Integumentary Intervention Plan Practice Flashcards

Practice flashcards covering integumentary intervention and wound treatment principles based on Jeff Feedar's PT lecture notes.

What is the core philosophy for wound treatment according to Jeff Feedar, PT?

Everything comes down to nutrition and blood flow

What change in wound drainage can indicate a potential infection?

Change in amount or color

How does a change in wound odor affect the assessment of infection?

It often indicates signs of a potential infection

What peri-wound signs suggest infection?

Redness or warmth

What patient-reported change often indicates infection?

Increase in pain or tenderness

What change in the quality of granulation tissue suggests infection?

Poor quality tissue or failure to produce good quality tissue

In terms of wound geometry, what indicates a failure in recovery?

No measurable wound contraction over time

Which systemic physical symptoms indicate potential wound infection?

Fever, loss of appetite, unusual fatigue, and depression

What is considered the gold standard for identifying tissue infection?

Tissue culture/punch biopsy

How should a PT determine if a wound is acute or chronic?

Check history for time of onset and evidence of the three phases of wound healing

What specific removal is necessary to create an ideal wound environment?

Removal of necrotic tissue and exogenous pathogens

When should debridement take place in a wound?

It should always take place if dead tissue is present, with very few exceptions

How should wound drainage be managed for an ideal environment?

It must be controlled; drainage is good but not in excess

If an infection is confirmed, what can be added to the wound to kill off cells?

Cytotoxic materials

What is the definition of exudates according to the notes?

A liquid inflammation product

What type of microflora should be maintained in the wound?

Endogenous nonpathogenic microflora

What are the three goals of moisture management in wound care?

Maintain moisture, create moisture if absent, and control moisture in excess

How can blood flow be assessed during a wound examination?

History, color, temperature, and Doppler

What is one method a PT can use to facilitate more blood flow?

Positioning

How does nutrition contribute to facilitating blood flow?

It supports blood flow and overall wound healing

Which dietary components are highlighted as nutritional support?

Vit C, protein, and fluids

What role do dressings and moisture play in blood flow?

They help facilitate and maintain blood flow within the wound environment

Which electro-modality can assist in facilitating blood circulation?

Electrical Stimulation (E-stim)

What intervention is used to manage edema and maintain blood flow?

Compression

Besides warmth and blood flow, what chemical state should be maintained in the wound?

Acidic (Maintenance of voltage gradients)

What specific biological components must be protected in a wound?

Growth factors

From which cells are growth factors in a wound released?

Platelets

What measures should a PT take to protect a wound from infection?

Wear gloves, mask, keep wound covered, and use sterile technique

How should dressing changes be managed to protect the wound?

Minimize dressing changes to avoid disturbing the wound

How should protection be planned in a hospital setting?

Place signs outside patient rooms and communicate with nursing staff

What is the goal for controlling epithelialization?

Granulate from the bed up and prevent the wound from closing early

How often should the client and the wound be checked?

Every day

What constitutes the procedural pathway for interventions?

Cleansing, debridement, topical agents, dressings, pressure relief, modalities, and follow-up care

Name three methods of wound cleansing.

WP, pulsatile lavage, and saline rinse

What are the two categories of debridement?

Non-selective and selective

What does PRD stand for?

Pressure Relieving Devices

List five electrical modalities used in wound treatment.

UV, US, E-stim, hyperbaric $O_2$, and cold laser

What are two examples of 'special interventions' for wounds?

Splinting and total contact casting

What tools are used for edema control?

Pressure garments, elevation, and pneumatic pump

What are the three specific requirements for nutritional support?

Vit C, protein, and fluids

What follow-up care techniques are recommended?

Scar massage, HEP, PRDs, pressure garments, and referral

What is the primary reasoning for wearing PPE in wound care?

To protect the therapist

What are the two types of gowns used?

Clean and sterile

What is the purpose of wearing a cap?

Prevention of spread of pathogens between therapist hair and the wound

What is the purpose of wearing a mask?

Protecting the patient from mouth pathogens and the therapist from splashes

Why are goggles or safety glasses required?

Important for any kind of splash

Name a common risk for exposure involving hydrotherapy.

Pulsatile lavage (Pulsavac)

Identify three conditions or fluids that increase exposure risk.

Contact with other body fluids, coughing, and TB or Hep B

When is sharp debridement a risk for exposure?

When there is contact with active bleeding or dried blood

What is a major rationale for the decline in Whirlpool (WP) use?

Risk of contamination and cross contamination

What is the risk of a 'dependent position' during WP for arterial disease patients?

Body parts hanging down is usually not good for these wounds

What physical loss occurs for the patient during WP?

Loss of endogenous fluids and heat loss (core and surface)

How does WP affect the inflammatory stage of healing?

It may prolong the inflammatory stage

What physiological changes occur in heart and respiratory rates during WP?

They increase

What does WP do to normal skin defenses?

It inactivates them

What is the recommended duration for a WP session?

Small areas for $5-10\,minutes$

What temperature should WP use?

Neutral warmth (normothermia)

For which specific injury is WP considered an indication for intensive cleaning?

Burn wounds

When is WP indicated for peripheral circulation?

On selected patients needing stimulation

What is a contraindication for WP treatment?

Granulation tissue

What should be avoided or minimized during WP to protect tissue?

Agitation or the use of water jets

What are five synonyms for pulsed lavage?

Lavage, jet lavage, mechanical lavage, pulsatile lavage, and mechanical irrigation

What is the goal of pulse lavage pressure?

To use the least PSI possible

What is the specific PSI range for pulsed lavage?

$$4-15\,psi$$

What is the function of surfactants in cleansing?

Cleaning a messy wound without whirlpool

What is the cytotoxicity dilution ratio for surfactants?

$$1:10$$

When are surfactants contraindicated?

If PSI is over $8$ or on clean wounds ready for autolytic cleansing

What is the most gentle cleansing rinse?

Saline rinses

What is the maximum PSI for pouring or bulb syringe saline rinses?

$$\lt 4\,psi$$

Which organization position HOD P06-18-31-36 defines PT responsibilities?

House of Delegates

According to HOD P06-18-31-36, what intervention is exclusively performed by the PT?

Sharp selective debridement

What manual therapy components are exclusive to PTs according to HOD P06-18-31-36?

Spinal and peripheral joint mobilization/manipulation and dry needling

What does the 'P' stand for in HOD P06-17-05-04?

Position

What is debridement?

The removal of foreign material including biofilm, and dead or damaged tissue

Do PTs debride in the absence of necrotic tissue?

No

What must a PT educate a family about regarding necrotic wounds?

A necrotic wound gets bigger before it gets better

What are the two key functions of debridement?

Reduce bioburden/prevent infection and restore circulation for oxygenation

What does 'N' debridement stand for?

Non-selective (takes out all tissue)

What does 'S' debridement stand for?

Selective (controlled removal)

How do wet-to-dry dressings function?

Gauze is applied wet with saline and when dry, it is removed to pull off eschar and exudates

What is a major drawback for the patient using wet-to-dry dressings?

It is painful

When is N-surgical debridement indicated?

When rapid removal is needed under general anesthesia

What defines N-forceful irrigation?

A device rubbed right over the top of the wound

When is N-forceful irrigation contraindicated?

Clean, non-infected, granulating, superficial wounds

What is the primary indicator for S-sharp debridement?

Necrotic tissue

What is a contraindication for S-sharp debridement?

Viable tissue

In enzymatic debridement, what are enzymes mixed with?

Topical gel or petroleum jelly

How often is enzymatic debridement applied?

Once a day

What type of enzyme breaks down collagenous materials in chronic wounds?

Protease

Why is chemical/enzymatic debridement contraindicated for large wounds?

It is expensive, painful, and takes a long time

What are three alternative names for Maggot Debridement Therapy?

Maggot therapy, Larval therapy, and Biosurgery

Why has there been a new interest in MDT?

Multi-resistant bacteria like staphylococcus aureus

What is the only reported side effect of MDT?

Sensation of crawling

What wound environment is compatible with MDT?

Moist wound healing

What wound environment is a contraindication for MDT?

Wet wounds (maggots can't survive)

What is autolytic debridement?

The removal of necrotic tissue through self-produced enzymes naturally in wound fluids

What are the benefits of autolytic debridement?

Less painful, less traumatic, less expensive, and more biocompatible

When is autolytic debridement contraindicated?

When maceration is present in the peri-wound tissue

What comparison should always be made when evaluating topical agents?

Cytotoxicity vs biocompatibility

How does Povidone-Iodine rank in cytotoxicity?

Too cytotoxic for PT practice standards