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Wound healing - BMI - INC risk for P ulcer at what #?
</= 21
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Wound healing - hydration - how much? how much for pts on air-fluidized beds
- 3 or more L of H2O/day
- Air-fluidized bed = 40-60 ml/Kg/day
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Wound healing - calories; protein; albumin
- Calories - 25-35 kcal/kg/body weight
- Protein - 1.5-2.5 gm/kg body weight
- Albumin - 3.5-5.5 mg/di
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E-stim for wound healing - 3
- Continuous waveform application w/DC
- High-voltage pulsed current
- Pulsed biphasic current
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What does (—) P wound therapy (VAC) help with? - 4
- Infection
- Edema
- Maintains a moist wound environment
- INC localized blood flow
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(—) P wound therapy (VAC) - parameters - 2
- Open-cell foam dressing placed into wound
- P - controlled sub atmospheric P - typically 125 mmHg below ambient P
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Which wound healing modality can be used w/infected wounds?
VAC
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Hyperbaric oxygen (HBO) - does what?indications (7); CONTRA (5)
DEC edema + hyperoxygenating tissues
- Osteomyelitis
- Diabetic wounds
- Crush injuries
- Compartment syndromes
- Thermal burns
- Radiation necrosis
- Compromised flaps/grafts
- CONTRA:
- Untreated pneumothorax
- Active malignancy
- Pregnancy
- Seizures
- Emphesyma
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Wound cleansing - what saline?
Normal - 0.9% NaCl
-
Wound cleansing - irrigation - at what psi?
4-15
-
Wound cleansing - hydrotherapy - indicated for
Ulcers w/large amounts of exudate, slough & necrotic tissue
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Selective debridement - types - 3
-
Nonselective debridement - 1; ex - 4
- Mechanical:
- Hydrotherapy - Whirlpool
- Wet-to-dry gauze dressing
- Wound irrigation - pulsatile lavage
- Dextronomers
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Autolytic debridement - done how?; indications (4); CONTRA (3)
- Promotes faster wound healing w/less pain by facilitating moist wound environment
- Occlusive or semiocclusive moisture-retentive dressings
- Ex: hydrocolloids, hydrogels, transparent films
- Indications:
- Individuals on anticoagulant therapy
- Individuals who can't tolerate other forms of debridement
- All necrotic wounds in people who are medically stable
- CONTRA:
- Infected wounds
- Wounds of immunosuppressed individuals
- Dry gangrene or dry ischemic wounds
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Enzymatic debridement - what type; Indication (4); CONTRA (3)
Selective - CHEMICAL
- Indications:
- Infected & non-infected necrotic wounds
- Eschar after cross-hatching
- Homebound individuals
- People who can't tolerate surgical debridement
- CONTRA:
- Ischemic wounds unless adequate vascular status has been determined
- Dry gangrene
- Clean, granulated wounds
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Mechanical debridement - what type; does what?; indications (1); CONTRA (1)
Nonselective - Removes tissue by physical forces - May remove healthy tissue as well
- Indications:
- Wounds w/moist necrotic tissue or foreign material present
- CONTRA:
- Clean, granulated wounds
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Sharp Debridement - what type?; indications (4); CONTRA (1)
- Indications:Eschar
- Thick, adherent necrotic tissue
- Deep (stage III/IV) or complicated P ulcers
- Advancing cellulitus w/sepsis
- CONTRA:
- Individual on anticoagulant therapy
-
Panafil - what is it used for? What can be expected w/it?
- Keratolytic enzyme used for selective debridement
- Greenish or yellowish exude can be expected - normal
-
Post radiation therapy - observe for what? why? What is CONTRA?
- Skin care precautions - avoid topical use of alcohol/drying agents; avoid positioning pt on radiated site
- Bc immediate effects of radiation - erythema; edema; dryness; itching; hair loss; fingernail loss; loose skin
- CONTRA - heat modalities
-
Wound healing - E-stim - anode vs. cathode; placement how?
- Anode - promote healing in clean, uninfected wounds
- Cathode - promote healing in infected wounds
- PLACE ELCETRODE IN WOUND
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