Practical #2

Question 1

Neuropathic Wounds Pain

Answer 1

Lack of pain complaint due to neuropathy

Possible paresthesias

Question 2

Neuropathic Wounds Position

Answer 2

Plantar foot
Plantar aspect of metatarsal heads
Plantar aspect of midfoot if Charcot deformity
May occur under calluses
May occur in areas of pressure/friction from inappropriate footwear

Question 3

Neuropathic Wounds Presentation

Answer 3

Round, punched-out lesions
Callused rim
Minimal drainage unless infected
Eschar or necrotic material uncommon unless infected

Question 4

Neuropathic Wounds Periwound

Answer 4

Skin is dry, cracked
Callus present
Structural deformities
Claw toes
Rocker-bottom foot/Charcot deformity
Prior amputation

Question 5

Neuropathic Wounds Pulses and Temp

Answer 5

both normal

Question 6

Neuropathic Tests and Measures

Answer 6

Sensory integrity
Sensation to light touch
Sensation to vibration

Question 7

Neuropathic Education

Answer 7

Daily foot checks

Question 8

Neuropathic PT Inteventions

Answer 8

Offloading

Question 9

Neuropathic in clinic

Answer 9

Estim

Question 10

Arterial Pain

Answer 10

Pain, often severe, increased with elevation

Question 11

Arterial Position

Answer 11

Primarily lower extremity
Commonly toes, lateral malleolus, anterior leg
Rarely above the knee
Trauma key precipitating factor
Distal toes
Dorsal foot
Areas of trauma

Question 12

Arterial Presentation

Answer 12

Round, regular
May conform to precipitating trauma
Pale granulation tissue if present
Possible necrotic tissue/black eschar/ Gangrene
Minimal or no bleeding/drainage

Question 13

Arterial Periwound

Answer 13

Thin, shiny, anhydrous skin
Loss of hair growth
Thickened, yellow nails
Pale, dusky, cyanotic skin
Possible muscle atrophy
Possible dependent rubor
Loss of hair growth
Thickened, yellow nails
Pale, dusky, cyanotic
Black eschar

Question 14

Arterial Pulses and Temperature

Answer 14

decreased in both

pulses can be absent

Question 15

Arterial Tests and Measures

Answer 15

ABI
TBI
TCPO2

Question 16

Arterial Education

Answer 16

Protect feet and legs from

trauma, chemicals, excessive heat and cold

Question 17

Arterial PT Interventions

Answer 17

Aerobic Exercise

Question 18

Arterial in clinic

Answer 18

Estim

Question 19

Venous Pain

Answer 19

Mild to moderate

Decreased with elevation/compression

Question 20

Venous Position

Answer 20

Medial malleolus
Medial lower leg
Areas of trauma

Question 21

Venous Presentation

Answer 21

Irregular shape
Red, ruddy wound bed
Fibrous, glossy coating
Copious drainage

Question 22

Venous Periwound

Answer 22

Edema
Cellulitis, dermatitis
Hemosideran deposition
Lipodermatosclerosis

Question 23

Venous Pulses and Temperature

Answer 23

Normal

Normal to mild warmth

Question 24

Venous Tests and Measures

Answer 24

ABI

Question 25

Venous Education

Answer 25

Etiology | Calf Muscle Pump

Question 26

Venous PT Intervention

Answer 26

Elevation

Question 27

Venous in Clinic

Answer 27

Compression

Question 28

Pressure Pain

Answer 28

Category I pressure ulcers may be tender instead of painful Patients with neurological deficits may not perceive pain Patients who are unable to communicate may demonstrate pain by grimacing, withdrawal, or moaning

Question 29

Pressure Ulcer Position

Answer 29

Majority on lower half of body over boney prominence 95% of pressure ulcers located over sacrum, greater trochanter, ischial tuberosity, posterior calcaneous, lateral malleolus Areas of outside pressure: casts, tubing, shoes

Question 30

Pressure Presentation

Answer 30

Patients with full-thickness pressure ulcers more likely to have multiple ulcers

Question 31

Pressure Periwound

Answer 31

Nonblanchable erythema Mottled Ring of inflammation around ulcer Dermatitis

Question 32

Pressure Pulses

Answer 32

Usually not applicable due to proximal ulcer location | Usually normal unless concomitant PVD

Question 33

Pressure Temperature

Answer 33

Increased in areas of reactive hyperemia | Decreased in areas of ischemia

Question 34

Pressure tests and measures

Answer 34

Pressure ulcer staging

Question 35

Pressure ulcer education

Answer 35

Control pressure and shear forces Positioning/offloading/pressure relief/turn schedule Importance of proper support surfaces (mattress/cushion)

Question 36

Pressure PT Inteventions

Answer 36

Assist with mobility, transfers, and weight shifts Flexibility exercise to minimize contractures Gait training Transfers and bed mobility Emphasize minimizing friction and shear

Question 37

Pressure ulcer in clinic

Answer 37

Estim

Question 38

Pressure Ulcer Stage I:

Answer 38

Intact skin with non-blanchable redness of a localized area

Question 39

Pressure Ulcer Stage II:

Answer 39

Partial thickness loss of dermis. Presents as a shallow open ulcer with a red pink wound bed without slough

Question 40

Pressure Ulcer Stage III

Answer 40

Full thickness tissue loss | Subcutaneous fat may be visible but bone, tendon or muscle not exposed

Question 41

Pressure Ulcer Stage IV:

Answer 41

Full thickness tissue loss with exposed tendon or muscle

Question 42

Estim Frequency:

Answer 42

80–115 Hz

Question 43

Estim Intensity

Answer 43

75–200 V

Question 44

Estim interpulse

Answer 44

50–100 microseconds

Question 45

Estim time

Answer 45

45-60 mins | 3–7 day/wk for 30 min/day