Term
| Topics for pt education (7) |
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Definition
1. foot care instruction
2. pressure relief techniques to avoid skin problems
3. transfer techniques to reduce trauma and shear force
4. LE elevation to reduce edema
5. adequate nutrition
6. approp wound dressing techniques
7. pathophys of wound to promote better understanding of good wound care importance |
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Term
| Considerations in hydrotherapy use (6) |
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Definition
1. presumed primary effects are tissue hydration, inc. circ., debridement (effectiveness may be very limited)
2. water agitation may damage new granulation tissue and epidermal cells
3. antibacterial agents may be cytotoxic to healthy tissue
4. an alternative could be soaking wound in water in a sterile basin to hydrate tissue prior to debridement
5. another alt is pulse lavage to facilitate debridement
6. CI/precautions: dry gangrene, cardiac/pulm compromise, fever>102, extremity edema |
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Term
| Selective debridement types (3) |
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Definition
1. mechanical/manual-fastest but has risks of sepsis and bleeding
2. topical enzymes-only digest necrotic tissue (Accuzyme, Panafil)
3. Autolysis-self-debridement of necrotic tissue (macrophages, can be facilitated by occlusive dressings) |
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Term
| Contraindications for selective debridement (4) |
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Definition
1. eschar-covered wounds in a pt w/ arterial insufficiency
2. dry gangrene
3. eschar-covered bone or tendon
4. anticoagulant meds |
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Term
| Non-selective debridement types (4) |
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Definition
1. whirlpool
2. wet-to-dry gauze dressings
3. hydrogen peroxide
4. pulse lavage |
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Term
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Definition
| most useful w/ venous insufficiency ulcers; stable cavitation may modify cell membrane permeability; acoustic streaming may facilitate the transport of calcium ions into the cell and the release of 5HT from platelets (inc. protein synthesis by fibroblasts, inc. release of chemotaxic factors from mast cells/macrophages/platelets, fibroblasts will secrete more collagen w/ more regular arrangement of collagen fibers, can accelerate wound contraction) |
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Term
| Venous insufficiency ulcer characteristics (4) |
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Definition
1. shallow base
2. usually located near medial malleolus
3. brown or purple skin discoloration near ulcer and extending to midcalf
4. LE edema/liposclerosis from foot extending to knee |
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Term
| Etiology of venous insufficiency ulcers |
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Definition
1. "leaky" venules
2. WBC trapping |
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Term
| Treatment of venous insufficiency ulcers (5) |
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Definition
1. edema management
2. whirlpool should be avoided by cleaning the ulcer may be an adjunct to tx
3. US may enhance healing
4. care of periwound skin (moisturize and dec. trauma to skin)
5. pt education regarding lifelong commitment to edema management |
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Term
| Hypothesized effects of E-stim (5) |
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Definition
1. attraction of inflammatory cells
2. modification of endogenous bioelectrical potential of tissue
3. stimulation of DNA and protein synthesis in fibroblasts
4. bactericidal effects
5. enhanced circulation |
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Term
| Treatment method for E-stim |
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Definition
| wound is lightly packed w/ saline moistened gauze; tx electrodes placed over packed wound; dispersive electrode placed distal to tx electrodes if possible; do 45 min-1 hr 5-7x/wk |
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Term
| Etiology and complications to healing for a diabetic ulcer |
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Definition
| pressure or external forces lead to inc. likelihood for developing ulcers and dec. wound healing potential (collagen metabolism is defective; impaired immune response secondary to defects in leukocyte function) |
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Term
| Treatment of diabetic ulcers (3) |
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Definition
1. absolute rest to injured site (NWB ambulation, WC prescription, bedrest)
2. total-contact casting to distribute WB pressure throughout lower leg secondary to total contact
3. debridement and dressings |
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Term
| Other notables for diabetic ulcer |
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Definition
| prescribe post-healing sandal w/ rigid rocker sole; extra depth shoes w/ accommodative custom-molded inserts; consistent/frequent pt edu; best intervention is PREVENTION edu. |
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