Wound Interventions; Adjunct Treatment Options Flashcards

1
Q

E Stim - a number of RCTs support the use of estim for what wounds

A

pressure, neuropathic and venous insufficiency

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2
Q

E stim - Medicare coverage for estim only if

A

Stage 3 or 4 pressure, arterial, diabetic, and venous ulcers that is being used as adjunctive tx AND there has to have not been any measurable signs of healing for at least 30 days of tx with standard wound care!

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3
Q

E stim contraindications

A
Malignancy
Osteomyelitis (untreated)
Use of metal ion therapies
Electronic implant effects
Not over reflex centers
Pregnant uterus
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4
Q

Effects of E stim

A
Dec pain and edema
Inc blood flow and O2 supply (inc cutenaous PP of oxygen)
Antibacterial effects
Increase ATP
Promotes collagen matrix organization
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5
Q

High voltage pulsed current - how is it applied

A

Can be applied directly to the wound, to peri wound area, or via immersion

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6
Q

High voltage pulsed current - polarity

A

Neg until progress is made, then switch to positive
If infected, start positive
45-60 min, 3-5 days/week
(time consuming - have home units now)

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7
Q

High voltage pulsed current - negative polarity effects

A
1 Epidermal proliferation
2 Inc blood flow
3 Fibroblast proliferation
4 Enhanced collagen synthesis
5 Attract neutrophils
6 Lyse necrotic tissue
7 Edema reduction
8 Stimulate granulation
9 Capillary growth
10 Bacteriocidal effect
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8
Q

High voltage pulsed current - positive polarity effects

A

1 Attract macrophages to area
2 Epithelial growth
3 Stimulate formation of new capillaries
4 Bacteriocidal effect

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9
Q

Ultrasound - what are its effects

A
It increases angiogenesis
Accelerates mast cells and macrophages
Inc cellular Ca uptake
Inc fibroplastic activity
Stimulates NO synthesis which inc vascular perfusion
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10
Q

Ultrasound - application

A

Cleanse the wound
Apply gel to the peri wound area
Sheet hydrogel applied over the wound area

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11
Q

Ultrasound - parameters

A
1 or 3 MHz depedning on depth needed
20% duty cycle
0.3 with acute
0.5 with reparative stage
up to 1.0 with early remodeling stage 
Overall lower duty and intensity to minimize thermal effects)
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12
Q

Low frequency ultrasound - frequencies

A

22.5, 25, 35 kHz are for selective debridement

40 kHz for long wave mist US (non debriding)

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13
Q

Low frequency US - properties

A

Antibacterial
Contact or non contact transport of US through an atomized vapor mist
40Hz is non contact and non debriding

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14
Q

Disadvantage to low frequency US

A

Can only be used on smaller wounds

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15
Q

Ultraviolet is what

A

Form of radiant energy

Follows physical laws of radiant energy - reflection, refraction, absorption, inverse square, cosine law

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16
Q

Ultraviolet - wavelengths

A

UVA 400-320
UVB 320-280
UVC 280-200

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17
Q

Ultraviolet - Which wavelength has peak bacteriocidal effects

A

UVC!

So use this for infection

18
Q

Ultraviolet - depth of penetration with A, B, C

A
C = stays very superficial on epidermis (melanocytes)
B = basale layer of epidermis 
A = deeper into papillary layer of dermis
19
Q

Sources of UV rays

A

Sun - UVC is filtered by ozone
UVA and UVB reach earth though
Mercury/Quartz lamps can be used

20
Q

Effects of UV rays

A

Inflammatory response
Stratum corneum thickening
Inc vit D production
Bactericidal effects

21
Q

Effects of UV rays - inflammatory response

A

VD, inc permeability, inc cellular activity

22
Q

Effect of UV rays - Stratum corneum thickening leads to

A

exfoliation
melanocyte migration
activation of melanin

23
Q

Effect of UV rays - Inc vit D production which does what

A

improves calcium and phosphorus availability

24
Q

Effect of UV rays - bactericidal effects -wich is most effective

25
MED is what
Minimal erythemal dose
26
MED - how to determine
1 - explain to pt and clean area 2 EYE PROTECTION for PT and pt 3 Place MED cutout on area - cover surrounding area 4 Position lamp 30 in away 5 Expose each shape for 15 sec, starting with 75 shape 6 Pt should check area and track the time it takes for each shape to show up and then resolve
27
MED - Dosage - MED - Time to response? Time to resolution? Skin Reaction?
Response: 4 to 6 hrs Resolution: within 24 hours Skin rxn: slightly red
28
MED - Dosage - E4 - Time to response? Time to resolution? Skin Reaction?
Response: 2 hrs Resolution: several days Skin rxn: sig erythema, blistering, exfoliation, pigmentation, edema, exudate
29
With UVA and UVB what can you use as way to figure out dosage? What will be the distance between the source and the body part?
MED Skin typing about 30 inches
30
UVC - effects Treatment parameters
Bactericidal effects Exposure time in 3 to 5 sec increments, might need up to 30 sec for some pathogens Distance is determined by equipment Might also help reduce odor
31
Negative pressure wound therapy (NPWT) AKA
vacuum assisted closure
32
Negative pressure wound therapy (NPWT) - how does it work
Wound bed must be 100% granular! Has to be clean! Sterile foam placed into wound bed Lightly fill tunnels and undermined areas Collection canister is connected to pump free end of tubing placed into the wound bed Film placed over it to seal Pump turned on (125 mmHg) Intermittent or continuous Keep on for 48-72 hours
33
Negative pressure wound therapy Indications (NPWT) -
``` Acute and traumatic wounds Subacute wounds (dehisced incision) Pressure ulcers Chronic open wounds (stasis ulcers and diabetic ulcers) Meshed grafts Flaps ```
34
Negative pressure wound therapy (NPWT) - small ambulant is recommended for
``` Venous stasis ulcers LE diabetic ulcers Pressure ulcers Dehisced incisions Grafts LE flaps ```
35
Negative pressure wound therapy (NPWT) - Contraindicated for
Fistulas to organs or body cavities Necrotic tissue in eschar Osteomyelitis (untreated) Malignancy in the wound
36
Hyperbaric oxygen therapy - application
systemic or topical application
37
Hyperbaric oxygen therapy - how does it work
Inc oxygen concentration gradient May dec bacterial growth Limited research to support efficacy
38
Total contact cast - used to treat
Grade 1 and grade 2 neuropathic ulcers
39
Total contact cast - how does it work
Allows weight bearing with better distribution of forces Improves circulation secondary to edema control and warmth Protects foot and leg from additional trauma
40
Total contact cast - contraindicated
With infection or gangrene In conditions with fluctuating edema ABIs less than 0.5 (she says mayber even 0.7)`
41
Total contact cast - negatives
Requires training to apply | If improperly applied, there is significant risk of additional skin breakdown and infection! NEUROPATHY!
42
Total contact cast - steps
1 Apply primary dressing 2 Stockinette 3 Felt is applied in areas of body prominence 4 Cover toes with foam 5 Add thin layer of cast padding 6 Apply fiberglass casting tape 7 Mold cast tape to extremity with use of a moist elastic wrap 8 Use cast shoe if a walking heel was not incorporated into the cast