difficult. characterized as centrilobular, panlobular or paraseptal. symptoms include: dyspnea, chronic cough, orthopnea, barrel chest, increased use of accessory muscles, and increased RR.
emphysema
288
# Revered
lungs fail to fully expand due to a weakened diaphragm, structural inability of chest wall to expand, and a decrease in elasticity of lung tissue. symptoms include: shortness of breath, persistent non-productive cough, increased RR. results in a decrease in all lung volumes.
restrictive pulmonary disease
289
# Revered
bacterial infection that is transmitted by airborne fashion (coughing, sneezing, speaking). lungs are primarily involved, however TB can occur in kidneys, lymph nodes, and meninges. lesions in the lungs can be seen with x ray. symptoms: fatigue, weight loss, loss of appetite, low grade fever, productive cough, chest discomfort, and dyspnea. treatment includes anti-tb drug therapy. prevention of TB through immunization is recommended for children.
tuberculosis
290
# Revered
bronchodilator agents, inhaled corticosteriod agents, mucolytic agents, expectorant agents, antiasthmatic agents. examples: albuterol, serevent, epnephrine, vanceril, flovent, decadron, mucosil, plumozyne, guafenesin, terpin hydrate, intal, tilade
pharmacological intervention for pulmonary management
291
# Revered
...
transfers: levels of phys assistance
292
# Revered
patient does not require any assistance to complete task
independent
293
# Revered
patient requires therapist to observe throughout completion of task
supervision
294
# Revered
patient requires therapist to maintain contact with patient to complete task. usually needed to assist of there is a loss of balance
contact guard
295
# Revered
patient requires 25% assist from therapist to complete task
min assist
296
# Revered
patient requires 50% assist from therapist to complete task
mod assist
297
# Revered
patient requires 75% assist from therapist to complete task
max assist
298
# Revered
patient is unable to participate and therapist must provide all effort to perform task
dependent
299
# Revered
used to transfer patient from a stretcher to a bed or treatment plinth. 3 therapists carry patient in supine position. therapist at head usually gives commands.
3 person carry/lift
300
# Revered
used to transfer a patient btwn two surfaces of different heights or when transferring a patient to the floor.
2 person lift
301
# Revered
used to transfer a patient who cannot stand independently, but can bear some weight thru the trunk and LEs. therapist should position patient at a 45 degree angle to the destination surface. patient places UEs on therapist's shoulders, but should not pull on therapist's neck. should position patient at edge of surface, hold patient around hips and under butt, block patients knees in order to avoid buckling. therapist should utilize momentum, straighten his or her legs and raise patient or allow patient to remain squatting, and pivot and slowly lower patient to destination surface.
dependent squat pivot transfer
302
# Revered
used for a patient who has some sitting balance and some UE strength and can adequately follow directions. patient should be positioned at edge of w/c or bed and should lean to one side while placing one end of sliding board under proximal thigh. other end should be position on destination surface. use both arms to initiate a push up and scoot across board. therapist should guard in front of patient and assists as needed as patient performs a series of push ups across the board.
sliding board transfer
303
# Revered
used when a patient is able to stand and bear weight through one or both of LEs. must possess functional balance and ability to pivot.
stand pivot transfer
304
# Revered
...
wheelchair facts
305
# Revered
seat width: 18 inches, set depth: 16 inches, seat height: 20 inches
adult w/c specs:
306
# Revered
decreased seat height (17.5 inches) to allow for propulsion using the unaffected foot
hemi-height w/c
307
# Revered
can be positioned 2 inches posteriorly from normal for patients with amputations to increase the BOS and to compensate for diminished weight in front of w/c
rear wheel axles
308
# Revered
allow intermittent or constant reclined positioning
reclining w/c
309
# Revered
allow for reclined position without losing required 90 degrees of knee flexion. entire chair reclines without any anatomical changes in positioning.
tilt-in-space w/c
310
# Revered
seat height/leg length: 19.5 to 20.5 inches. measure from user's heel to popliteal fold and add 2 inches to allow clearance of foot rest.
standard w/c measurements for proper fit
311
# Revered
measure from user's bottom along lateral thigh to popliteal fold, then subtract approx 2 inches to avoid pressure from front edge of seat against popliteal space. 16 inches average.
seat depth
312
# Revered
measure the widest aspect of user's bottom or hips and add aprx 2 inches. will provide space for clothing and clearance of trochanters from armrest side panel. approx 18 inches is average.
seat width
313
# Revered
measure from seat of chair to floor of axilla with user's shoulder flexed to 90 and then subtract 4 inches. this will allow final back height to be below inferior angles of scapula. 16-16 1/2 inches average.
back height
314
# Revered
measure from seat of chair to olecranon process with user's elbow flexed to 90 and then add one inch. average usually 9 inches above chair seat.
armrest height
315
# Revered
parallel bars, walkers, axillary crutches, lofstrand crutches, canes
assistive devices
316
# Revered
proper fit includes bar height that allows for 20-25 degrees of elbow flexion while grasping bars approx four to six inches in front of body.
parallel bars
317
# Revered
can be used with all levels of weight bearing. should allow for 20-25 degrees of elbow flexion. used with 3 point gait pattern
walker
318
# Revered
all levels of weight bearing, but requires higher coordination for proper use. 6 inches in front, two inches out (lateral) to patient. crutch height should be adjusted no greater than 3 finger widths from axilla. handgrip height should be adjusted to ulnar styloid process and allow for 20-25 degrees of elbow flexion while grasping.
axillary crutches
319
# Revered
20-25 degrees of elbow flexion while holding handgrips with crutches 6 inches in front and 2 inches lateral. arm cuff should be positioned 1 to 1 1/2 inches below olecranon process so it does not interfere with elbow flexion
lofstrand (forearm) crutches
320
# Revered
provides minimal stability and support during ambulation, mainly for balance.
cane
321
# Revered
non weight bearing
NWB
322
# Revered
toe touch weight bearing
TTWB
323
# Revered
partial weight bearing
PWB
324
# Revered
weight bearing as tolerated
WBAT
325
# Revered
full weight bearing
FWB
326
# Revered
when patient uses 2 crutches or canes. moves left crutch forward while simultaneously advancing rt lower extremity ad vice versa.
2 point gait
327
# Revered
walker or crutches. injured lower extremity may have decreased weight bearing. AD is advanced followed by injured LE and then uninjured LE. AD and each LE are considered separate points
3 point gait
328
# Revered
each advancement of crutch or cane as well as LEs indicates a single point, used one at a time.
4 point gait
329
# Revered
patient with bilateral trunk and or LE weakness uses crutches or a walker and advances LEs at the same time only to point of AD.
swing to gait
330
# Revered
advances LEs thru AD
swing through
331
# Revered
monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. used to measure blood pressure or obtain blood samples. considered more accurate than traditional measures of blood pressure and does not require repeated needle punctures
arterial line
332
# Revered
applied over shaft of penis and is held in place by a padded strap or adhesive tape
external catheter
333
# Revered
indwelling urinary tract catheter that has a balloon attachment at one end. balloon which is filled with air or sterile water must be deflated before catheter can be removed
foley catheter
334
# Revered
indwelling urinary catheter that is surgically inserted directly into patient's bladder. insertion of a suprapubic catheter is performed under general anesthesia
suprapubic catheter
335
# Revered
soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site
swan-ganz catheter
336
# Revered
consists of a sterile fluid source, pump, clamp, and catheter to insert into a vein. can be used to infuse fluids, electrolytes, nutrients, and medication. IV lines are most commonly inserted into superficial veins such as basilic, cephalic, or antecubital.
intravenous system
337
# Revered
tubing extends into patient's nostrils approx 1 cm. oxgyen therapy can deliver up to 6 L of oxygen per min
nasal cannula
338
# Revered
plastic tube inserted thru a nostril that extends into stomach. commonly used for liquid feeding, medication administration or to remove gas from the stomach
nasogastric tube
339
# Revered
photoelectric device used to determine the oxygen saturation of blood. device is most commonly applied to finger or ear. often used to assess activity tolerance
oximeter
340
# Revered
inflammation and repair, pain, restriction in motion, and abnormal tone.
indications for therapeutic modalities
341
# Revered
inflammation (1-6 days), proliferative phase (day 3-day 20), maturation phase (day 9 - ongoing)
phases of tissue healing
342
# Revered
occurs secondary to trauma or disease. required for healing to occur. presents with calor, rubor, tumor, dolor. clot formation and phagocytosis occur
inflammation phase of tissue healing
343
# Revered
involves connective tissue and epithelial cells. epithelialization, collagen production, wound contracture, and neurovascularization occur
proliferative phase
344
# Revered
longest in duration, progression towards restoration of the prior function of injured tissues, collagen synthesis and lysis balance, collagen fiber orientation
maturation phase
345
# Revered
can occur during healing process when collagen production greatly exceeds collagen lysis. extends beyond original boundaries of an injury and damages healthy tissues.
keloid scar
346
# Revered
can occur during healing process when collagen production greatly exceeds collagen lysis. will be raised, but remain within borders of original injury
hypertrophic scar
347
# Revered
conduction, conversion, convection, evaporation, radiation
principles of heat transfer
348
# Revered
direct contact btwn 2 materials at different temperatures. ex: hot pack, paraffin, ice massage, cold pack
heat conduction
349
# Revered
air or water moving in a constant motion across body. ex: whirlpool
heat convection
350
# Revered
transfer of heat when nonthermal energy is absorbed into tissue and transformed into heat. ex: diathermy and ultrasound
heat conversion
351
# Revered
transfer of heat as a liquid absorbs energy and changes from to a vapor. ex: vapocoolant spray
heat evaporation
352
# Revered
direct transfer of heat from a radiation energy source of higher temperature to one of cooler temperature. directly absorbed without the need for a medium. ex: infrared lamp
heat radiation
353
# Revered
ex: ice massage, cold pack, cold bath, vapocoolant spray
cryotherapy
354
# Revered
initial decrease of blood flow to treated area, decreased temp, increase pain threshold, decrease metabolism, decrease edema, initial vasoconstriction, decrease nerve conduction velocity, decrease nerve conduction velocity, reduce spasticity of muscle, produce analgesic effects
cryotherapy's therapeutic effects
355
# Revered
acute or chronic pain, myofascial pain syndrome, muscle spasm, bursitis, acute or subacute inflammation, musculoskeletal trauma, reduction of spasticity, tendonitis
cryotherapy's indications
356
# Revered
compromised circulation, peripheral vascular disease, ischemic tissue, cold hypersensitivity, raynaud's phenomenon, cold urticaria, hypertension, infection, cryoglobinemia
cryotherapy contraindications
357
# Revered
intense cold within 3 mins, aching/burning sensation from 4-7 mins, anesthesia to analgesia from 8-15 mins, numbness from 15-30 mins
stages of perceived symptoms during cryotherapy
358
# Revered
5-10 min treatment time
ice massage
359
# Revered
requires a temp of 23 degrees. apply cold pack wrapped in moistened towel to area for 15 mins. application may extend to 30 mins but requires observation every 10 minutes (for spasticity) can be applied every one to two hours for reduction of inflammation and pain control.
cold pack
360
# Revered
used for immersion of distal extremities. water temp ranges from 55 to 64 degrees. immersed for 5 to 15 mins to attain desired effects
cold bath
361
# Revered
often used in conjunction with passive stretching. fluori-methane is a commonly used vapocollant spray that is typically applied from prox to distal muscle attachments.
vapocoolant sprays
362
# Revered
fluidotherapy, hot pack, infrared lamp, paraffin
superficial heating agents
363
# Revered
diathermy, ultrasound (and phonopheresis)
deep heating agents
364
# Revered
increase temp, increase blood flow to area, decrease nerve conduction latency, vasodilation, increase muscle elasticity, increase collagen extensibility, decreases tone
heating therapeutic effects
365
# Revered
pain control, chronic inflammatory conditions, trigger point, tissue healing, muscle spasm, decreased ROM, densensitization
heating indications
366
# Revered
circulatory impairment, area of malignancy, acute musculoskeletal trauma, bleeding, sensory impairment, thrombophlebities, arterial disease
heating contraindications
367
# Revered
container that circulates warm air and small cellulose particles. extremity is placed into container and dry heat is generated thru energy transferred by forced convection. promotes tissue healing and prevention of edema. body part should be placed into unit prior to turning machine on. temp should be set between 111-125 degrees. treatment time usually 20 minutes.
fluidotherapy
368
# Revered
effects include soft tissue healing, promoting relaxation, decreasing pain and stiffness. must be stored in hot water between 158-167 degrees. requires 6-8 towels around hot pack. require approx 20 minutes to achieve desire effects
hot pack
369
# Revered
produces superficial heating of tissue through radiant heat. form of heating is usually limited to penetration of less than one to three millimeters. use is declining due to risk of burns during treatment. patient should be positioned approx 20 inches from source. 20 inches in distance should equal 20 minutes of treatment. as distance decreases, intensity will increase and time of total treatment should decrease.
infrared lamp (IR)
370
# Revered
most commonly used superficial heating agent of distal extremities. temp should be between 113-126 degrees. dip patient's hand and wrap with plastic bag with a towel around it to insulate and maintain heating for approx 15-20 mins.
paraffin wax
371
# Revered
converts high frequency electromagnetic energy into therapeutic heat. produces vibration of molecules within a specific tissue, generates heat and elevates tissue temperature. main therapeutic effect is enhancement of soft tissue healing. can be delivered in continuous or pulsed mode. pulsed mode is usually used for thermal effects at 27.12 MHz.
diathermy
372
# Revered
low back, abdomen, pelvis of a pregnant woman, internal and external metal objects, eyes, malignant area, intrauterine device, cardiac pacemaker, pain and temp sensory deficits, moist wound dressing, testes, acute inflammation, ischemic tissue
contraindications for diathermy
373
# Revered
inductive application: wrap coils around extremity that has been covered by a towel, place drum over treatment area. patient must remain in same position throughout treatment. treatment time varies from 15-30 mins.
diathermy parameters
374
# Revered
common deep heating agent that transfers heat through conversion. elevates tissue temp to depths up to 5 cms, and uses inaudible acoustic mechanical vibrations of high frequency to produce thermal and nonthermal effects. crystal transducer converts electrical energy into sound.
ultrasound
375
# Revered
thermal: increase extensibility of collagen structure, decrease joint stiffness, pain relief, increase blood flow, decrease muscle spasm
ultrasound therapeutic effects
376
# Revered
nonthermal: stimulation of tissue regeneration, pain relief, soft tissue repair, increase blood flow,
ultrasound therapeutic effects (nonthermal)
377
# Revered
soft tissue repair, contracture, bone fracture, trigger point, dermal ulcer, scar tissue, pain, plantar wart, muscle spasm
indications for u/s
378
# Revered
over eyes, over pregnant uterus, over cemented prosthetic joint, impaired circulation, impaired pain or temp sensory deficits, over heart, over testes, over epiphyseal areas in children, infection, over malignancy
contraindications for u/s
379
# Revered
place transducer over area before turning on machine (and gel already applied to head). move in small circular pattern over treatment area. maintain contact with skin and stay within treatment area. an area two to three times the size of the transducer typically requires a duration of five minutes of treatment. intensity for continuous u/s is normally set btwn .5 to 2 w/cm2 for thermal effects. pulsed u/s is normally set between .5 to .75 w/cm2 with a 20% duty cycle for nonthermal effects
u/s treatment parameters
380
# Revered
beam nonuniformity ratio: ratio of intensity of highest peak to average intensity of all peaks. lower BNR, more favorable, since most patients will be less likely to experience hot spots and or discomfort during treatment. BNR values should range btwn 2:1 and 6:1, most devices often fall in 5:1 or 6:1 range.
BNR
381
# Revered
effective radiating area. area of transducer that transmits u/s energy. always smaller than total size of transducer head.
ERA
382
# Revered
occurs as a result of acoustic energy generated by u/s that develops into microscopic bubbles causing cavities that surround soft tissues. the bubbles expand and contract.
acoustic cavitation
383
# Revered
stable cavitation: microscopic bubbles increase and decrease in size but do not burst. triggers microsteaming. transient (unstable) cavitation: microscopic bubbles increase in size over multiple cycles and implode. this causes brief moments of local temperature ad pressure increases in area surrounding those bubbles. process should not occur during therapeutic u/s since intensities required are much higher than 3 w/cm2.
2 types of cavitation that occur:
384
# Revered
minute flow of fluid that takes place around vapor-filled bubbles that oscillate and pulsate
microsteaming
385
# Revered
term for the consistent and circular flow of cellular fluids that results from u/s. responsible for altering cellular activity and the transport of fluids to different portions of the field.
acoustic streaming
386
# Revered
use of u/s for transdermal delivery of medication. u/s enhances the distribution of medication through the skin, provides a high concentration of the drug directly to the treatment site and avoids risks that may be involved with injection of medication. medications regularly used in phonophoresis include anti-inflammatory agents or analgesics. effective with both continuous and pulsed techniques.
phonophoresis
387
# Revered
the internal and external use of water in the treatment of disease. transfers heat thru conduction or convection and is administered in tanks of varying sizes. main therapeutic effects: wound care, unloading of weight, and reduction of edema.
hydrotherapy
388
# Revered
(archmides): there is an upward force on body when immersed in water equal to amount of water that has been displaced by the body. ability to float in water results from the body possessing a specific gravity less than that of water.
buoyancy
389
# Revered
water exerts pressure that is perpendicular to the body and increases in proportion with the depth of immersion
hydrostatic pressure
390
# Revered
water molecules tend to attract to each other and provide resistance to movement of the body in the water. resistance by water increases in proportion to speed of motion.
resistance
391
# Revered
computation for specific gravity of water is equal to 1. human body varies based on size and somatotype but typically has a specific gravity of less than 1 (average .974). therefore, a personal will generally float when fully submerged in water.
specific gravity
392
# Revered
measure of the ability of a fluid to store heat. calculated as amount of thermal energy required to increase fluid's temp by one unit. water can store 4 times the heat as compared to air. water's thermal conductivity is approx 25 times faster than air at the same temp.
specific heat
393
# Revered
comprised of profile drag, wave drag and surface drag forces. is a hydromechanic force exerted on a person submerged in water that normally opposes the direction of the body's motion.
total drag force
394
# Revered
increase blood flow, increase core temp, relaxation, pain relief, vasodilation, decrease abnormal tone, wound/debridement
therapeutic effects of hydrotherapy:
395
# Revered
burn care, superficial heating or cooling, edema control, muscle strain, arthritis, desensitization of residual limb with contrast bath, pain management, wound care, decreased ROM, pool therapy/exercise, sprain, joint stiffness, muscle spasm/spasticity
indications for hydrotherapy:
396
# Revered
peripheral vascular disease, gangrene, severe infection, urinary/fecal incontinence, advanced cardiov or pulm disease, buerger's disease w/contrast bath, impaired circulation, renal infection, bleeding surface area, diminished sensation
contraindication for hydrotherapy:
397
# Revered
extremity tank, lowboy tank, highboy tank, hubbard tank, therapeutic pool
types of hydrotherapy
398
# Revered
32-79 degrees: acute inflammation of distal extremities, 79-92 degrees: exercise, 92-96: wound care, spasticity, 96-98: cardiopulmonary compromise, treatment of burns, 99-104: pain management, 104-110: chronic rheumatoid or osteoarthritis, increased ROM
treatment temps for water
399
# Revered
treatment time ranges from between 10 and 30 mins. select water temp based on diagnosis and goals and assist pt into comfortable position, monitor vital signs and level of comfort.
treatment parameters for whirlpool
400
# Revered
general contraindications for superficial or deep heating, including incontinence, open areas, fear of water, confusion, and significant respiratory pathology. recommended populations for pool therapy include patients with arthritis, musculoskeletal injuries, neuro deficits, sci, cva, ms, and selected cardiopulmonary diagnoses. tank must be cleaned after each use with a disinfectant and antibacterial agent.
treatment parameters for pool therapy
401
# Revered
modality that applies mechanical forces to body to separate joint surfaces and decrease pressure. force can be applied manually by therapist or mechanically by a machine.
mechanical agent: traction
402
# Revered
joint distraction, soft tissue stretching, muscle relaxation, reduction of disk protrusion, joint mobility
therapeutic effects of traction
403
# Revered
nerve impingement, herniated or protruding disc, subacute joint inflammation, spondylolisthesis, joint hypomobility, paraspinal muscle spasm, degenerative joint disease, osteophyte formation
indications for traction
404
# Revered
when motion is contraindicated, joint instability, tumor, pregnancy, acute inflammatory response, acute sprain, osteoporosis, fracture
contraindications for traction
405
# Revered
treatment time is 5-20 mins. cervical: pt supine with approx 25-35 degrees of neck flexion, should start with a force btwn 10-15 lbs and progress to 7% of pt's body weight as tolerated for separation of vertebrae. lumbar can be supine or prone, and should be set with a force of less than half body weight for initial treatment. traction force of 25-50 lbs is recommended when initiating mechanical lumbar traction. force of up to 50% of body weight is required for actual separation of the vertebrae.
treatment parameters for traction
406
# Revered
physical agent that applies a mechanical force to increase pressure on treated body part. works to keep venous and lymphatic flow from pooling into interstitial space. static compression utilizes bandaging and compression garments to shape residual limbs, control edema, prevent abnormal scar formation, and reduce risk of dvt. intermittent compression with a pneumatic device is used to reduce edema.
compression
407
# Revered
control of peripheral edema, shaping of residual limb, management of scar formation, improve lymphatic and venous return, and prevention of DVT
therapeutic effects of compression
408
# Revered
lymphedema, new res limb, risk for DVT, edema, stasis ulcers, hypertrophic scarring
indications for compression
409
# Revered
malignancy of treated area, DVT, unstable or acute fracture, heart failure, infection of treated area, pulm edema, circulatory obstruction
contraindications for compression
410
# Revered
therapist should measure girth and bp. therapist should set parameters based on desire effect. stockinette should be put over extremity and then compression sleeve. 3:1 ratio is generally used for on/off time with inflation btwn 40 to 100 seconds and deflation btwn 10-35 seconds. inflation pressure generally ranges from 30-80 mm Hg and should not exceed patient's diastolic bp. treatment of upper extremities generally requires btwn 30 and 60 mm Hg of inflation pressure while treatment of LEs requires btwn 40 and 80 mm Hg of inflation pressure. treatment time varies for diagnosis, from 2-4 hours and is utilized from 3 x per week to 3 x per day. when treatment time is up, therapist should reassess extremity and remeasure girth and bp
treatment parameters
411
# Revered
form of energy that is used therapeutically and absorbed one to two millimeters into the skin. divided into UV-A and UV-B, and UV-C. most effective use of UV is to treat skin disorders
UV: ultraviolet light
412
# Revered
facilitate healing, exfoliation, Vit D production, increase pigmentation, tanning
therapeutic effects of UV
413
# Revered
acne, psoriasis, tetany, Vit D deficiency, chronic ulcer/wound, osteomalacia/rickets, sinusitis
indications for UV
414
# Revered
photosensitive meds, lupus erythematosus, tb, herpes, renal or hepatic pathology, DM, pellagra
contraindications for UV
415
# Revered
therapist must obtain a minimal erythemal dose before treatment (MED). this is the time of exposure needed to produce an area of mild redness btwn 8 and 24 hours after treatment. MED is tested by paper cutouts on forearm and therapist should wear goggles. squares on skin should be exposed in 15 sec increments for 15, 30, 45, 60 and 75 seconds and inspected after an 8 hr period to determine MED. treatment time should increase each consecutive treatment day since skin adapts to the UV exposure.
treatment parameters for UV
416
# Revered
manual therapeutic modality that produces physiologic effects through stroking, rubbing, and pressure.
massage
417
# Revered
light in stroke and produces a reflexive response. performed at beginning and end of massage to allow patient to relax and should be directed towards the heart.
effleurage
418
# Revered
incorporates small circular motion over a trigger point or muscle spasm. deep massage technique that penetrates into the depth of a muscle and attempts to reduce edema, loosen adhesions, and relieve muscle spasm. used with chronic inflammation or with overuse injuries
friction
419
# Revered
kneading where muscle is squeezed and rolled under therapist's hands. distal to proximal sequence of kneading over muscle. can be performed with 2 hands over larger muscle groups or with as few as two fingers over smaller muscles.
petrissage
420
# Revered
provides stimulation through rapid and alternating movements such as tapping, hacking, cupping, and slapping. purpose is to enhance circulation and stimulate peripheral nerve endings
tapotement
421
# Revered
places hands or fingers firmly over area and uses a rapid shaking motion that causes vibration to treatment area. used primarily for relaxation.
vibration
422
# Revered
increases lymphatic circulation, removal of metabolic waste, decrease muscle atrophy, decrease anxiety and tension, facilitate healing, stimulate reflexive effects, reduction of edema, loosen adhesions, decrease muscle spasm
therapeutic effects of massage
423
# Revered
pain, decreased ROM, edema, adhesions, myositis, lactic acid excess, migraine, trigger point, muscle spasm and cramping, scar tissue, bursitis, tendonitis, intermittent claudication, raynaud's syndrome
indications for massage
424
# Revered
infection, arterioscelrosis, thrombus, cellulitis, acute injury, embolus, cancer.
contraindications for massage
425
# Revered
used for facilitation of skeletal muscle contraction, stimulation of denervated muscle, pain management, to retard muscle atrophy, osteogenesis, driving medications through the skin, and wound management
electrotherapy
426
# Revered
cardiac pacemaker, patient with a bladder stimulator, over carotid sinus, seizure disorders, phlebitis, malignancy, over a pregnant uterus, cardiac arrhythmia, osteomyelitis
contraindications
427
# Revered
techniques include: monopolar, bipolar, and quadripolar
electrode configuration
428
# Revered
active (smaller) electrode is placed over target area. second dispersive electrode is placed at another site away from the target area. used for wounds, iontophoresis, and treatment of edema
monopolar
429
# Revered
2 active electrodes are placed over target area. electrodes usually same size. used for muscle weakness, neuromuscular facilitation, spasms, and ROM
bipolar
430
# Revered
2 electrodes from 2 separate stimulating circuits are positioned so that the individual currents intersect with each other. utilized with interferential current.
quadripolar
431
# Revered
when using a smaller electrode it is particularly important to understand that since the current density is quite high compared to a larger electrode, the patient will be more susceptible to pain and potential tissue damage.
electrode size
432
# Revered
increased current density, increased impedance, decreased current flow
small electrodes
433
# Revered
decreased current density, decreased impedance, increased current flow
large electrodes
434
# Revered
pain management, urinary incontinence, edema management, osteoarthritic pain, migraines
estim indications
435
# Revered
malignancy, with all types of electrical implants, during first trimester of pregnancy, over lower abdomen/uterus during pregnancy, over anterior transcervical area
estim contraindication
436
# Revered
also known as galvanic, constant flow of electrons from anode to cathode without interruption. iontophoresis uses direct current
direct current
437
# Revered
polarity that changes from positive to negative with change in direction of current flow. biphasic, symmetrical or asymmetrical, and is a waveform that is sinusoidal in shape. used in muscle retraining, spasticity and stimulation of denervated muscle
alternating current
438
# Revered
combines two high frequency alternating waveforms that are biphasic. used for deep muscle stimulation. attempts to reach deeper tissues using higher frequencies of each waveform along with overall shorter pulse widths. uses a frequency of 50-1250 pps and a pulse width of 50-150 microseconds for pain management; and a frequency of 20-50 pps and pulse width of 100-200 microseconds for muscle contractions
interferential current
439
# Revered
medium frequency polyphasic waveform. alternating current is produced in a 50 burst per second interval with a pulse width range of 50-200 microseconds, and an interburst interval of 10 milliseconds. type of NMES or FES and is believed to augment muscle strengthening by depolarizing both sensory and motor nerve fibers resulting in tetanic contractions that are painless and stronger than those made voluntarily by the patient. electrode should be placed parallel to muscle fibers along line of pull of muscle group.
russian current
440
# Revered
average peak current amplitude of 100 mA, 50 bursts per second, with on/off time ration of 10/50. usually is done 10 evoked contractions with a 10 second contraction and a 50 second rest period between each of the 10 contractions.
russian stim parameters
441
# Revered
neuromuscular electrical stimulation: used to facilitate skeletal muscle activity. stim of an innervated muscle occurs when an electrical stimulus of appropriate intensity and duration is administered to the corresponding peripheral nerve. commonly used to facilitate return of controlled functional muscular activity or to maintain postural alignment until recovery occurs.
NMES
442
# Revered
bipolar electrode placement over muscle. interrupted current is used with a range of 20-40 pulses per second an on time of 6-10 secs followed by off time of approx 50-60 secs. 15-20 mins for several times a day
NMES parameters
443
# Revered
widely used for acute and chronic inflammation. main effects of TENS include pain relief through gate control theory. used for home use and is portable.
TENS: transcutaneous electrical nerve stimulation
444
# Revered
cardiac pacemakers, epilepsy, during 1st trimester
TENS contraindications
445
# Revered
conventional, acupuncture like, pulse burst, and brief intense (high-intensity)
TENS Parameters
446
# Revered
frequency: 50-100 Hz, duration: 20-100 microseconds, amplitude: 10-30 mA
conventional TENS
447
# Revered
frequency: 1-4 Hz, 100-200 microseconds, amplitude: 30-80 mA
acupuncture like TENS
448
# Revered
frequency: 70-100 Hz/burst, duration: 40-75 microseconds, amplitude: 30-60 mA
pulse burst
449
# Revered
frequency: 70-100 Hz/burst, duration: 150-200 microseconds, amplitude: 30-60 mA
brief intense (high intensity)
450
# Revered
electrodes may be placed on sites of nerve roots, trigger points, acupuncture sites or key points of pain and sensitivity. net polarity is normally equal to zero. if waveform is unbalanced, there will be an accumulation of charges that will lead to skin irritation under the electrodes. includes a pulse duration that can vary from 20-400 microseconds; pulse frequency that varies in range from 1-200 Hz, and current amplitude from .1-120 mA.
TENS guidelines
451
# Revered
process by which medications are induced through the skin into the body by means of continuous direct current electrical stimulation. medication is separated into ions based on the polarity of the current.
iontophoresis
452
# Revered
acidic reaction can cause hardening of skin. alkaline reaction can cause skin to soften over time.
acidic/alkaline reaction
453
# Revered
technique used to stabilize the pH of skin during ionto by placing buffering agents into electrode pads that cover drug reservoir area within the electrode
buffering
454
# Revered
decomposition of a compound that results from passing an electrical current through it
electrolysis
455
# Revered
occurs during ionto where there is an exchange btwn ions within solutions and electrodes
electron exchange
456
# Revered
decomposition of water when electrical current is passed through it. water will be reduced to a net accumulation of hydrogen ions (H+) under anode and hydroxyl ions (OH-) under the cathode.
redox reaction
457
# Revered
pt should never lie on top of electrodes. unit should be set to continuous direct current. polarity must be set to same polarity as ion solution. ion solution should be massaged into treatment site or space within electrode. conductive surface area of the negative electrode (cathode) is twice the size of the conductive surface area of the positive electrode (anode) regardless of which on is the active electrode. active electrode must be placed over target area the the dispersive electrode should be placed as far as possible from active electrode. slowly increase intensity towards a max of five milliamperes. treatment should last 15-20 mins. additional time is required for treatment at an intensity of less than five milliamperes.
iontophoresis parameters
458
# Revered
positive charge: lidocaine, hydrocortisone, histamine, lithium, magnesium, zinc. negative charge: acetate, dexamethasone, salicylate, iodine, chlorine, tap water (+ and -)
therapeutic ions and charge
459
# Revered
high voltage pulsed current: twin peak monophasic, pulsed current. produces high electromotive forces. has a phase duration of 5-20 microsecs (fixed in most machines), a short pulse duration that ranges btwn 100-200 microsecs, and voltage greater than 150V to a max of 500V. one large dispersive pad along with one, two or four active electrodes. active electrodes can be positive or negative in polarity based on treatment goals.
hvpc
460
# Revered
wound management, pain management, soft tissue edema, levator ani syndrome, muscle spasm, muscle weakness, bell's palsy
indications for hvpc
461
# Revered
cardiac pacemakers, over heavy scarring tissues, malignancy, pregnancy
contraindications for hvpc
462
# Revered
secure one electrode over wound (using warm sterile gauze and sponge) and other over healthy skin a min of 5 cm from wound itself. polarity should be in reversal mode so that it allows for 50% of treatment with positive polarity. frequency is generally 30-200 pps, amplitude 1-500V, and duration of treatment from 10-60 mins per session. dermal wounds should be treated 5-7 days per week for best results
hvpc parameters
463
# Revered
science of evaluating motor units (anterior horn cell, axon, neuromuscular junctions and muscle fibers innervated by unit) through use of intramuscular needle electrodes or surface electrodes. potentials include abnormal: spontaneous and voluntary.
electromyography
464
# Revered
modality that uses an electromechanical device to provide visual and or auditory feedback. can be utilized to receive information related to motor performance, kinesthetic performance or physiological response. can measure peripheral skin temp, changes in blood volume thru vasodilation and vasoconstriction using finger phototransmission, sweat gland activity, and electrical activity during muscle contraction. electromyographic feedback is the most commonly used biofeedback modality in clinical setting.
biofeedback
465
# Revered
muscle activity, heart rate, balance, skin temp, bp, posture, abnormal mvmt, normal mvmt
biofeedback measures:
466
# Revered
myoelectric/electromyographic biofeedback, EMG-BF, position biofeedback, bp biofeedback, respiratory bioFB, sphincter control biofb, temp and blood flow bioFB, electroencephalographic bioFB
types of feedback
467
# Revered
muscle relaxation, improve muscle strength, decrease muscle spasm, neuromuscular control, decrease accessory muscle use, decrease pain
biofeedback therapeutic effects
468
# Revered
muscle spasm, pain, sci, urinary incontinence, improve neuromuscular control, muscle weakness, hemiplegia, cp, bowel incontinence, promote relaxation
biofeedback indications
469
# Revered
any condition where muscle contraction is detrimental, skin irritation at electrode site
biofeedback contraindications
470
# Revered
2 active electrodes and 1 ground electrode in a bipolar arrangement best deletes "noise" (noise is any extraneous electrical activity not produced by the contraction of the muscle). surface electrodes with some form of conduction gel are required to adhere to prepared, clean skin. electrodes should be placed parallel to direction of the muscle fibers, set level of sensitivity on device relative to treatment goals: low level sensitivity settings for muscle re-education, high level sensitivity setting for relaxation
biofeedback treatment guidelines
471
# Revered
2 active electrodes should be placed parallel to muscle fibers and close to each other. reference or ground electrode can be placed anywhere on the body, but is often secured between 2 active electrodes. signals are transmitted to a differential amplifier and info is conveyed thru visual and audio feedback. for muscle re-education, should begin with pt performing a max muscle contraction. sensitivity of bfb unit should be set at a low sensitivity setting and adjusted so that the pt can perform reps at a ratio of 2/3rds of max muscle contraction. isometric contractions should continue for 6-10 secs with relaxation in btwn each contraction. treatment duration for a single muscle group is 5-10 mins. treatment for muscle relaxation requires a high sensitivity setting and a similar electrode placement with active electrodes initially positioned close to each other. as patient improves with relaxation, electrodes should be placed further apart and sensitivity setting increased. during this treatment, patient may also benefit from adjunct relaxation techniques such as imagery. treatment duration of 10-15 mins is usually adequate to attain relaxation.
biofeedback treatment parameters
472
# Revered
ground fault circuit interrupter: designed to cut off electrical supply to a piece of equipment if it detects any form of leakage or ground fault.
gfci:
473
# Revered
...
electrotherapy terms
474
# Revered
an occurrence where a nerve and muscle membrane's threshold for excitability increases secondary to a stimulation by a pulse that has a slow phase rise time. the quicker the rise time, the less the nerve can accommodate to the impulse.
accommodation
475
# Revered
alternating current allows for the constant change in flow of ions
alternating current (biphasic)
476
# Revered
unit of measure used to describe rate of current
ampere
477
# Revered
magnitude of current. often labeled intensity or voltage.
amplitude
478
# Revered
positively charged electrode that attracts negative ions
anode
479
# Revered
negatively charged electrode that attracts positive ions
cathode
480
# Revered
pulse that moves in one direction, returns to baseline, then in other direction and back to baseline again within a predetermined amount of time.
biphasic
481
# Revered
symmetrical: positive phase is identical to negative phase, asymmetrical: positive phase and negative phase are not identical in shape, balanced: positive phase's electrical charge is equal to negative phase's electrical charge, unbalanced: positive phase and negative phase do not have identical electrical charges
types of biphasic pulse
482
# Revered
interrupted group of pulses that are delivered in a finite series and a predetermined frequency
burst
483
# Revered
property of an insulator that allows for the storage of energy when opposing surfaces of the insulator have an electrical potential difference
capacitance
484
# Revered
testing procedure used to measure amount of time required to produce a small muscle contraction at a particular intensity
chronaxie
485
# Revered
ease at which a particular material will allow current flow (mho)
conductance
486
# Revered
flow electrons from one place to another
current
487
# Revered
constant unidirectional flow of ions. dependent on polarity
direct current (monophasic)
488
# Revered
time period of stimulation and time period of rest btwn periods of stimulation.
duration of stimulus/duration of rest
489
# Revered
percentage of time that electrical current is on in relation to entire treatment time.
duty cycle
490
# Revered
resistance of a tissue to electrical current
electrical impedance
491
# Revered
determines number of pulses delivered through each channel per second. often labeled "rate"
frequency
492
# Revered
characterized by a waveform greater than 150 volts with a short pulse duration. is intermittent and is used for deeper tissue penetration
high volt current
493
# Revered
property of a substance that provides resistance to flow of current by offering an alternate current
impedance
494
# Revered
how easily a certain material will induce an electromotive force (emf) within a circuit
inductance
495
# Revered
period of time of electrical inactivity btwn each pulse, usually expressed in microsecs or millisecs
interpulse interval
496
# Revered
positively or negatively charged atome
ion
497
# Revered
waveform of less than 150 volts and is used for neuromuscular stimulation
low volt current
498
# Revered
pulse that has either a positive or negative polarity and moves in only one direction from a zero baseline and returns to baseline within a predetermined amount of time
monophasic
499
# Revered
gained one or more electrons and possesses a negative charge
negative ion
500
# Revered
current of an electrical current. there is a direct proportional relationship btwn current and voltage and an indirect proportional relationship btwn current and resistance
ohm's law
501
# Revered
lost one or more electrons and possesses a positive charge
positive ion
502
# Revered
pulse is one individual waveform
pulse
503
# Revered
amount of time that it takes to complete all phases of a single pulse. often labeled "pulse width"
pulse duration
504
# Revered
allows for a non-continuous flow of either alternating or direct current with periods of no electrical activity
pulsed current (interrupted)
505
# Revered
refers to number of seconds it takes for amplitude to gradually increase or decrease to the max value set by amplitude control
ramp
506
# Revered
ability of a material to oppose the flow of ions through it
resistance
507
# Revered
minimal intensity used with a long current duration that produces a small muscle contraction
rheobase
508
# Revered
unit of measure of electrical power or electromotive force
volt
509
# Revered
consistent pattern of a current measured on an oscilloscope
waveform
510
# Revered
...
clinical application templates executive summaries
511
# Revered
usually one to two inches above tendinous insertion on calcaneous, greatest btwn 30-50 yrs of age, typically be unable to stand on their toes and tend to exhibit a positive Thompson test
achilles tendon rupture
512
# Revered
occurs more in middle-aged population, greater incidence in women, arthrogram can assist with dx by detecting decreased volume of fluid within the joint capsule, ROM restriction typically in a capsular pattern (lateral rotation, abduction, medial rotation)
adhesive capsulitis
513
# Revered
risk is higher in males, usually occurs between 40-70, clinical presentation may include both upper and lower motorneuron involvement with weakness occurring in a distal to prox progression, average course of dx is 2-5 yrs with only 20-30% of patients surviving longer than five years
amyotrophic lateral sclerosis
514
# Revered
systemic condition, inflammation of spine and larger peripheral joints, males greater risk btwn 20-40, presentation initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension
ankylosing spondylitis
515
# Revered
most commonly occurs during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position, females involved in selected sports have higher ligament injury rates, approx 2/3 of time acl is completely torn, there is an associated meniscal tear
anterior cruciate ligament sprain
516
# Revered
increased incidence of injury is associated with selected sports such as baseball pitching, swimming, rowing, gymnastics, and tennis; characterized by subjective reports of a deep ache directly in front and on top of the shoulder made worse with overhead activities or lifting, examination may reveal a positive speed's test or yergason's test
bicipital tendonitis
517
# Revered
incidence is higher in females with most common age being from 35-55, muscle atrophy is often noted in abductor pollicis brevis muscle and later in the thenar muscles; electromyography studies, tinel's sign, and phalen's test can be used to assist with confirming diagnosis
carpel tunnel syndrome
518
# Revered
spastic cp involves upper motor neuron damage; athetoid cp involves damage to cerebellum, cerebellar pathways or both; clinical presentation includes motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance impairments; mental retardation and epilepsy are present in 50-60% of children diagnosed with cp.
cerebral palsy
519
# Revered
types include ischemic (thrombus, embolus, lacunar) and hemorrhagic stroke (intracerebral, subdural, subarachnoid), left CVA may present with weakness or paralysis to rt side, impaired processing, heightened frustration, aphasia, dysphagia, and motor apraxia. right cva may present with weakness or paralysis to left side, poor attention span, impaired awareness and judgment, spatial deficits, memory deficits, emotional lability, and impulsive behavior
cva: cerebrovascular accident
520
# Revered
etiologies include arrhythmia, pulm embolism, hypertension, valvular heart disease, myocarditis, unstable angina, renal failure, severe anemia;
chf: congestive heart failure
521
# Revered
causes exocrine glands to overproduce thick mucus which causes subsequent obstruction, autosomal recessive genetic disorder located on long arm of chromosome seven, terminal disease but death age has increased to 32 yrs due to early detection and management
cystic fibrosis
522
# Revered
caused by weakening of joints that allows for forward slippage of one vertebral segment on one below due to degenerative changes, most common site is L4/L5, william's flexion exercises may be indicated to strengthen abs and reduce lumbar lordosis
degenerative spondylolisthesis
523
# Revered
insulin is functionally absent due to destruction of beta cells of pancreas; where insulin would normally be produced. starts in children ages 4 or older, adolescense. symptoms include polyuria, polydipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration
diabetes mellitus (type 1)
524
# Revered
clinical presentation: hypotonia, flattened nasal bridge, simian line (palmar crease), epicanthal folds, enlargement of tongue and dd.
down syndrome
525
# Revered
x linked recessive trait manifesting in only male offspring while female offspring become carriers. waddling gait, prox muscle weakness, toe walking, pseudohypertrophy of calf and difficulty climbing stairs. rapid progression of this disease with inability to ambulate by ten to 12 yrs of age with death occurring as teenager or less frequently in the 20's.
duchenne muscular dystrophy
526
# Revered
nonarticular rheumatic condition with pain caused by tender points within muscles, tendons, and ligaments. pain exists in all 4 quadrants of body and there is pain in at least 11 of 18 standardized tender point sites
fibromyalgia
527
# Revered
burn causes immediate cellular and tissue death and subsequent vascular destruction, eschar forms from necrotic cells and creates a dry and hard layer that requires debridement. absent sensation and pain due to destruction of free nerve endings
full thickness burns
528
# Revered
motor weakness in a distal to prox progression, sensory impairment, and possible respiratory paralysis. may be an autoimmune response to a previous respiratory infection, flu, immunization or surgery. patients usually have full recovery
guillain barre syndrome
529
# Revered
chronic progressive genetic disorder that is fatal within 15 to 20 yrs after clinical manifestation. degeneration and atrophy of basal ganglia (stiatum) and cerebral cortex w/in brain. clinically presents with enlarged ventricles secondary to atrophy of basal ganglia, mental deterioration, speech disturbances and ataxic gait
huntingtons disease
530
# Revered
autoimmune disorder found in children less than 16 that occurs when immune cells mistakenly begin to attack the joints and organs causing local and systemic effects. girls more likely than boys. symptoms include joint swelling, pain, stiffness
juvenile rheumatoid arthritis
531
# Revered
inflammation or degenerative changes at common extensor tendon that attaches to lateral epicondyle of elbow. repeated overuse of wrist extensors. clinical symptoms include difficulty holding or gripping objects and insufficient forearm functional strength
lateral epicondylitis (tennis elbow)
532
# Revered
consists of dermal and epidermal layers, air follicles, nails, sebaceous glands, sweat glands
integumentary system
533
# Revered
true skin: well vascularized, elastic, flexible and tough.
dermis
534
# Revered
avascular, consists of outermost layer of skin
epidermis
535
# Revered
occur secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis
arterial insufficiency ulcers
536
# Revered
occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration
venous insufficiency ulcers
537
# Revered
decubitus ulcer: results from sustained or prolonged pressure at levels greater than the level of capillary pressure on the tissue
pressure ulcer
538
# Revered
secondary complication usually associated with a combination of ischemia and neuropathy. most often associated with diabetes. frequently found on plantar surface of foot, often beneath the metatarsal heads. wound has good granulation tissue and little or no drainage. often do not report pain due to altered sensation
neuropathic ulcer
539
# Revered
lower one third of leg, toes, web spaces. smooth edges, well defined, lack of granulation tissue, tend to be deep. severe pain, diminished or absent pedal pulses, normal edema, decreased skin temperature, thin and shiny tissue, hair loss, yellow nails. leg elevation increases pain.
arterial ulcers
540
# Revered
proximal to the medial malleolus, irregular shape, shallow, mild to moderate pain, normal pedal pulses, increased edema, normal skin temp, flaky, dry skin, leg elevation lessens pain
venous ulcers
541
# Revered
cleansing the ulcer, rest, reducing risk factors, limb protection
intervention for arterial insufficiency ulcer
542
# Revered
cleansing the ulcer, compression to control edema
intervention for venous insufficiency ulcer
543
# Revered
gel forming polymer such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. absorb exudate by swelling into a gel like mass and vary from being occlusive to semi permeable. does not attach to actual wound itself and is instead anchored to intact skin surrounding the wound.
hydrocolloid dressing
544
# Revered
useful for partial and full thickness wounds. can be effective with granular or necrotic wounds
when to use hydrocolloids
545
# Revered
moist environment for wound healing, enables autolytic debridement, offers protection from microbial contamination, provides moderate absorption, does not require a secondary dressing, provides a waterproof surface
advantages to hydrocolloids
546
# Revered
may traumatize surrounding intact skin upon removal, may tend to roll in areas of excessive friction, cannot be used on infected wounds
disadvantages to hydrocolloids
547
# Revered
consist of varying amounts of water and varying amounts of gel-forming materials such as glycerin, dressings are available in sheet form or amorphous form
hydrogels
548
# Revered
commonly used on superficial and partial thickness wounds (abrasions, blisters, pressure ulcers) that have minimal drainage. rather than absorb drainage, hydrogels are moisture retentive
when to use hydrogels
549
# Revered
provides a moist environment for wound healing, enables autolytic debridement, may reduce pressure and diminish pain, can be used as a coupling agent for ultrasound, minimally adheres to wound
advantages to hydrogels
550
# Revered
potential for dressings to dehydrate, cannot be used on wounds with significant drainage, typically requires a secondary dressing
disadvantages to hydrogels
551
# Revered
composed from a hydrophilic polyurethane base. hydrophilic at wound contact surface and are hydrophobic on the outer surface. allows exudates to be absorbed into the foam through the hydrophilic layer. most commonly available in sheets or pads with varying degrees of thickness.
foam dressings
552
# Revered
used to provide protection over partial and full thickness wounds with varying levels of exudate. can be used as secondary dressings over amorphous hydrogels
when to use foam dressings
553
# Revered
provides a moist environment for wound healing, available in adhesive and nonadhesive forms, provides prophylactic protection and cushioning, encourages autolytic debridement, provides moderate absorption
advantages to foam dressings
554
# Revered
may tend to roll in areas of excessive friction, adhesive form may traumatize periwound area upon removal, lack of transparency makes inspection of wound difficult
disadvantages to foam dressings
555
# Revered
film dressings are thin membranes made from transparent polyurethane with water resistant adhesives. permeable to vapor and oxygen, but are mostly impermeable to bacteria and water. highly elastic, conform to a variety of body contours, and allow easy visual inspection of the wound since they are transparent.
transparent film
556
# Revered
useful for superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.
when to use transparent films
557
# Revered
provides a moist environment for wound healing, enables autolytic debridement, allows visualization of the wound, resistant to shearing and frictional forces, cost effective over time
advantages to transparent films
558
# Revered
excessive accumulation of exudates can result in periwound maceration, adhesive may traumatize periwound area upon removal, cannot be used on infected wounds
disadvantages to transparent films
559
# Revered
most readily available used in inpatient environment. commonly used on infected or non-infected wounds of any size. can be used for wet to wet, wet to moist, or wet to dry debridement. readily available and cost effective but has a tendency to adhere to wound bed. requires frequent dressing changes. increased infection rate compared to occlusive dressings
gauze dressings
560
# Revered
consist of calcium salt of alganic acid that is extracted from seaweed. highly permeable and non-occlusive. requires a secondary dressing. based on the interaction of calcium ions in the dressing and the sodium ions in the wound exudate.
alginates
561
# Revered
typically used on partial and full thickness draining wounds such as pressure wounds or venous insufficiency ulcers, often used on infected wounds due to likelihood excessive drainage.
when to use alginates
562
# Revered
high absorptive capacity, enables autolytic debridement, offers protection from microbial contamination, can be used on infected or uninfected wounds, non-adhering to wound
advantages to alginates
563
# Revered
may require frequent dressing changes based on level of exudate, requires a secondary dressing, cannot be used on wound with an exposed tendon, joint capsule or bone
disadvantages to alginates
564
# Revered
refers to ability of a dressing to transmit moisture, vapor or gases from wound bed to atmosphere. truly occlusive substance would be completely impermeable, while a truly non-occlusive substance would be completely permeable.
occlusion
565
# Revered
hydrocolloids, hydrogels, semi-permeable foam, semi-permeable film, impregnated gauze, alginates, and traditional gauze
most occlusive to non-occlusive
566
# Revered
alginates, semi-permeable foam, hydrocolloids, hydrogels, semi-permeable film
most moisture retentive to least moisture retentive
567
# Revered
primary - direct contact with wound. secondary - directly over primary dressing to provide protection, absorption, and/or occlusion
primary versus secondary dressing
568
# Revered
remove only nonviable tissue from a wound. selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement
selective debridement
569
# Revered
red: protect wound, maintain moist environment, yellow: moist yellow slough. debride necrotic tissue and absorb drainage. black: debride necrotic tissue.
red-yellow-black tissue
570
# Revered
requires use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound. most often used for wounds with large amounts of thick, adherent, necrotic tissue, also for cellulitis or sepsis. most expedient form of removing necrotic tissue. PTs are permitted to perform sharp debridement in the majority of states.
sharp debridement
571
# Revered
topical application of enzymes to surface of necrotic tissue. can be used on infected and non-infected wounds with necrotic tissue. may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques. can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage
enzymatic debridement
572
# Revered
using body's own mechanisms to remove nonviable tissue. methods include transparent films, hydrocolloids, hydrogels and alginates. results in a moist wound environment that permits rehydration of the necrotic tissue and eschar and allows enzymes to digest the nonviable tissue. can be used with any amount of necrotic tissue and is non-invasive and pain free; however takes longer for wound healing to occur. should not be performed on infected wounds.
autolytic debridement
