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Practice topics Exam 3 > Wound Interventions; Adjunct Treatment Options > Flashcards

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

A

UVC

25
Q

MED is what

A

Minimal erythemal dose

26
Q

MED - how to determine

A

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
Q

MED - Dosage - MED - Time to response? Time to resolution? Skin Reaction?

A

Response: 4 to 6 hrs
Resolution: within 24 hours
Skin rxn: slightly red

28
Q

MED - Dosage - E4 - Time to response? Time to resolution? Skin Reaction?

A

Response: 2 hrs
Resolution: several days
Skin rxn: sig erythema, blistering, exfoliation, pigmentation, edema, exudate

29
Q

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?

A

MED
Skin typing

about 30 inches

30
Q

UVC - effects

Treatment parameters

A

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
Q

Negative pressure wound therapy (NPWT) AKA

A

vacuum assisted closure

32
Q

Negative pressure wound therapy (NPWT) - how does it work

A

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
Q

Negative pressure wound therapy Indications (NPWT) -

A 
Acute and traumatic wounds
Subacute wounds (dehisced incision) 
Pressure ulcers
Chronic open wounds (stasis ulcers and diabetic ulcers)
Meshed grafts
Flaps
34
Q

Negative pressure wound therapy (NPWT) - small ambulant is recommended for

A 
Venous stasis ulcers
LE diabetic ulcers
Pressure ulcers
Dehisced incisions
Grafts 
LE flaps
35
Q

Negative pressure wound therapy (NPWT) - Contraindicated for

A

Fistulas to organs or body cavities
Necrotic tissue in eschar
Osteomyelitis (untreated)
Malignancy in the wound

36
Q

Hyperbaric oxygen therapy - application

A

systemic or topical application

37
Q

Hyperbaric oxygen therapy - how does it work

A

Inc oxygen concentration gradient
May dec bacterial growth
Limited research to support efficacy

38
Q

Total contact cast - used to treat

A

Grade 1 and grade 2 neuropathic ulcers

39
Q

Total contact cast - how does it work

A

Allows weight bearing with better distribution of forces
Improves circulation secondary to edema control and warmth
Protects foot and leg from additional trauma

40
Q

Total contact cast - contraindicated

A

With infection or gangrene
In conditions with fluctuating edema
ABIs less than 0.5 (she says mayber even 0.7)`

41
Q

Total contact cast - negatives

A

Requires training to apply

If improperly applied, there is significant risk of additional skin breakdown and infection! NEUROPATHY!

42
Q

Total contact cast - steps

A

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

Practice topics Exam 3 (9 decks)

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