WOUND HEALING ALTERNATIVES IN MANAGEMENT

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WOUND HEALING ALTERNATIVES IN MANAGEMENT

• JOSEPH MCCULLOUGH
• LUTHER KLOTH
• JEFFREY A. FEDDER

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HISTORY AND SUBJECTIVE EXAMINATION

• HISTORY
• Patient/Therapist relationship development
• Age, gender, occupation
• When did wound develop
• How did it start
• Sudden onset
• Gradual onset

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History

• What Happened
• Degree and location of immediate symptoms
• When did the patient first notice
• Medications
• History of peripheral vascular disease,
  hypertension or CHF

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History

• Allergies
• Previous treatment for same condition

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Social History

• Use of tobacco
• Diet
• Occupation
• caregivers
• Home/residence
• Hobbies

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Subjective information

• What are symptoms?
• Where are the symptoms
• How do the symptoms behave?-the area and behavior
  of symptom logy
• See diagram page 115 in text

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Objective Information

• Visual, smell, touch
• Gait
• Location
• Vascular
• Neurologic
• Size, depth, shape, girth
• ROM/Strength

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Assessment

• Examiner assimilates the subjective and objective
  information
• Establishes short and long term goals
• Incorporates patients goals in the process
• Selects the appropriate duration and treatment
  techniques to obtain goals

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CHAPTER 8

• CLINICAL MANAGEMENT OF CHRONIC WOUNDS

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WOUND ENVIRNOMENT

• Moisture
• Drainage- Transudate, Exudate, Pus
• Edema
• Scab Formation
• The Proliferative Phase of Wound Healing
• Re-epithelialization

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Infection

• Wound sepsis
• Wound Cleansing
• Guidelines for Evaluating topical Agents
• Cytotoxicity
• Contraindications

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Goal Setting

• (stg)Debride necrotic collagen
• Discontinue saline moistened gauze
• 25 reduction in wound depth in 3 weeks
• (LTG)PROTECT WOUND ENVIRNOMENT
• DISCONTINUE CADS
• 85 WOUND DEPTH IN 8 WKS-100 IN 12 WEEKS

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Goals

• Dietary considerations
• Podiatric
• Surgical considerations
• Pressure relieving device
• Education of caregivers

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CHAPTER 9

• PREVENTION AND MANAGEMENT OF PRESSURE ULCERS

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Etiology

• Pressure Induced Ischemia
• Time-Pressure Relationships
• Shearing forces -superficial and deep
• Dermal vascular arrangement
• Vascular occlusion time
• Pressure Gradients

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PRESSURE, SHEAR AND FRICTION EFFECTSON POSTIONAL
CHANGES AND CONDITIONS

• Position of Body
• Heel Ulcers
• Shearing Forces
• Friction

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RISK FACTORS FOR PRESSURE ULCERS

• Beds
• Wheelchairs
• Patients general physical medical and mental
  status

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Risk Factor Tools

• Braden Scale
• Norton Scale
• Gosnell Scale

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Risk Factors ( Generic )

• Immobility
• Inactivity
• malnutrition
• Sensory impairment
• cognitive deficits
• Pathological mechanical and physical states
• Medical diagnosis and physical condition
• Skin characteristics
• Medications
• Advancing Age

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Pressure Ulceration Interventions (generic)

• Appropriate PRD
• Dietition/Nurse recommendations
• Cleanse and dry skin
• Maintain linen and proper clothing
• Application of appropriate wound product
• Perform medical review of systems
• Review all medications

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Pressure Ulcer Staging

• Stage I-Nonblancable erythema of intact skin
• Stage II-Partial thickness skin loss involving
  epidermis or dermis or both
• Stage III-Full thickness skin loss involving
  damage or necrosis or subcutaneous tissue to
  underlying fascia
• Stage IV-Full thickness skin with destruction to
  muscle, bone, etc...

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OPEN WOUND AND PRESSURE ULCER DOCUMENTAION

• Stage Site Size
• Shape Tracing Graph Photo
• Undermining
• Probability of undermining
• duration before current examination
• PRD in bed or wheelchair
• Turning schedule
• Referral needed
• Correct Wheelchair fit

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Pressure Relieving Devices

• Measurements
• TIP-tissue interface measurement-electropneumatic
  sensor between support surface and highest point
  of pts bony prominence

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Types of PRDs-PRESSURE REDUCING DEVICES

• Foam
• Gel
• Water
• Static-Air
• Dynamic-Air
• Low Air Loss
• Air Fluidized

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CHAPTER 10

• TREATMENT OF WOUNDS CAUSED BY VASCULAR
  INSUFFICIENCY

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Venous Insufficeincy

• Pathogenesis
• Venous thrombosis
• Venous obstruction
• venous dilation or varicosity
• hemorrhage
• ulceration

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Clinical Features

• Occurs in lower extremity
• Hemosiderin pigmentation
• liposclerosis
• Edema
• Painless
• Slow onset
• Duration is very long

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Venous Ulcers

• Treatment
• Conservative/surgical approach
• elevation and compression
• Support stockings
• Cleansing
• Exercise-antigravitational

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Arterial Insufficiency

• Pathogenesis
• Arteriosclerosis obliterans
• Raynauds
• Intermittent claudication
• Thromboangitis obliterans-Beugers disease
• Necrotizing Vasculitides
• Sickle Cell anemia

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Arterial Ulcerations

• Well demarcated border
• lacks epithelieum
• location around toes, interdigital spaces, dorsum
  of foot, lat. Malleolus
• Decreased pulses
• pallor on elevation, rubor on dependency
• slow nail growth
• Loss of leg and foot hair
• Atropic skin