Module Four: Wound Care, Prosthetics

Wounds & Misc

100

Name the phases of the wound healing process?

Hemostasis Inflammation Repair/proliferation Remodeling/maturation

200

Name signs that would indicate abnormal wound healing

Absent inflammation Chronic Inflammation Hypogranulation Hypertrophic scarring Keloids Dehiscence

300

Your patient has a venous ulceration. You perform an ABI test & the value is .8. You proceed by:

Treating with compression: contraindicated if ABI <.6

400

What is the ideal wound healing environment?

Moist, warm, dead tissue removed (risk of infection if dead tissue remains, prevents epithelialization & granulation), no excess exudate (maceration), protected from invading pathogens, protecting from trauma during dressing changes

500

Your pt has a diabetic ulcer that penetrates Sub-Q tissue, extends into sub-Q fat and fascia. No gangrene or osteomyelitis are present. What stage is it?

Stage II (no gangrene/osteomyelitis present)

Burns

100

Your pt has a full-thickness burn to the R arm. How do you tx to prevent hypertrophic scarring?

Compression Bandage

200

You have a pt who's sustained a burn. You're careful to tx and watch for these complications

1. Compartment syndrome 2. Burn scar contracture 3. Infection: Pulmonary from inhaled toxins 4. Metobolic (increase in core temp, metabolic activity 5. CV: decrease in volume, decrease in CO 6. GI: shock, may need supplemental feedings

300

What're the different classifications of burns? (degrees & describe)

1st degree:superficial thickness - redness, no blistering, heals in 3-5 days 2nd degree: Superficial partial thickness - epidermis & part of dermis. Redness/blistering, PAINFUL! Heals in 2 wks, min scarring Deep partial thickness: epidermis & dermis, moist to dry texture, no blisters, EXTREMELY PAINFUL! scar formation, pigment changes 3rd degree: total dermis, white, waxy, tan, charred, scar formation, pigment changes, Decreased sensation - may not be as P!

400

You want to use positioning techniques to manage contractures. You do this by: (what positions will you place the pt?)

AVOID FLEX (may require splints) 1. GH: 90 deg AB w/slight scaption 2. Elbow: EXT 3. Wrist: EXT 4. MCP: FLX 5. PIP/DIP: EXT 6. Knee EXT 7. Ankle neutral 8. Neck: avoid chin to chest positions

500

Describe the PT management & goals of a patient who's sustained a burn:

Exam: 1. Pt hx, ROS, tests & measures Goals: ensure clean burn to allow healing/grafting, min. edema, prevent loss of ROM, prevent contractures prevent complications, educate on positioning, scar management

Gait

100

Loading response is mostly __ ms activity (Name the ms and how they act)

Eccentric knee EXT, pre-tibials, isometric AB

200

You see the greatest amount of DF in this phase of gait

Midstance

300

You hypothesize your amputee pt has weak quads. He/she may present with these gait deviations:

1. anterior trunk bending (secondary gait deviation) 2. Insufficient/absent knee flexion (2 deviation) 3. Excessive knee flexion (1) 4. early heel rise in midstance/knee FLX/drop off terminal stance (1) 5. Fear of knee buckling (2)

400

You should always measure gait characteristics with your amputee patients. These are some examples of outcome measures you can use.

1. gait speed 2. 10 m walk 3. 2 MWT 4. 6MWT: predictive of fxn 5. TUG 6. L-test Other outcome measures: 1. amputee mobility predictor 2. ABC scale

500

Name the phases of gait and explain each one naming key ms activity

Initial contact (ISO knee, hip ext, pre-tibials), loading response (ECC extensors), midstance (ecc soleus), terminal stance (gastroc for push off), preswing (SH biceps fem for knee flx), initial swing (momentum & pre-tib to bring foot to neutral), mid swing (same as initial swing), terminal swing (ecc HS)

Prosthetics

100

In normal midstance, you need eccentric soleus to control tibia moving forward. In prosthetic gait, this is replaced by:

hip extensors

200

If we don't strengthen hip EXT, we may see these gait deviations:

1. Excessive knee FLX from initial contact to midstance 2. Instability of prosthetic knee

300

To help the amputee pt, the TFA socket is set in a ___ tilt and __ (frontal plane). For the TTA pt, the socket is aligned in ___ tilt.

1. Posterior tilt 2. AD to get AB stretch & better length-tension 3. TTA: anterior

400

Pt with s/p TFA displays lateral trunk bending toward the involved LE while ambulating. What causes the gait abnormality?

Medial wall too high, Weak abductors, Abductor contracture

500

A pt s/p TFA ~ 4 wks ago is in your clinic. He's having trouble transferring and presents with weakness. You decide to improve gait mechanics by:

Performing prone hip EXT stretching (to prevent hip FLX contracture in the months to come)

More Wounds!

100

You're treating your pt with a diabetic ulcer on calf just superior to the medial malleolus. The wound is discharging heavy amounts of purulent drainage. What type of dressing do you use?

Calcium Alginate (foams)

200

What is an unstageable pressure ulcer?

Wound base is covered by slough and/or eschar

300

Your pt presents with diabetic foot deformity. You take the time to educate them on:

1. Checking feet daily/self-inspection/skin care 2. Visiting podiatrist regularly 3. Orthotics

400

You have a patient who presents with diabetic foot deformity. What tests & measures do you run?

1. Footwear observation 2. visual inspection of both ft 3. foot deformities 4. leg length discrepancy 5. ROM & Strength 6. Protective sensation 7. Vascular insufficiency 8. Edema 9. Balance

500

PAD classic sxs: CVI classic sxs: PAD & CVI Management

1. PAD sxs: intermittent claudication, aching/cramping in calves, reproducible onset of signs 2. CVI sxs: edema, sxs worse when standing A. PAD: sxs relieved by standing/dependent position, walking program 30 min, 3x/wk for 6 mo B. CVI: sxs relieved with elevation, walking, shifting weight. Exercise - calf pump, daily walking program. Elevate 20-30 min, 3+/day, use compression (unless contraindicated due to mixed arterial/venous disease)