Studying (coughcrammingcough)

What I did not mention in my previous post was the phrase that I uttered in just about every conversation I had in Boston: "a lot of possibilities"... this referred to the exactly that in so many different facets, but until I can get started on making some of them into reality I have a test to study for...

Here's a quick review of what I am reviewing for tomorrow's "Specific Systems" exam (a lot of this is from the notes provided by a great specialist in wound care, I would like to acknowledge him for this information but will not be putting his name just yet):

PT in Wound Care:

• The Integumentary system is one of the four main systems we PT's treat (along with musculoskel., neuromuscular, and cardiovascular)
• A&P of Skin (epidermis, dermis, subcutaneous tissue)
• 

Holy jeez... I just lost about 2 hours of work that I had for the rest of this entry... oy vey... boo to you blogspot for not helping me retrieve that draft I was trying to save :(

well, it was a great review for me to type up even if it didn't get put up here for you all to "enjoy"

I was up to talking about specific interventions for wounds, specifically at types of dressings... darn it! stuff like that (losing a lot of work because of internet foolishness) really upsets me... but I have no time to be upset therefore I will try to continue where I left off or jump to something that would actually make sense... dang I am pissed about that though... I bring you to a type of intervention for wounds

• Adjuncitve therapies (all modalities have indications and contraindications not listed here for time purposes:):
• Vacuum Assisted Closure (V.A.C.) - removes interstitial swelling, increases rate of granulation tis. formation
• Non-contact Normothermic Wound Therapy (NNWT) - maintains a warm and moist environment thus helping the body heal the wound
• E-stim
• Ultrasound
• Ultraviolet C
• Hyperbaric Oxygen Therapy (HBO)
• Cold Laser (Low Level Laser Therapy-LLLT) - No contraindications except you need to avoid pointing this into the eyes
• In general, factors that adversely affect wound healing can be remembered by using the mnemonic device DIDN'T HEAL
• Diabetes, Infection, Drugs, Nutritional problems, Tissue necrosis, Hypoxia, Excessive tension on wound edges, Another wound, Low temp.
  
• Dressings:
• Alginate: highly absorbent (made of seaweed extract), can be used to pack wounds
• Foams: useful for absorbing and cleaning wounds with minimal exudate
• Hydrocolloid: used for dry wounds
• Hydrogel: see Hydrocolloid also can add anesthetic element
• Films: used to cover wounds whether it is dry or it is being packed with absorbent dressings
  
• Types of Burns: scalds, flame, flash, contact, electrical (only show small amount of damage externally, most of damage internal), chemical, special consideration for burns in elderly
• Degrees of Burn: 1st-just epidermis, 2nd-partial-thickness (goes into dermis - treated as full thickness), 3rd-full-thickness (through dermis and possibly through subcutaneous layer), 4th-damage extends to bones, muscle, tendon, fascia...
• I would like to reiterate how upset I am about losing so much of this post...
• Extent of Burns: expressed as a percentage of TBSA, Rule of Nines used (different for children, an alternative that is said to be more accurate and age specific is the Lund-Browder Method), another method is the palm method which considers the patients hand on one side to be equal to 1% of TBSA (used for small or irregularly shaped burns)
• Generally important to keep wound clean, infection free (defined as 100,000 bacteria per gram of tissue for normal level immune systems)
• Complications of burns include HO (formation of bone where there wasn't any before), peripheral neuropathy, pathological scars, inhalation injury, metabolic complications, cardiac/circulation complications
• PT Goals of the Burn patient
• Acute stage: limit loss of ROM/prevent contractures - PROM performed, increasing AROM and strengthening, reduce edema, splinting, antideformity-positioning
• Subacute: Functional training (ADL's), AROM/PROM, strengthening, minimize edema, scar management
• Pressure Injuries- often happen at bony prominences and factors include shear, friction, moisture, heat, over compression, medical co-morbidities, malnutrition
• Pressure Injury Classifications (full versus partial thickness):
1. area of swelling
2. partial thickness - can go into dermis but not through it - presents as a blister, abrasion or shallow crater
3. full thickness - damage to subcutaneous, may get to fascia but not through it
4. full thickness through fascia thus damaging muscle, bone, tendons and joint capsules
• Diabetic ulcers/management
• Venous/Arterial insufficiency ulcers (2 separate kinds)
• Review of ABI: 1.2 usually indicates a patient with diabetes and is a false negative for what the test is looking for (secondary to hardening vessels), if it is <0.8 then compression is contraindicated, <0.5 tissue necrosis is present but debridement is contraindicated
  
• PT Implications
• Status Post (S/P) Bypass Sx (Surgery): assess the following: suture lines, skin flaps, pulses, temp, swelling, breathing capabilities, pain... log-rolling indicated for aortoiliac Sx, WBAT (except with foot complications), avoid elevation (above heart)
• S/P Endovascular procedures: complete and strict bed rest for 4-6 hrs., continuous pressure on puncture site, unrestricted activity next day
• S/P Plastic Sx (skin grafts) - complete and strict bed rest for 5 days with dressing left in place for the same length, leg elevation, ambulation based on surgeon's orders
  
• There are cases of amputation with certain wounds/burns bringing me to a whole other part of the exam material...

Amputations... actually at this point I need some sleep... but this is a pretty lengthy subject... there will also be a section of the exam reserved for "Female Genital Issues"... I will direct you to the Women's Health Section of the APTA for more information on this subject...
Good Night (or day or morning, depending on whenever you read this...)
All the best.