Electrotherapeutic Modalities, Physical Agents, and Mechanical Modalities Flashcards Preview

822: Integumentary > Electrotherapeutic Modalities, Physical Agents, and Mechanical Modalities > Flashcards

Flashcards in Electrotherapeutic Modalities, Physical Agents, and Mechanical Modalities Deck (101)
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1

What are 7 modalities and physical agents than can be used to enhance wound healing?

- Wound irrigation
- Whirlpool
- Pulsed lavage
- Electrical stimulation
- Ultrasound
- Negative pressure wound therapy
- Hyperbaric oxygen

2

What can be defined as the use of fluid to remove loosely adhered debris, bacteria, exudate, draining residue and residual topical agents?

Wound Irrigation

3

What are 3 advantages to wound irrigation?

- Facilitates debridement
- Assists with achieving and maintaining a moist wound environment
- Enhances wound healing

4

Irrigation after whirlpool removes _ times more bacteria than whirlpool alone

4

5

Wound irrigation is an acceptable intervention for all types of wounds and is the only direct wound intervention for what type of wound?

healing granular wounds

6

In what type of wound is irrigation contraindicated?

Wounds with active, profuse bleeding

7

Wound irrigation should use _-__ psi of pressure

4-15

8

Recent recommendations for irrigation suggest that pressures between __-__ psi are most effective for preventing infection

10-15

9

What are 6 advantages to wound irrigation?

- simple
- quick
- inexpensive
- effective
- can use for wound in any location
- can be used in any setting

10

What is the main disadvantage to wound irrigation?

Irrigant runoff may soil bed lines or patient clothing, which may result in the clinician using less irrigant solution than necessary, making the treatment less effective

11

What are 3 alternatives to wound irrigation?

- Soak wound with saline-moistened gauze
- whirlpool
- pulsed lavage

12

Whirlpool is a form of _______ (selective/nonselective) mechanical debridement

nonselective

13

What are the 7 main purposes of whirlpool?

- debrides loosely adherent devitalized tissues, foreign debris, and surface bacteria
- softens necrotic tissue and eschar
- hydrates the wound bed and promotes moist wound healing
- promotes circulation
- associated with decreased patient pain complaint during wound care procedures
- eases ROM for patients with burn injuries
- can help soak off adherent wound dressings

14

Whirlpool is indicated in what 4 types of wounds?

- infected wounds
- nondraining wounds
- wounds with thick eschar
- wounds with loosely necrotic tissue or thick exudate

15

Whirlpool is contraindicated in what 4 types of wounds?

- Clean, granulating, or epithelializing wounds
- Edematous, draining, or macerated wounds
- Wounds with tunneling, undermining, skinfolds that can’t be effectively irrigated
- Active bleeding wounds

16

What should you be cautious of when treating arterial insufficiency ulcers with whirlpool?

lower the temperature

17

In what type of patients is whirlpool contraindicated?

- patients with edema or lymphedema
- incontinent patients
- patients who are hydrophobic, confused, combative, with seizures
- patients with multiple open wounds

18

__% of burn units using whirlpool therapy use the immersion method

81

19

Small whirlpools should be filled with water between __ to __ degrees Fahrenheit. Larger whirlpools need to be slightly warmer, but should never exceed ___ degrees

92-98

102

20

Whirlpool treatments should be completed in __-__ minutes

10-20

21

What are 3 advantages to whirlpool treatment?

- provides a comfortable environment to perform ROM exercises
- promotes moist wound healing
- available in most clinical settings

22

What are 4 disadvantages to whirlpool treatment?

- the irrigation pressure cannot be calibrated
- there is potential for maceration, edema, and cross-contamination
- time intensive for setup and cleanup
- expensive

23

What can be defined as the delivery of wound irrigant under pressure by an electrically powered device?

Pulsed Lavage

24

What are the 4 positive effects of pulsed lavage?

- Irrigates wound bed with precisely calibrated pressure
- Assist with obtaining/maintaining moist wound environment
- Facilitates debridement
- May enhance granulation tissue formation, epithelialization, and tissue perfusion

25

In what type of wounds is pulsed lavage indicated?

- arterial insufficiency wounds
- venous insufficiency wounds
- diabetic ulcers
- pressure ulcers
- small burns
- surgical wounds
- wounds with tunneling/undermining

26

When is pulsed lavage contraindicated?

- in wounds with exposed arteries, nerves, tendons, capsules, or bone
- on facial wounds
- recent grafts or surgical procedures
- wounds that are actively bleeding

27

Patients with a _____ allergy should not be treated with pulsed lavage

latex

28

What are 3 situations in which pulsed lavage should be used with caution?

- patients taking anticoagulants because of the potential for hemorrhage
- insensate patients to decrease the risk of unperceived trauma
- patients with deep tunneling wounds to prevent damage from the probing wound tip

29

If the pulsed lavage pressure is greater than 15 psi what is the risk?

increased bacteria penetration into wound tissues

30

Depending on the wound size and severity there should be anywhere around ____-____ mL of irrigant in the irrigant reservoir and should be between ___-___ degrees Fahrenheit.

1000-3000

102-106

31

What is the appropriate PPE requirement while performing pulsed lavage and why?

Everyone in the room is required to wear PPE in order to protect them from splash injury and aerosolization

32

In order to prevent cross-contamination what are the environmental requirements while performing pulsed lavage?

- room with four walls and a door
- cover IV sites/open areas not being treated
- wipe down all horizontal surfaces

33

What are the 6 advantages of pulsed lavage treatment?

- encourages thorough irrigation
- can be used in any setting and on a wound in any location
- quick
- low risk of cross-contamination
- decreased pain
- ergonomical

34

What are the 4 disadvantages of pulsed lavage treatment?

- messy
- expense
- not appropriate for large wounds
- some parts are "one-time use"

35

It has been shown that electrical stimulation can increase the rate of wound healing by ___% compared to standard care

144

36

Typical wound care electrical stimulation uses ____ volt pulse current

high

37

What are the 7 purported ways in which electrical stimulation is thought to facilitate wound healing?

- restores the current of injury
- causes galvanotaxis
- stimulates cells
- increases blood flow
- increases bactericidal abilities
- reduces edema
- facilitates debridement

38

Normally, the epidermis is electro____ with respect to the dermis creating a skin "battery". A break in skin integrity disrupts this battery making the wound electro____ compared to the surrounding tissues

negative

positive

39

What is galvanotaxis?

the stimulation of cells to move along an electrical current

40

Electrical stimulation-mediated angiogenesis may be mediated by what activation of what?

vascular endothelial growth factor (VEGF)

41

Does the antibacterial effect seem to be greatest under the anode or cathode?

cathode (negative electrode)

42

______ stimulation is believed to facilitate autolytic debridement

Negative/Cathodal

43

Electrical stimulation is indicated as an adjunct to would healing for what type of wound?

chronic or recalcitrant wounds that are clean or infected, granular or necrotic

44

According to the Center for Medicare and Medicaid Services electrical stimulation should be considered in patients with stage __ or __ pressure ulcers that fail to respond after 30 days of standard care

III or IV

45

What are the 4 contraindications to using electrical stimulation as an adjunct to wound healing?

- simple, uncomplicated wounds
- untreated osteomyelitis
- not in combination with topical agents containing heavy metals
- wounds that are actively bleeding

46

In what type of patients should electrical stimulation be used cautiously?

Patients with sensory neuropathy

47

What are the 3 techniques for applying electrical stimulation to facilitate wound healing?

- direct
- immersion
- periwound

48

Describe the direct technique

A saline or hydrogel moistened gauze is placed within the wound bed and covered with a carbon electrode.
The return electrode should be placed approximately 15-20 cm proximally or on the opposite body surface

49

If there is a decline in wound status or if there is no improvement after _ weeks electrical stimulation, alternative interventions must be considered.

2

50

In what type of patient is the immersion technique best used for?

Patients with multiple and or foot ulcers

51

Describe the immersion technique

The wound is placed in a nonmetal basin filled with water. The treatment electrode is then placed contact side down within the basin, essentially making the entire water-filled area the treatment electrode.

52

What are the advantages to the periwound technique?

- the wound dressings can be kept in place
- decreased potential for wound contamination

53

E-Stim Parameters

Frequency: __-___Hz

80-115

54

E-Stim Parameters

Intesnity: __-___ Volts

75-200

comfortable parenthesia (submotor)

55

E-Stim Parameters

Interpulse Interval: __-___ microseconds

50-100

56

Is the anode or cathode used to decrease wound infection?

cathode

57

Is the anode or cathode used to restore the normal current of injury, promote granulation tissue formation, and enhance epithelialization?

anode

58

Due to the varying effects of e-stim polarity when should the cathode be used?

the first several days of treatment because it may reduce bioburden (even in wounds that are not infected)

59

How long should e-stim treatment sessions be?

45-60 minutes or as little as 30 minutes if performed BID

60

How many times per week should e-stim be performed in IP and in OP?

IP: once or twice daily

OP: 3 times per week

61

What are the 4 advantages to e-stim?

- research supports its efficacy
- can be used in any setting due to its portability
- painless
- less setup and cleanup time than whirlpool

62

What are the 3 disadvantages to e-stim?

- time consuming
- increased risk of wound contamination
- not appropriate for large, extensive burn wounds

63

What are 2 alternatives to electrical stimulation?

- ultrasound
- hyperbaric oxygen

64

There appears to be sufficient evidence that states ultrasound is helpful in facilitating healing in _______ wounds

recalcitrant/chronic

65

What are the proposed effects of ultrasound?

- enhances all 3 phases of wound healing
- enhances wound contraction
- improves scar pliability

66

What 3 things does ultrasound increase during the wound healing process?

- collagen deposition
- granulation tissue formation
- angiogenesis

67

Noncontact low frequency (25-40 kHz) ultrasound in combination with saline mist can help to do what 2 things?

- debride wounds with adherent fibrin
- decrease bioburden within chronic wounds

68

What are the 4 contraindications to ultrasound for wound healing?

- untreated osteomyelitis
- wounds with active profuse bleeding
- severe AI
- DVT

69

What are the 3 application techniques for ultrasound?

- direct
- immersion
- periwound

70

Describe the application of direct ultrasound

Deep wounds should be filled with amorphous hydrogel or normal saline to allow for the transmission of energy into the wound bed.
The wound must be covered with a barrier to prevent contamination from the conductive gel.
Apply ultrasound gel over the barrier.

71

What type of barrier transmits the greatest amount of ultrasound energy?

sheet hydrogels

72

True or False

It is appropriate to use varying barriers when treating wounds with ultrasound.

False

They should use the same type of barrier to ensure a consistent treatment dosage

73

When performing immersion ultrasound how should the sound head be held in respect to the wound?

0.5 to 1.0 cm away from the surface of the wound and periwound

74

Ultrasound Parameters

Frequency: __ MHz for superficial wounds and __ MHz for deep wounds

3.0

1.0

75

Ultrasound Parameters

Intensity: __-__ W/cm squared

0.5-1.0

no greater than 1.5 for remodeling closed wounds

76

Ultrasound Parameters

Pulse Rate: __-__%

20-25%

77

The treatment area for ultrasound should be divided into zones equal to __ times the area of the sound head.

1.5

78

Each ultrasound treatment zone should be treated for _ minutes initially, increased to 30 second intervals until reaching _ minutes of treatment per zone.

2

3

79

How many times per week should ultrasound be performed in acute wounds and in chronic wounds?

acute: once or twice daily

chronic: 3 times per week

80

Noncontact low-frequency ultrasound Parameters

Frequency: __-__ kHz

25-40

81

Noncontact low-frequency ultrasound Parameters

Treatment Time: __-__ seconds per cm squared with a minimum of _ minutes for wounds less than 15 cm

20-60

4

82

What are the 5 advantages to using ultrasound as an adjunct for wound healing?

- can be used in any setting
- quick
- less setup and cleanup time
- does not hyperhydrate
- does not require dependent positioning

83

What are the 4 disadvantages to using ultrasound as an adjunct for wound healing?

- not as much research support
- not appropriate for large wounds
- may be painful or difficult to perform
- increased risk of contamination

84

What are the 8 proposed effects of negative pressure wound therapy?

- increase local blood flow
- decrease wound/periwound edema
- increase granulation tissue formation
- increase angiogenesis
- increase epithelialization
- decrease wound bioburden
- promote cell proliferation
- maintain moist, warm wound environment

85

What are 3 examples in which NPWT can be used on a wound?

- postsurgical wounds and grafts
- wounds with exposed deep tissue or hardware
- traumatic wounds

86

In what type of wounds is NPWT contraindicated?

- dry wounds
- necrotic wounds
- wounds in body cavities
- wounds over malignancies
- in the presence of exposed blood vessels
- untreated osteomyelitis

87

Caution should be used with applying NPWT to what type of patient?

patients on anticoagulants or with wounds that are actively bleeding

88

What is black polyurethane foam used to do?

enhance granulation tissue formation and wound contraction

89

What is white PVA foam used to do?

enhance epithelialization

90

How much pressure is applied during NPWT?

50–175 mm Hg

125 mmHg is optimal

91

How long is the NPWT dressing left in place?

12-72 hours

92

What are the 3 advantages to using NPWT?

- may cost less over time
- can be used in any setting
- helps maintain a warm, moist wound environment

93

What are the 7 disadvantages to using NPWT?

- no standard for use
- possibly painful
- may hinder patient mobility
- noisy
- challenging to obtain an air-tight seal
- may cause skin damage and ulceration due to negative pressure
- expensive

94

Tissue partial pressure of oxygen must be greater than __ mm Hg for normal healing

40

95

What are the 4 ways in which hyperbaric oxygen may enhance wound healing?

- increases the oxygen concentration gradient
- reduces bacterial growth
- increases angiogenesis, granulation tissue formation, epithelialization, and wound contraction
- reduces edema

96

What are the 7 indications for hyperbaric oxygen?

- gas gangrene
- peripheral ischemia
- crush injury
- Wagner grade 3 or higher
- progressive necrotizing fasciitis
- osteomyelitis
- osteoradionecrosis

97

What are the 6 contraindications to hyperbaric oxygen?

- DVT
- congestive heart failure
- claustrophobia
- pregnancy
- severe AI
- noncomplicated wounds

98

When patients are in a hyperbaric oxygen treatment they are breating 100% at __-__ atm

2.0-2.5

99

If wound size does not decrease by 50% after __ hyperbaric oxygen treatments, the wound is unlikely to respond to this modality.

10

100

What is the main advantage of systemic HBO?

the TCOM test can be used to help the HCP determine the potential for improvement with therapy

101

What are 2 disadvantages to using hyperbaric oxygen?

- extremely high cost
- extensive treatment time