Week 6- Patient Positioning/Orthotics/Adaptive Equipment, Integumentary Basics/Burns Flashcards
PART 1: PATIENT POSITIONING/ORTHOTICS,ADAPTIVE EQUIPMENT
PART 1: PATIENT POSITIONING/ORTHOTICS,ADAPTIVE EQUIPMENT
What are 3 of the most commonly used cervical collars?
- Philadelphia
- Aspen
- Miami J
- ___________ collar is good at restricting flexion/extension but doesn’t do as good of a job with rotation.
- _______ and __________ collars are good at restricting motion in every plane.
- Philadelphia
- Aspen and Miami J
______________ collars limit at both the lower cervical and upper thoracic area.
Cervicothoracic
A ________ is the most restrictive and involves pins going into the skull to restrict cervical and upper thoracic movement.
Halo
What are 3 hyperextension orthoses that help prevent flexion?
- Jewett
- CASH
- HE Brace w/ neck support
______ orthoses (_____) work like a body cast to control spinal posture.
thoracolumbar sacral orthoses (TLSO)
What are 3 LE orthotics used?
- Walking boot
- AFO
- Knee Splints
With knee splints, where should the dial be?
Right at the joint line.
What are hip abductor wedges used for?
Used for total hip so they are reminded to not cross their legs.
With arm slings, it is important to support the _____.
hand
What are sock butlers and arm butlers used for?
Used for patients who need to get on compressive garments.
What are the goals of patient positioning? (3)
Patient comfort Skin hygiene (reduce risk of pressure sores) Joint mobility (reduce risk of joint contractures)
- Avoid _______ positioning.
- Educate patient on ________ relief.
- ________ schedule for individuals unable to reposition themselves.
- static
- pressure
- turning
Pillows do’s and dont’s?
DO
-float heels, elevate UE, use for sidelying, prevent hip ER in supine
DO NOT
-place under knees, keep neck flexed
Specialty beds are often used for high-risk patients, be sure that during mobility it is __________ inflated. Return it to setting after mobility is over.
-maximally
What do pressure relief beds do?
Changes pressure points throughout the bed on a continual basis to prevent pressure sores.
- _____ cushions provide the least pressure relief but the most postural support.
- ______ cushions provide moderate pressure relief and moderate postural stability.
- _____ cushions provide the most pressure relief and the least postural stability.
- Foam
- Gel
- Air
A _____-____-_______ chair is used for patients who can’t pressure relief.
tilt-in-space
For diabetic foot ulcers, what is the gold standard for offloading?
total contact cast
- Where are we looking at in the integumentary evaluation?
- What are we looking for in the integumentary evaluation?
- At high-risk areas
- Under orthotics
- At surgical sites
- Location, Color, Temperature, Condition, Edema
- Look for nonblanching skin
- Observe skin for pressure areas caused by medical devices (ie, catheters)
- Ask patient to identify areas of discomfort
How should you position each of these patients?
- THA
- TKA
- TLSO splint after spinal surgery
- Head trauma on mech vent
- THA: Putting patient back to bed in supine.
- TKA: Lying supine in bed with head elevated, lots of knee pain.
- TLSO splint after spinal surgery: Pt seated in bedside chair, complains of pain in anterior part of orthosis.
- Head trauma on mech vent: Unconscious patient lying in bed hooked up to multiple lines, right neck rotation from mech vent tubing.
PART 2: INTEGUMENTARY AND BURNS
PART 2: INTEGUMENTARY AND BURNS
The Epidermis:
- The integumentary system is our _______ organ system!
- What are the functions of it?
- How many layers are there?
- largest
- temperature/moisture regulation, sensation, protection from infection/disease,cosmesis, and interacts with our environment
- five layers
What are the 5 layers of the epidermis and a way to remember them?
- Stratum Corneum
- Stratum Lucidium
- Stratum Granulosum
- Stratum Spinosum
- Stratum Basale
(C)ome, (L)ets (G)et a (S)un (B)urn
- What is the function of melanocytes?
- What is the function of Merkel cells?
- What is the function of Langerhans’ cells?
- Melanocytes: produce melanin, which gives skin its pigment (also protects from UV skin rays).
- Merkel cells: specialized mechanoreceptors to provide information about light touch
- Langerhans’ cells: in deeper epidermal layers and help fight infection by attacking and engulfing foreign material
The Dermis:
- __ layers that are _______ vascularized.
- _______ produce collagen and elastin.
- Support structures: hair follicles, sudoriferous glands, sebaceous glands, vasculature, lymphatics.
- ________ endings!
- 2, highly
- fibroblasts
- nerve
What are some risk factors for acquiring wounds and wound healing?
- Medications: anti-coagulants, steroids, immunosuppressants
- Diabetes (chronic blood sugar > 250)
- Tobacco use
- Poor nutritional status (especially protein)
- CV comorbidities
- Reactive/autoimmune processes
- Reduced mobility
With poor nutritional status, we look at _________ for long term protein nutrition and ________ for short term protein nutrition.
- albumin
- pre-albumin
- What is the cause of decubitus ulcers “bed sores”?
- Where is it usually over?
- Lesion caused by unrelieved pressure resulting in damage to underlying tissue.
- Usually occur over bony prominences that contact surface.
- The pathogenesis for decubitus ulcers is pressure causes ___________, excessive pressure can lead to tissue ___________.
- If the pressure is relieved, we see temporary reactive hyperemia and no tissue damage. If it is ____-__________ _________ (Stage I), then damage has begun.
- ischemia, necrosis
- NON-BLANCHABLE ERYTHEMA
- How many stages of decubitus ulcers are there?
- What else are we looking at?
- 4 stages
- looking at color, infection, smell, pain (unless decreased sensation)
- In what stage of decubitus ulcers do we see it reaching past the dermis/epidermis and into the subcutaneous layer?
- In which layer do we see it reach muscle and bone?
- Stage III
- Stage IV
If we see stage IV decubitus ulcer where bone is exposed, we should assume they have what?
osteomyelitis
In order for wounds to heal, there has to be sufficient circulation, what is one way to measure this?
Ankle Brachial Index (ABI)
ABI:
- Diagnostic test of _____.
- Test of distal LE perfusion performed in radiology or with bedside doppler machine.
- SBP ______/SBP ______
- PAD
- SBP ankle/SBP UE
- What ABI is normal?
- What ABI is mild PAD?
- What ABI is moderate PAD?
- What ABI is severe PAD?
- 1.0-1.4
- 0.8-0.9
- 0.5-0.8
- <0.5
With decubitus ulcers, _________ is key. What are some ways to do this?
Prevention
- bed positioning (reposition high-risk every 2 hours)
- WC cushioning and unweighting/pressure relief, tilt in space WC if pt unable to perform pressure relief
What are the causes of burns in order of prevalence?
- Fire/flame (43%)
- Scald (34%)
- Contact (9%)
- Other (7%)
- Electrical (4%)
- Chemical (3%)
What are the 4 types of burns?
- Thermal
- Electrical
- Chemical
- UV and Ionizing Radiation
- What type of burns have an entry and exit wound?
- What type of burns involves contact with hot object, liquid, flame, steam, intense heat?
- What type of burns involve sunburn, radiation treatment for cancer?
- What type of burns involves contact with alkili or acid substance.?
- Electrical
- Thermal
- UV and Ionizing Radiation
- Chemical
- How do we categorize burns?
- How many degrees of burns are there?
- Thickness and severity of damage to epidermis, dermis, and subcutaneous tissues.
- 3
Superficial Burns (First Degree):
- Only __________ affected.
- Red, dry, and painful with no ___________.
- What are some examples?
- How long until it heals usually?
- Does it have long-term damage?
- epidermis
- blisters
- sunburn, burn from curling iron
- 1 week
- no long-term damage
Partial Thickness Burns (Second Degree):
- _______ and part of _______ damaged.
- Red, __________, swollen, painful.
- Skin may appear ____ or shiny.
- Skin may be ________ or have irregular discoloration.
- Dressing changes can be painful – pain management.
- May heal in ___ weeks, or require more advanced management.
- Can be classified as __________ or _____.
epidermis, dermis
- blistered
- wet or shiny
- white
- 3 weeks
- superficial or deep
Full Thickness Burns (Third Degree):
- __________ and entire ______ are damaged.
- Dry, _______ skin.
- Brown, yellow, white, or black color to skin.
- ____ pain – nerve endings are gone.
- Require extensive medical management for healing.
- epidermis and entire dermis
- leathery
- no pain
Total body surface area for burn injury is calculated using the Rule of ______ (Lund and Browder diagram). Describe the percentages on this diagram for each body part.
Rule of Nines
- Head = 9
- Chest = 9
- Abdomen = 9
- Upper back = 9
- Lower back = 9
- Arm (front and back) = 9
- Front of each leg = 9
- Back of each leg = 9
- Groin = 1
What are the medical priorities in burn rehabilitation?
- Pain management
- Electrolyte and fluid management
- Nutrition
- Wound care (Antimicrobials, skin substitutes)
- Infection Prevention
- Pulmonary status
- Psychological adjustment support
- Surgery and skin graft management
What are some interventions after burn injury?
- Contracture management and positioning.
- Splinting.
- Scar management.
- Prevent wound infection.
- Improve mobility and cardiovascular function.
Contracture Management:
- Healing scar is at high risk for ____________ development, which significantly impacts function.
- __________ is key for acute injury and to manage post-surgical edema. (Initiate positioning program as soon as possible)
- Consider use of pillows (or no pillow under head), towels, wash cloths.
- ________ more likely with increased depth of injury.
- contractures
- positioning
- splinting
Splinting and Burn Injuries:
- Required with increased burn _______.
- Collaboration with ___ needed.
- Goal = promote _______ alignment for optimal function.
- depth
- OT
- neutral
Scarring is most likely to occur with ___________ burn injuries.
full thickness
What are the 2 most common scar types?
- Hypertrophic scars: raised above normal skin surface. Occur at time of injury.
- Keloid scars: grow beyond area of original injury. Grow months/years after injury
Scar Management (Compression Garment):
- Customized to patient, frequent re-assessment.
- ___-___ mmHg.
- Goal: scar maturation, protect healing skin, shrink scar.
- ___ hour/day wear schedule.
- ___-___ month wear time.
- Unknown mechanism of action.
- ? Patient compliance and efficacy.
- Can be used to protect tissues when grafting is delayed.
- 24-30mmHg
- 23h/day
- 6-12 month
Scar Management (Silicone Sheets):
- Applied under compression garments or where garments cannot conform to skin.
- Comfortable, do not restrict movement.
- Some studies show reduction in scar with prolonged application/wear time.
- ___-___ months, >___ hours/day Unknown mechanism of action.
-6-12 months, >20h/day
What are a few other scar management options?
- Scar massage
- Injections
- Surgery
When is surgery used?
As a last resort if it severely impacts function. Creates a new wound, and the cycle of healing begins again.
