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Physical Agent Modalities > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

Nerve endings in the dermis

A

Mechanoreceptors for pain, touch, heat, and cold

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2
Q

Soft tissue injuries

A

Trauma or overuse to muscle, tendons, or ligaments

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3
Q

Muscle contusions

A

Bruises
Presents with ecchymosis (tissue discoloration), swelling, formation of hard feeling mass, and hematoma

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4
Q

At what percent stretch do tendons tear?

A

When stretched 5-8% beyond normal length

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5
Q

Sprain

A

Injury involving stretching or tearing of a ligament or joint capsule

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6
Q

First degree sprain or strain

A

No readily observable tissue destruction

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7
Q

Secondary degree sprain or strain

A

Detectable joint instability and muscle weakness

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8
Q

Third degree sprain or strain

A

Severe pain, loss of tissue continuity, decreased ROM, complete joint instability

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9
Q

Cramp

A

Painful, clonic-type muscle pain

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10
Q

Muscle spasm

A

Involuntary contraction of short duration
Trigger points

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11
Q

Myositis

A

Inflammation of muscle connective tissue

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12
Q

Fasciitis

A

Inflammation of sheaths of fascia

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13
Q

Tenosynovitis

A

Inflammation of tendon sheath
Causes pain or swelling with tendon movement

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14
Q

Tendonitis

A

Inflammation of a tendon
Causes pain or swelling with tendon movement

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15
Q

Bursitis

A

Irritation of bursa

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16
Q

Myositis ossificans

A

Accumulation of mineral deposits in muscle
Can occur with a loss of movement

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17
Q

Calcific tendinitis

A

Mineral deposits in tendon

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18
Q

Abrasions

A

Scratches, bruises, and mild burns

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19
Q

Lacerations

A

Tissue is torn open with irregular tearing of skin

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20
Q

Granulation scar tissue

A

Red healthy connective tissue with good blood flow that will continue to heal
Special cells respond to tissue injury by producing a collagenous glue
Matures into a dense fibrous scar

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21
Q

Three sequalae after tissue damage

A

Resolution
- Dead cellular material and debris removed by phagocytosis
- Tissue is left with original architecture in tact

Regeneration
- Lost tissue replaced by proliferation of cells

Repair
- Lost tissue is replaced by fibrous scar

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22
Q

Angiogenesis

A

Process of new cell growth or budding, producing blood vessels during granulation phase of wound healing

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23
Q

Contraction

A

Bringing together wound edges causing the wound size to become smaller

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24
Q

Exudate

A

Fluid from wounds

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25
Q

Ischemia

A

Loss or deficiency of blood to an area

26
Q

Maceration

A

Softening, whitening, and breaking down of skin from prolonged exposure to moisture

27
Q

Slough

A

Nectrotic dead tissue, cream or yellow in color, stringy

28
Q

Eschar

A

Necrotic dry, black, and hard tissue

29
Q

Wound healing timeline

A

4 weeks
Inflammatory phase (time of injury - 7 days)
Proliferative phase (3 days after injury - 3 weeks)
Maturation/remodeling phase (2 weeks after injury - 1 year or longer)

30
Q

Inflammatory phase

A

From time of injury - 7 days
Leukocytes, neutrophils, and monocytes are sent to the injured area to decontaminate the wound
Blood vessels dilate in response to histamine release to provide increased blood supply for healing
Blood flow to area causes are to become red, hot, swollen, and painful
Edema surrounds wounds to bind edges together
Associated with red, blue, or purple skin color, heat, swelling, pain, and potentially some loss in function
Neurovascularization occurs

31
Q

What happens if too much inflammation occurs?

A

Excessive scar is produced

32
Q

Neovascularization

A

New circulatory loops fill wound creating highly pink to reddish wound color
Immobilization is essential during this phase to permit vascular regrowth and prevent skin breakdown

33
Q

Inflammatory phase intervention

A

Minimize all factors that can prevent or prolong inflammation by assisting the role of macrophages

Antibiotics
Debridement
Wound cleaning

34
Q

Proliferative phase (Epithelialization or granulation phase)

A

Lasts 3 days- 3 weeks after injury
Damaged area is filled with new connective tissue and covered with new epithelium
Granulation tissue fills in the wound site, binding and protecting the area (granulation)
Epithelial cells migrate upward and repair the wounded area (epithelization)
Wound contraction results in decreased size of wound
Scabs form a temporary barrier and should not be disturbed

35
Q

Proliferative phase intervention

A

Dressings should be kept moist and not permitted to dry out to facilitate epithelization
Graded range of motion exercises and functional activities assist in controlled wound contraction and ensure the surrounding skin is supple and mobile

36
Q

Maturation (Remodeling) phase

A

2 weeks - 1 year or longer after injury
Continued fibroblastic activity and collagen synthesis and lysis lead development of a scar with maximum tensile strength
Scar formed is dense, disorganized, and may appear rosier
Scar formation occurs when collagen synthesis exceeds collagen lysis

37
Q

Hypertrophic scars

A

Scars within the boundaries of the lesion

38
Q

Keloid scars

A

Scars that extend beyond the boundary of the wound and appear raised

39
Q

Maturation/remodeling phase intervention

A

Goal is to influence scar formation by applying controlled stress as scar matures
Serial casting
Positional heat and stretch
Graston & Manual techniques
Electrical stimulation/iontophoresis
Selective hand activties
Low-load prolonged stress

40
Q

Why does low-dosaged pulsed ultrasound help with wound healing?

A

Decreased infection by disintegrating macrophages

41
Q

Tension theory

A

Internal and external stresses that are placed on the wound affect and align the fibers during remodeling

42
Q

Tensile strength of skin at 2 weeks

A

Remodeled skin is 20% of the pre-wound strength

43
Q

Tensile strength of skin at 5 weeks

A

Remodeled skin is 50% of pre-wound strength

44
Q

Tensile strength of skin at 10 weeks

A

Remodeled skin is at 80% pre-wound strength
Tensile strength is weaker and will never exceed 80%

45
Q

Induction theory

A

Scar tissue attempts to mimic the characteristics of the tissue it is healing

46
Q

Wound classification based on depth of tissue

A

Partial thickness wounds
Full thickness wounds

47
Q

Partial thickness wounds

A

Involve the epidermal layer and may include the superficial layer
Does not extend through the dermis
Wounds are shallow, moist, and painful
Wound base appears bright pink or red
Heals by epithelialization and may be characterized by a crust or covering consisting of blood and debris particles

48
Q

Full-thickness wounds

A

Involve the epidermis, dermis, and subcutaneous tissues (muscle, fascia, tendons, and bone)
May include necrotic tissue or infection
Secondary intention healing (Inflammatory, proliferative and remodeling phase)

49
Q

Wound classification based on color

A

Red
Yellow
Black

50
Q

Red wounds

A

Indicate the wound is clean, healing, and granulating without complications

51
Q

Intervention for red wounds

A

Provide a moist wound environment to facilitate epithelization and reduce crust/scab formation
Minimize any damage to newly formed tissue

52
Q

Yellow wounds

A

Indicates the wound is possibly infected or contains necrotic tissue
Contains devitalized slough or fibrous exudate which can promote bacterial growth and infection

53
Q

Intervention for yellow wounds

A

Needs debridement and cleaning of the area
Remove exudate and debris

54
Q

Black wounds

A

Indicates that the tissue is necrotic
Requires cleaning and debridement of the area

55
Q

Primary closure (intention closure)

A

Wounds that are closed via surgical incisions occur when full-thickness surgical incisions or acute wound edges are sutured together
Most often when there is minimal skin loss and acute wound edges that can be approximated together

56
Q

Secondary closure

A

Wounds that are left open following surgery to allow for healing
Allows for more mobility after healing
Used on wounds that are open, large, and full thickeness
Allowed to heal by production of connective scar tissue

57
Q

Delayed primary closure (tertiary intention closure)

A

Wounds that are initially left open for a short period of time followed by approximation and closure of the wound
Occurs in complex wounds that may be infected or contaminated

58
Q

Barriers to wound healing

A

Low blood oxygen content
Infection
Foreign bodies
Lack of perfusion (blood flow)/ arterial insufficiency / venous insufficiency
Neuropathy
Sustained pressure
Malnutrition
Systemic disease (diabetes mellitus, artherosclerosis, AIDs)
Prescription immunosuppressants

59
Q

Signs of an infected wound

A

Prolonged or unusual erythema
Yellow fibrin slough or necrotic tissue
Increased wound pain and tenderness
Heat
Edema
Pus
Increased body temperature
Pan
Purulent drainage
Uncharacteristic odor

60
Q

Use of hydrotherapy for wound healing

A

Can be used to cleanse and debride wound

61
Q

Use of electrical stimulation for wound healing

A

Assists in debridement and facilitates epithelialization and contraction of the wound

62
Q

Use of ultrasound for wound healing

A

Promotes wound healing during proliferative and remodeling phase for management of soft tissue inflammation

Physical Agent Modalities (14 decks)

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