Week 2 VI Interventions

Question 1

what are the considerations for compression

Answer 1

• comfort, cosmesis and tolerance.
• frequency it has to be changes
• can they change at home or in the clinic
• condition of the skin
• vascular status
• ambulation
• patient status
• cost
• has it worked before

Question 2

TF: decisions with the compression for VI is final

Answer 2

false, it is a changing status based on wound and drainage changes and you work until you find what is right

Question 3

what is a tube-like (Tubigrip)

Answer 3

least compression and inexpensive, and easy to apply, reapply and remove. It is reusable and comfortable. will stretch with repeated use, and LIGHT COMPRESSION

Question 4

when is tube -like utilized

Answer 4

with UE and LE issues or at risk of mild edema, sprains, wounds.

Question 5

how much pressure does tube-like usually give

Answer 5

10-12 mmHg

Question 6

what is a long stretch

Answer 6

it stretches a long way and wants to return to its resting state (ACE WRAP). can give constant compression but can feel tight at rest.

Question 7

TF: you do not get more compression with calf muscle contraction with a long stretch

Answer 7

false, you do get more

Question 8

what kinds of patients is the long stretch good for

Answer 8

ambulatory patients

Question 9

how do you apply the long wrap

Answer 9

figure 8 or spiral technique, and is hard to do on your own

Question 10

TF; long stretches do not telescope

Answer 10

false they do which can cause injury and restricted blood flow

Question 11

TF: we do not need to be cautious with long stretch and patients with AI

Answer 11

false, we do

Question 12

long stretch is reusable but what is wrong with it

Answer 12

it is quick to stretch and does not have consistent tension

Question 13

what is a short stretch

Answer 13

short distances, and is applied with consistent tension and spiral layering with about 50% overlap.

Question 14

TF: short stretch can telescope

Answer 14

yes, so you need to frequently re-wrap

Question 15

can you use short stretch for people with AI

Answer 15

yes, unless the compression is contraindicated

Question 16

Short stretch is good for what types of ulcers

Answer 16

AI and VI

Question 17

when is the lowest compression with a short stretch and highest

Answer 17

at rest, highest with muscle contraction

Question 18

what is an inelastic dressing

Answer 18

unna boot that is applies with only enough tension to keep it in place. it is 2-3 layers over the whole LE and needs a secondary wrap to keep it from telescoping

Question 19

how long can you wear an unna boot, but what is a draw back

Answer 19

up to 1 week. stinks because as edema decreases it will telescope, and it can also rub at the anterior ankle

Question 20

what is a multi-layer wrap

Answer 20

2-4 layers with higher compression of 30-40 mmHg. it is on during both work and rest and with long stretch, can feel tight at rest

Question 21

when can a multi-layer feel tight at rest

Answer 21

with a long stretch layer

Question 22

what is the draw back of the multi-layer

Answer 22

money, takes a while to apply, adds bulk, single use

Question 23

what are some good things with multi-layer? who can wear it? how long?

Answer 23

less telescoping, wear for 1 week, good for ambulatory and non ambulatory

Question 24

what are stockings

Answer 24

for VI and vein and support health

Question 25

how often do you need to replace stocking

Answer 25

every 6 months, and you should have 2 pairs so you can wear one and wash the other by hand and air dry

Question 26

when can you wear stockings

Answer 26

with wound closure and after the edema is resolved

Question 27

TF: the stockings are 100% effective at prevention

Answer 27

false

Question 28

what are garments

Answer 28

• farrow wrap is a foot piece and velcro that is easy to don and doff over stockings
• circ -aid is a custom no inelastic velcro bands for VI and lymphedema.

Question 29

what is LaPlace’s law

Answer 29

compression equals the tension of the # layers x4630 /limb girth x bandage width

Question 30

how can we use la places law

Answer 30

for adjustments, with graduated or graded compression, and an increase or decrease in tension. you can change the number of layers

Question 31

how is there normally achieved graded compression

Answer 31

with changes in leg circumference, like the calf vs the ankle

Question 32

what about bandage width and compression

Answer 32

the smaller, the higher the compression

Question 33

what is the caution with smaller rolls

Answer 33

at the foot and ankle, you may need fewer layers

Question 34

Figure 8 wrap has ____ the compression of a spiral wrap

Answer 34

2x

Question 35

what are some exercises for VI ulcers

Answer 35

ankle pumps, ABCs
gastric stretches for ankle ROM
heel toe raises in sitting and standing 
step overs (3-4 inch obstacle)
exaggerated heel toe (walking)
biking 
aquatics

Question 36

what are some things we can educate the patient about

Answer 36

compression
extended standing, siting or crossing the legs
elevation care and replacement of stockings
healthy lifestyle

Question 37

what is true elevation

Answer 37

above the heart level, and when this is not possible and you are in a dependent position, must have compression

Question 38

what are the goals for physical therapy interventions with VI

Answer 38

prevent and recognize early s/s
refer for screenings and repair 
treatment by the stage of healing 
relieve pressure and congestion 
care for wounds (drainage and protection)
compression 
help patients adjust

Question 39

what is the general technique for spiral and figure 8

Answer 39

50% overlap and 50% tension

with base of toes to just over gastric (2 fingers at the posterior knee) with smooth and no wrinkles

Question 40

what about techniques for graduated and graded compression

Answer 40

ankle (30-40mmHg) and proximal calf (18mmHg). ankle circumference with multilayer for higher compression and the leg shape and padding make a difference.