2.3: Evaluation, prognosis, and developing patient goals

What is the evaluation process?

Summarize exam findings and then identify the problems using ICF components

What categories do you use to organize to find a diagnosis?

- Wound description

- Wound healing phase

- Impairments

- Activity and participation limitations

- Contextual factors

What is a PT diagnosis?

Summary of clusters of clinical and functional signs and symptoms

What is a wound diagnosis?

Description of wound condition, classification, or staging

What is the wound healing phase diagnosis?

The combination of time (acute vs chronic) and phase of wound healing (inflammation, proliferation, epithelization)

What is the appearance and description of the acute inflammation phase?

Shallow crater with pink to red tissue: serous/serosanguinous exudate present

What is the appearance and description of the chronic inflammation phase?

Presence of necrotic tissue, biofilm/yellow slough

What is the appearance and description of the absence of the inflammation phase?

body does not mount an adequate inflammatory response --> wound surface is covered with necrotic tissue

What is the appearance and description of the acute proliferation phase?

Shiny, bright pink to red granulation tissue

What is the appearance and description of the chronic proliferation phase?

Excessive formation of granulation tissue/ hyper-granulation tissue.

What is the appearance and description of the absence of the proliferation phase?

Necrotic tissue may still be present. Pale wound bed; impaired angiogenesis. Slow --> absent wound contraction

What is the appearance and description of the acute epithelialization phase?

Normal: epidermal cells migrating from wound edge

What is the appearance and description of the chronic epithelialization phase?

Build up of epidermal cells: e.g., Hyperkeratosis, epiboly

What is the appearance and description of the absence of the epithelization phase?

Wound epithelization 'stalls'; senescence

What do impairments indicate on the ICF model?

- Skin/wound: wound healing phase

- sensation

- pain

- swelling

- limited ROM

- impaired mm performance

- impaired balance and/or coordination

What do activity limitations indicate on the ICF model?

- ADL's

- Bed mobility

- Transfers

- Ambulation

What do participation limitations indicate on the ICF model?

- getting to and from work

- Getting to and from leisure activities

- Role as family member

What do environmental factors indicate on the ICF model?

- Living environment: impact of poverty on wound healing

- presence of stairs within or accessing the home

What do personal factors indicate on the ICF model?

- Substance/ETOH abuse

- Ability to care for wounds

- Poor compliance with medication

Acute, clean partial thickness wound/incision will heal within _____________ in the

absence of systemic complications that slow healing.

14 - 21 days

The ______ __ ________ __ _____ is a good indicator of future closure.

rate of decrease in size

Chronic wounds can get 'stuck' in the inflammatory stage with either hypo- or

hypergranulation, preventing what?

contraction and closure

While we may not be able to predict the time to wound closure, we can develop goals based on what?

PT diagnosis:

1. wound condition and healing phase

2. impairments

3. activity and participation limitations

4. contextual factors

What do goals serve as?

Basis for planning interventions

What is the intervention if the goal is to decrease necrotic tissue?

Cleanse and debride

What is the intervention if the goal is to control exudate/drainage?

Select and apply an appropriate dressing

What is the intervention if the goal is to decrease edema?

Compression (dressing); pt education

(elevation, activate mm pump)

What is the intervention if the goal is to increase ROM?

Stretching and ROM exercises

What is the intervention if the goal is to increase IND in activities?

Strengthening exercises;

Functional movement re-education