120 final exam Flashcards
(167 cards)
1
Q
autograft
A
tissue taken from one part of the body and put onto another; safest and fastest-healing
tissue that can be used
2
Q
allograft
A
taken from another person; takes
longer to incorporate into the recipient’s body
3
Q
xenograft
A
tissue taken from a different
species; for example pigs
4
Q
Dermagraft or Apligraf
A
Made from foreskin of babies, which is stimulated to
grow on an absorbable scaffold
5
Q
Most wounds are…
A
Venous
80-90% of wounds are
venous insufficiency
ulcers
6
Q
Characteristics of arterial
disease
A
- Pain (while walking and at
rest) - Foot cool or cold
- Weak or absent pulses
- Absence of hair
- Common areas include the
anterior leg, lateral malleolus,
midfoot, tips of toes
Thick toenails
7
Q
Characteristics of venous
disease
A
- Foot warm
- Edema
- Brawny skin pigment changes
- Varicose veins
- Ulcer location usually above
ankle; medial and lateral leg,
medial malleolus
generally not painful
8
Q
venous wounds caused by…
A
too much blood flow
(veins carry blood back to the heard)
9
Q
arterial wounds caused by…
A
lack of blood flow TO an area of
tissue
(Arteries carry blood Away from the heart)
10
Q
Examples of venous insufficiency
A
Blood clots, DVT, Hemorrhage
- Venous thrombosis (DVT)
- Thrombophilia (propensity
to form blood clots) - Venous dilation (varicose
veins) - Sedentary lifestyle
- Hemorrhage
- Number of pregnancies
and closeness of
pregnancies
11
Q
ischemia to tissues from pressure, moisture, immobilization, and friction or sheer forces on tissue cause…
A
pressure ulcers
12
Q
Stages of pressure ulcers (4)
A
- Stage I – non-blanchable
erythema - Stage II – partial thickness
skin loss. Abrasion, blister or
crater. - Stage III – Full thickness skin
loss involves subcutaneous
tissue down to fascia. - Stage IV – Full thickness skin
loss with damage to muscle,
bone, etc.
13
Q
Stage 1 of pressure ulcers
A
non-blanchable
erythema
14
Q
Stage 2 of pressure ulcers
A
partial thickness
skin loss. Abrasion, blister or
crater.
15
Q
Stage 3 of pressure ulcers
A
Full thickness skin
loss involves subcutaneous
tissue down to fascia.
16
Q
Stage 4 of pressure ulcers
A
Full thickness skin
loss with damage to muscle,
bone, etc.
17
Q
phases of wound healing
A
1- hemostasis
2- inflammation
3- proliferation
4- epithelialization
18
Q
phase 1 of wound healing
A
-Hemostasis
-From initial tissue damage—> 30mins
-Platelets stop bleeding/clotting
19
Q
phase 2 wound healing
A
-inflammation
- 3-7 days
- Warmth, swelling, redness, pain
- vasodilation
- transudate (fluid)
- Collagen synthesis begins= building new tissue
Non-thermal ultrasound is helpful at this stage!
20
Q
phase 3 wound healing
A
- proliferation
- granulation tissue
- new capillaries and increased collagen production
- antibody production = defend against infection
Pressure at this stage is helpful!
21
Q
phase 4 wound healing
A
-Epithelialization.
- tissue regeneration—> single thick layer of epithelial tissue covers the granulation tissue (from stage 3)
22
Q
Three distinct events in late phase 2 –>
phase 4 of healing are helping wound to heal…
A
▫ Formation of granulation tissue
▫ Contraction of the wound margins
▫ Re-epithelialization
23
Q
Treatment of Arterial Wounds
A
PROMOTE BLOOD FLOW
Debride = promote blood flow
keep pressure OFF = increase blood flow
keep area warm = promot blood flow
pray
24
Q
Treatment of Venous Wounds
A
COMPRESSION PRESSURE- adding compression to minimize edema (pressure)
control edema = compression, lymphedema massage
cleanse wound = gentle irritation
Debridement and dressing – duoderm or semipermeable foam
25
What wounds dressing could cause maceration?
hydrogels
hydrocolloids
26
masceration
softening and breakdown of skin due to excess moisture
27
dressings...
* Gauze
vs.
* Microenvironmental Dressings
▫ Calcium alginates
▫ Semi-permeable films
▫ Semi-permeable foams
▫ Hydrogels
▫ Hydrocolloids
28
gauze
* Inexpensive
* Simple to use
* Can be used over
infected wound
cons- reduces moisture, adherence, permeable to bacteria, debris
29
Permeability is ______ if wound is infected so
bacteria aren’t given a closed environment for
multiplying
good
30
Calcium Alginates
- made from seaweed
- highly absorbent
- permeability to oxygen = can be used of infected wound
cons- expensive, permeable to bacteria
31
characteristic of inflammation
redness
swelling
heat
pain
32
The most accurate form of selective debridement...
Autolytic debridement
33
Autolytic debreidment
Body’s natural enzymes and moisture break down dead tissue
34
Treatment of Pressure Wounds
most important...
REMOVE
PRESSURE!!!!!
35
Pt entire front torso and back of left leg is burned... what %
27%
36
Percent of surface area – Rule of
9s
- head = 9% (4.5% frontal and post)
- torso = 36% (18% frontal and post)
- arm = 9% (4.5% frontal and post)
- leg = 18% (9% frontal and post)
- pubic region = 1%
37
Pt arms are completely burned and posterior torso.. what %
36%
38
1st degree burn
- superficial burn
- only epidermis
- pink, dry, blanches under pressure
39
2nd degree burn (there are 2 categories)
- superficial
- partial thickness
- epidermis and top of dermis
- moist, weeping, blistering, pain
-deep
-partial thickness
- epidermis and dermis
- red, white eschar, blisters
40
3rd degree burn
- full-thickness
- epidermis and dermis and subdermal tissue
- require surgical debridement and skin grafting
41
Superficial burn only affecting the epidermis
1st degree
42
Partial- thickness burn affecting entire epidermis and top of dermis
2nd degree
43
Full-thickness burn affecting epidermis, dermis, and subdermal tissue
3rd degree
44
Phonophoresis
application of US with a topical drug intended to cause transdermal delivery of the drug to underlying structures
pulsed at .5-.75 w/cm2 for
5-10 minutes.
45
Thermal ultrasound effects
DEEP HEAT- heating is tissue-specific
* Vasodilation
* Decreased pain, increased pain threshold
* Decreased muscle spasm
* Temporary decrease in muscle strength and
endurance
* Increased metabolism
* Increased soft tissue extensibility
46
Non-thermal ultrasound effects
MECHANICAL EFFECTS
* Increase skin and cell membrane permeability
* Increase histamine release
* Increase macrophage response
* Increase rate of protein synthesis by fibroblasts
47
What is your treatment size in relation to US soundhead size
Treatment time is 5 minutes for area that is
twice the size of the sound head
48
how long would you perform US for an area 4x the size of the head?
10 mins
(5mins for an area 2x the size if the head)
49
(US) With 1 MHz frequency, usual range is...
1.0-1.5 w/cm2
50
(US) With 3 MHz frequency, usual range is...
0.5-1.0 w/cm2
51
With inflammatory cases, one should use (puled or continuous) ultrasound?
pulsed
52
US under water
* Water is the transmission medium. Degassed
water is best, or intermittently wipe air bubbles
off sound head.
* Increase intensity by about 50%. If you would
use 1.0 w/cm2, increase to 1.5 w/cm2 to account
for attenuation of sound into water.
* Hold sound head about 1 inch away. Try to keep
hand out of water or use rubber gloves
53
For underwater US, increase intensity by about ____.
If you would use 1.0 w/cm2, increase to ____ w/cm2 to account for attenuation of sound into water.
50%
1.5
54
Five Modes of Heat Transfer
* Conduction
* Convection
* Conversion
* Evaporation
* Radiation
55
Would you use pulsed or continuous ultrasound for phonophoresis?
pulsed
56
Conduction
direct contact
ex: hot packs
57
Convection
circulation of a medium of a warmer temperature.
ex: whirlpool
58
Conversion
changing or converting one form of
energy to another
ex: ultrasound
59
Evaporation
change of form from liquid to vapor
ex: vapocoolant spray
59
Radiation
hot to cooler material without the need for an intervening medium
ex: infrared light
60
Effects of Heat
* Vasodilation
* Decreased pain, increased pain threshold
* Decreased muscle spasm
* Temporary decrease in muscle strength and
endurance
* Increased metabolism
* Increased soft tissue extensibility
61
Types of Superficial Heat
* Hot packs
* Fluidotherapy
* Paraffin
* Whirlpool
62
(hot packs) Water temperature in the hydrocollator should be
________ degrees
160-165
63
Hot packs should be applied with ____ layers of towel
6-8
64
Effects of Cold
* Vasoconstriction
* Decreased nerve conduction velocity
* Increased pain threshold
* Analgesic effect via Gate Control theory
* Altered muscle strength
* Decreased spasticity
* Increased tone in flaccid muscle
* Decreased metabolic rate
65
Normal pressure with pulsed lavage
Pressure range is 4-15 psi.
Recommended for wounds containing necrotic tissue or debris, to be used until granulation bed is present
66
Intermittent Compression on/off ratio
3:1; generally 90 seconds on and 30
seconds off
Treatment time 1-4 hours
67
Intermittent compression pressure range...
____ in UE
____ in LE
30-60 in UE
40-80 in LE
68
What is thermoneutral temp?
94◦ (92-96◦)
maintained stable body temperature without needing to expend extra energy to either heat up or cool down
69
fluidotherapy temp range
105-125 degrees
70
paraffin temperature
125 degrees
71
Why do we use Rate of Perceived Exertion in pool therapy?
Heart rate in water is decreased:
* Hydrostatic pressure pushes
blood from periphery to
thorax and heart. Increased
central blood volume,
increased cardiac volume.
* Response of heart is
increased cardiac
contraction and stroke
volume. May increase heart
efficiency.
72
Diathermy, infrared radiation, and ultraviolet are (low, high) frequency types of radiation.
low
73
Which UV waves are used for Bactericidal effects?
UV-C
74
UV-A
- 320-400 nm
- penetrates deeper into the dermis
- ex: wrinkles, aging
75
UV-B
- 250-320 nm
- superficial effect
- ex: sunburn, melanoma.
76
UV-C
- 250 nm
-bacteriocidal properties and tissue healing
77
_______ is the negative electrode
cathode
78
________ is the positive electrode
anode
79
(T/F) We use estim to kill bacteria in the wound
true
80
estim resistance is measured in...
ohms
81
(estim) the difference is called electrical potential and is measured in...
volts
82
Current flow is measured in...
amps
83
(estim) when discussing resistance, the standard unit of measure is ______
ohms
84
(estim) when discussing intensity, the standard unit of measure is _____
amps
85
The actual flow of water (or people) down the slide.
Current
86
(estim) Which current used:
- wound healing
- iontophoresis
- stimulate the denervated muscle
Direct Current
87
Direct current
Uninterrupted flow of ions in one direction
88
(estim) Which current used for:
- muscle stimulation
Alternating Current
89
Alternating Current
Continuous flow of ions in alternating directions, by
changing the charge of the electrodes
90
Pulsed Current
Flow can be in one or alternating directions, but
difference is that current is interrupted at regular
intervals
91
Electrodes that are further apart will cause
current to flow _____
deeper
92
Muscle stimulation is greatest when electrodes are
oriented...
parallel to muscle fibers
93
Size of electrodes will affect...
current density
94
Size of electrodes
- Small electrodes will be better
for stimulating a discrete area.
- Equal-sized electrodes will provide equal amounts of stimulation (bipolar)
- If the electrodes of unequal size is used, the small electrode is the “active electrode”, and the bigger
the electrode is the “dispersive electrode.”
(monopolar technique)
95
TENS
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
E-stim controls pain by altering the perceptual
component of the symptom, rather than the
cause.
96
Gate theory
pain relief by stimulating the larger
diameter nerve fibers that don’t carry pain impulses,
closes the gate on pain sensations
97
Endorphin theory
hormonal modulation of pain
98
Parameter for sensory level TENS
- Pulse width or duration is low – 20-125 microseconds
- Pulse rate or frequency is high, 50-200 pps
- Amplitude is turned up just until the patient feels the tingling (sensory level).
99
Parameters for motor level/endorphins level TENS
- Pulse width or duration is high – 200-500 microseconds
- Pulse rate or frequency is low – 1-5 pps
- Amplitude is turned up until the patient gets a weak muscle twitching (motor level).
100
Gating pain with TENS
It’s called sensory level TENS, or conventional TENS
Response to this stimulation is very soon, usually within 5 minutes of beginning the stimulation. The pain relief lasts only a short time after discontinuing the TENS (maybe 1 hour).
101
Endorphin release with TENS
It’s called motor level TENS or low rate TENS
Preferred in chronic pain patients, especially
those with prolonged use of narcotics, or used if
conventional TENS is not successful and patient
can tolerate muscle contractions.
Response is slower to take effect, building up
over first two days. Pain relief lasts for several
hours.
102
Noxious level TENS
When TENS is set up to briefly overcome pain:
It’s called noxious level TENS or brief intense mode TENS.
Preferred when pain relief is needed very short term. Also use with chronic pain when other methods are not successful.
Onset of relief is rapid, within seconds. The duration of pain relief is lasting. The intention is to produce discomfort that is tolerable
103
Conventional TENS vs. noxious TENS settings
Conventional- pain relief within 5 mins, relief that only lasts about an hour
Noxious- pain relief in seconds, duration of pain relief is lasting.
104
IFC
Interferential stim
Used for pain control in a clinical setting. May have
beneficial effects by breaking pain-spasm-pain
cycle
AC
105
When using a Monopolar technique, one electrode is larger than the other. The _________ is the smaller one
active electrode
106
isograft
skin graft from a twin
107
Intermittent Compression formula for settings (AMY SAID THIS)
40/Dyastolic BP x 2hrs
108
Strength/duration curve
relationship between the intensity of an electrical stimulus at the motor point of a muscle
109
Electrode placement- Direct technique
- electrode in wound bed
- Monopolar technique
- Use gel pad or saline soaked gauze
- Used primarily for monophasic current
110
Electrode placement- Periwound technique
- electrodes on either side of wound on intact skin
- Bipolar technique.
-Used primarily for asymmetric biphasic current.
111
Unhealthy muscle on/off ratio
10:50
most rest time
1-5
112
Healthy muscle on/off ratio
10:10
1-1 equal contraction and rest time
113
Average muscle on/off ration
10:30
mild rest time
1-3
114
Indications for ESTIM
Pain control
Edema reduction
Wound healing
Delivery of medicine (iontophoresis)
Muscle contraction – to strengthen weak muscle, prevent
atrophy, fatigue muscle in spasm
115
iontophoresis placement for polarity
proliferation and pain-positive
inflammation- negative
116
Effects of Massage
* Reduced muscle spasm
* Increased blood flow to area
* Sedation or arousal
* Increased lymph return and
venous return
* Remodeling of connective
tissue
* Increased pliability of fascia
* Reduced anxiety
* Form of communication
117
petrissage
More manipulation of the soft tissue; tissues
are lifted, squeezed, etc.
* Kneading
* Skin rolling
* Compression – one hand
on top of the other
* C-technique
118
* Kneading
* Skin rolling
* Compression – one hand
on top of the other
* C-technique
are _________ techniques
petrissage
119
Tapotement
* Brisk percussion;
stimulating
* Loose hands
* Increases circulation
* Can promote respiratory
drainage when
combined with postural
techniques
any 'hitting' massage technique
* Hacking
* Rapping
* Cupping
* Clapping
* Slapping
* Tapping
* Pincement
* Quacking
120
* Hacking
* Rapping
* Cupping
* Clapping
* Slapping
* Tapping
* Pincement
* Quacking
are _________ techniques
tapotement
121
type of massage strokes (4)
* Effleurage
* Petrissage
* Friction massage
* Tapotement
122
Strength/duration curve (idk)
relationship between the intensity (strength) and duration of an electrical pulse needed to elicit a motor response, like a muscle contraction-----increasing the strength or duration of a pulse can lead to a response
In simpler terms, imagine you're trying to poke a finger. You can use a sharp pin for a short time, or a dull object for a longer time to get the same result. The strength-duration curve shows the different ways you can achieve a similar result using different combinations of strength and duration of your "poke"
123
Electrical stim and wound healing
High Volt estim:
Inflammatory (-) and Proliferative (+)
124
Wound Healing and estim: ____1_____ during the inflammatory phase, then ___2___
during proliferative phase
1) negative
2) posative
(-) during inflammatory phase, then (+)
during proliferative phase
125
High Volt
Interrupted monophasic DC
current, with twin spike
waveform. Very low pulse
duration, high amplitude.
126
In High Volt for Edema Control, the (negative or positive) goes over the edema?
127
monopolar
one big pad and one small pad
iontophoresis and high volt
128
varicose verins are an example of what kind of insuffivcieny
venous
129
pulse width is the same as
pulse duration
130
xenograft is a a skin graft taken from
two different species (pig/human)
131
in alternating current, the electrodes constantly change polarity (t/f)
true
132
with interferential stim, intensity is turned up to
sensory only
133
interferential stim is used
to treat a specific area
criss-cross electrodes
Treating for pain
take it up to sensory/tingle
134
pulse lavage psi
4-15 psi
135
a hot pack directly on the shoulder is what kind if energy transfer
conduction (direct contact)
136
Don't do ultrasound over growth plates
x
137
a wound needs constant moisture to heal (t/f)
true
138
Fluoidotherapy temp
105-125
139
resistance is measures in ________ with estim
ohms
140
2 modalities that are superficial
hotpack and fluidotherapy
141
events with ice massage
cold, burning, aching, numbness
142
heat by diathermy is an example of what kind of heat transfer
conversion
143
light therapy is used to promote healing (t/f)
true
144
the frequency to reach tetany is ____
50 pps
smaller muscle could potentially be less
145
most common stage of tissue healing where modalities are used to increase tissue extensibility
stage 2
146
acute pain is
localized
147
chronic pain
generally last longer than 6 months
148
majority of wounds are caused by _______
venous insufficiency
149
Hot pack contraindications
Acute inflammation, infection
Active Cancer or recent radiation
Active bleeding, open wounds
Cognitive/mental impairment
Thrombophlebitis, superficial or DVT
Peripheral vascular disease
Cardiac insufficiency
150
what frequency works on denervated nerves
direct
151
what frequency is high volt
pulsed direct current
152
What frequency is necessary to reach Tetany?
50
153
why e-stim is good for would healing
electricity kills bacteria
154
Electrical stim and wound healing...
high-volt inflammatory
high-volt proliferative
155
What is the neuromatrix Pain model
taking in psychosocial issues and history manifesting pain
156
Biomedical
diagnosis gets worse and pain gets worse.
Treatment= pain and diagnosis get better.
157
pulse width is the same as
pulse duration
158
pulse rate is the same as
pulse frequency
159
FES
functional electrical stimulation
160
ESTR
electrical stimulation (for) tissure repair
161
NMES
neuromuscular electrical stimulation
162
Contraindications (Massage) (8)
Avoid carotid sinus area, groin, axilla, front of elbow and back of knee, umbilicus, eyes.
If patient is ill or has a fever.
Contagious skin condition
Malignancy
Bleeding
Acute inflammation
Thrombophlebitis
Increased or decreased sensation
163
Contraindications (E-Stim) (7)
Demand type pacemakers
Over the carotid sinus
Blood clots or thrombophlebitis
Over phrenic nerve or bladder stimulator (SCI)
Over area of active bleeding
Cancer
Pregnancy
164
Contraindications (Ultrasound) (8)
Cancer
Pregnancy
Joint cement or plastic components
In area of pacemaker
Blood clots
Over eyes, genitals, carotid sinus, spinal cord
Epiphyseal plates
Breast implants
165
Contraindications (Cold Packs) (9)
Cold hypersensitivity
Cold intolerance
Raynaud’s disease/phenomenon
Over a regenerating peripheral nerve
Over area of impaired circulation
Cryoglobulinemia
DVT/thrombophlebitis
Chronic wounds/PVD
Anterior neck/carotid sinus
166
Contraindications to Superficial Heat (Hot Packs) (7) (+1)
Acute inflammation, infection
Active Cancer or recent radiation
Active bleeding, open wounds
Cognitive/mental impairment
Thrombophlebitis, superficial or DVT
Peripheral vascular disease
Cardiac insufficiency
Multiple Sclerosis (may be considered a precaution)
