Wound care : a collaborative practice manual / edited by Carrie Sussman, Barbara Bates-Jensen.

Format:

Book

Contributor:

Sussman, Carrie.

Bates-Jensen, Barbara M.

Language:

English

Subjects (All):

Wounds and injuries--Treatment.

Wounds and injuries.

Wounds and Injuries--nursing.

Wounds and Injuries--rehabilitation.

Physical Therapy Modalities--methods.

Wounds and Injuries--diagnosis.

Medical Subjects:

Wounds and Injuries--nursing.

Wounds and Injuries--rehabilitation.

Physical Therapy Modalities--methods.

Wounds and Injuries--diagnosis.

Physical Description:

xvi, 720 pages, 32 pages of plates : illustrations (partly color), forms ; 29 cm

Edition:

Third edition.

Other Title:

Wound care : a collaborative practice manual for health professionals

Place of Publication:

Baltimore ; Philadelphia, Pa. : Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.

Summary:

This latest edition integrates the most recent scientific findings with principles of good wound care to provide you with a complete set of current, evidence-based practices. Whether you are a physician, podiatrist, physician assistant, physical therapist, or nurse in any clinical setting, this text is designed to enable you to quickly jump to the information you need to respond to your patients' individual wound needs with the best care possible. This Third Edition continues to feature a multidisciplinary team of authors and contributors. Their various approaches and viewpoints combine to provide you with a variety of strategies and tactics for dealing with all types of wounds and all stages of wound care.

New to this Edition: Chapter on wound pain management presents the latest evidence on wound pain, as well as pharmaceutical and non-pharmaceutical wound pain interventions, Chapter on negative pressure wound therapy sets forth step-by-step procedures that enable you to use this therapy for many types of hard-to-heal wounds, Coverage of technologic advances, such as the use of ultrasound for wound debridement, laser, and a single patient use disposable device for delivering pulsed radio frequency, provides you with the most current information available in the field.

More Highlights and Features You'll Find Inside: Step-by-step wound care procedures help you to confidently administer both standard and cutting-edge wound care interventions and therapies, Patient teaching guidelines highlight critical points that patients and caregivers need to understand, Clinical case studies at the end of each chapter show how you can incorporate the information from the text into your everyday practice, Over 300 photos and illustrations help readers to visualize key concepts.

Contents:

Chapter 1 The Diagnostic Process 2

Step 1 Assessment Process 2

Review of Admission/Referral 3

Patient History 3

Systems Review and Physical Assessment 5

Wound Assessment 9

Patient Candidacy for Physical Therapy Services 9

Step 2 Diagnosis 9

Examination Strategy 9

Evaluation and Diagnosis 10

Step 3 Prognosis and Goals 11

Wound Prognosis Options 11

Evaluation of Progress and Outcomes 12

The Functional Outcome Report 15

Evaluation of Progress 16

Appendix 1A Patient History Form 18

Appendix 1B Focused Assessment for Wounds 19

Appendix 1C Sample Care Report Using HCFA-700 20

Chapter 2 Wound Healing Physiology: Acute and Chronic 21

Wound Healing Models 21

Superficial Wound Healing 21

Partial-Thickness Wound Healing 22

Primary Intention Healing 22

Full-Thickness or Secondary Intention Healing 22

Chronic Wound Healing 22

Fetal Wound Healing 23

Wound Healing Physiology 24

Inflammatory Phase 26

Coagulation Cascade or Hemostasis 26

Growth Factors and other Regulatory Proteins 26

Platelet Activation 30

Wound Space Hypoxia 30

Infection and Oxygen 30

The Complement System 31

Neutrophils 31

Macrophages 31

Nitric Oxide and Wound Healing 32

Mast Cells 32

Perfusion 32

Current of Injury 33

Fibroblasts 33

Inflammatory Phase in Chronic Wounds 33

Stimulus for Repair 33

Inadequate Perfusion and Ischemia 33

Free Radicals and Oxygen Reperfusion Injury 34

Epithelialization Phase 34

Keratinocytes 34

Epithelialization Phase in Chronic Wounds 36

Diminished Keratinocyte Migration 36

Proliferative Phase 36

Angiogenesis 37

Fibroblasts 37

Matrix Formation 37

Cross-Linking of Collagen 38

Myofibroblasts and Contraction 38

Proliferative Phase in Chronic Wounds 39

Fibroblast Senescence 39

Fibronectin Composition 39

Chronic Wound Fluid 39

Protracted Inflammatory and Proliferative Responses 40

Dead Space or Large Tissue Gap 40

Remodeling Phase 40

Matrix Remodeling 40

Matrix Metalloproteinases and Collagen Lysis or Degradation 41

Scar Formation 41

Remodeling Phase in Chronic Wounds 41

Factors Affecting Wound Healing 42

Intrinsic Factors 43

Extrinsic Factors 45

Iatrogenic Factors in Chronic Wound Healing 47

Chapter 3 Nutritional Assessment and Treatment 52

Nutritional Screening 52

Examples of Risk Factors: Examples 53

Nutritional Assessment 53

Physical Conditions 55

Anthropometry 57

Therapeutic Diets 57

Treatments and Medications 57

Lab Values 50

The Role of Nutrients in Wound Healing 62

Carbohydrates 62

Protein 62

Fats 66

Vitamins 66

Water 67

Minerals 68

Nutrition Based on Wound Etiology 69

Surgical Wounds 69

Burns 69

Skin Tears 69

Leg Ulcers 69

Dermatitis 69

Nutritional Support 69

Enteral and Parenteral Feeding 70

Documentation in the Medical Record 70

Appendix 3A Nutrition Intervention to Prevent Wounds 72

Appendix 3B Nutrition Risk Assessment 74

Appendix 3C Medical Nutrition Therapy Quarterly/MDS Progress Note 83

Appendix 3D Monthly Medical Nutrition Therapy Tube Feeding Progress Note 84

Chapter 4 Assessment of the Skin and Wound 85

Anatomy and Physiology of the Skin 85

Epidermis 85

Dermal Appendages 88

Dermis 88

Wound Classification Systems 88

Classification by Depth of Tissue Injury 89

National Pressure Ulcer Advisor Panel (NPUAP) Pressure Ulcer Staging System 89

Wagner Ulcer Grade Classification 91

The University of Texas Treatment Based Diabetic Foot Classification System 91

Marion Laboratories Red, Yellow, Black Wound Classification System 91

Wound Severity Diagnosis 92

The Assessment Process 92

Purpose and Frequency 93

Procedures for Assessment of Skin and Wound 94

Data Collection and Documentation Forms 94

Policy, Procedures, and Documentation 94

Assessment of Wound Attributes 94

Observation and Palpation Techniques 95

Assessment of Adjacent Tissues 95

Evaluation of Wound Healing Status 105

Acute Phase 106

Chronic Phase 106

Absent Phase 106

Identifying the Phase 106

Inflammatory Phase 107

Acute Inflammation 107

Chronic Inflammation 108

Absence of Inflammation 110

Proliferative Phase 112

Epithelialization Phase 114

Referral Criteria 119

Self-Care Teaching Guidelines for Skin and Wound Assessment 119

Chapter 5 Wound Measurements and Prediction of Healing 123

Wound Location 124

Baseline and Subsequent Measurements 125

Monitoring Wound Healing Measurements 125

Measurement Forms 126

Wound Size Measurement Accuracy and Reliability 127

Wound Size Measurements 127

How to Measure 129

Measurement of Undermining and Tunneling 129

Overall Undermined Estimated Size 130

Calculating the Overall Estimate 132

Wound Healing Rates as Predictors of Effectiveness of Therapeutic Interventions 132

Measurement of Wound Depth 135

Measuring Wound Volume 135

Measurement of Surrounding Skin Erythema 136

Wound Tracings 135

Wound Recovery Form 138

Using the Wound Recovery Graph 138

Digital Tracings 139

Wound Photography 140

Photographic Wound Assessment Tool 140

Video 141

Referral Criteria 141

Referral Sources 141

Self-Care Guidelines 142

Sample Instruction Sheet 142

Chapter 6 Tools to Measure Wound Healing 144

Criteria for Evaluating Wound Healing Tools 144

Validity 144

Reliability 146

Responsiveness 147

Clinical Practicality 147

Wound Characteristics 147

Location 147

Shape 147

Size 147

Depth 147

Edges 147

Undermining/Tunneling 148

Necrotic Tissue Characteristics 148

Exudate 149

Surrounding Skin Characteristics 149

Granulation Tissue 150

Epithelialization 150

Tools to Monitor Wound Healing 150

Introduction and Development of the Sussman Wound Healing Tool 150

Sussman Wound Healing Tool Attribute Definitions 151

Testing the SWHT 152

Using the SWHT 152

SWHT Forms 153

Sussman Wound Healing Tool Database 153

Introduction and Development of the Pressure Ulcer Scale for Healing 155

Introduction and Development of the Bates-Jensen Wound Assessment Tool (BWAT) or Pressure Sore Status Tool 157

Outcomes with Standardized Wound Assessment Using the BWAT 167

Availability and Clinical Use of the BWAT 167

Clinical Utility of Wound Healing Tools 168

Appendix 6A Long Ferm SWHT and Procedures for Using the SWHT 170

Appendix 6B Pressure Ulcer Scale for Healing and Instructions for Use 172

Appendix 6C Pompeo Individual Patient Pressure Ulcer Scale for Healing Form 175

Appendix 6D Bates-Jensen Would Assessment Tool 176

Chapter 7 Vascular Evaluation 180

History and Physical Examination 180

Vascular Testing-Introduction 181

Continuous Wave Doppler and the Ankle-Brachial Index 183

Segmental and Digital Plethysmography 184

Arterial and Venous Duplex 186

Transcutaneous Oxygen Measurements 187

Skin Perfusion Pressures and the Laser Doppler 187

Magnetic Resonance Angiography 188

Computed Tomography Angiography 189

Invasive Studies and Contrast Angiography 189

Venous Imaging 189

Venous Pressure Measurements 190

Photo Plethysmography (PPG) 190

Light Reflective Rheography (LRR) 190

String Gauge Plethysmography 190

Air Photo Plethysmography (APG) 190

Duplex Ultrasound 191

Other Studies 191

New Venous Studies 191

Lymphoscintigraphy 192

Referral Criteria 192

Self-Care Teaching Guidelines 192

Part II Management by Wound Characteristics 195

Chapter 8 Management of Necrotic Tissue 197

Significance of Necrotic Tissue 197

Arterial/Ischemic Wounds 198

Neurotrophic Wounds 198

Venous Disease Wounds 198

Pressure Sores 198

Interventions 198

Sharp Debridement 202

Outcome Measures 207

Amount of Necrotic Tissue 207

Type of Necrotic Tissue 207

Adherence of Necrotic Tissue 209

Referral

Criteria 209

Self-Care Teaching Guidelines 209

Appendix 8A Debridement Choices for Chronic Wounds 211

Chapter 9 Management of Exudate and Infection 215

Significance of Exudate 215

Assessment of Wound Exudate 216

Significance of Infection 217

Methicillin-resistant Staphylococcus aureus 218

Wound Colonization Versus Infection 219

Assessment of Wound Infection 219

Quantitative Wound Culture 220

Management of Exudate and Infection 222

Wound Cleansing 222

Topical Antimicrobials 226

Topical Dressings for Management of Exudate 228

Outcome Measures 229

Amount of Exudate 229

Type of Exudate 230

Referral Criteria 230

Self-Care Teaching Guidelines 231

Chapter 10 Management of Edema 234

Background Physiology of the Interstitial Space and Edema 235

Arteries and Veins 235

Lymph System 237

Interstitial Space in Action and Causes of Edema 237

Assessment 239

Evaluation, Diagnosis, History 239

Physical Examination 239

Adjunctive Tests 239

Management and Treatment of Edema 239

Inelastic Systems 241

Elastic Systems 241

Compression Stockings 242

Compression Pump Therapy 243

Special Concerns in Lymphedema 246

Chapter 11 Management of the Wound Environment with Dressings and Topical Agents 250

Inert Wound Dressings 251

Ideal Dressing 251

Modern Interactive Wound Dressings 251

Film Dressings 252

Combination Film Dressings 253

Foam Dressings 253

Hydrogels 254

Hydrocolloids 255

Alginates 256

Combination Alginates 257

Hydroactive Dressings 257

Miscellaneous Dressings 258

Hydrofibers 258

Silicone 259

Topical Antimicrobials 259

Silver 259

Topical Antimicrobials-Iodine 260

Charcoal 260

Collagen 260

Hyaluronic Acid Derivatives 250

Enzymes 260

Hypertonic Saline 253

Dressing Choice 264

Secondary Dressings 264

Use of Antiseptics in Wounds 264

Antiseptics and Acute Wounds 266

Antibiotics 266

Wound Cleansing 266

Chapter 12 Management of the Wound Environment with Advanced Therapies 268

Growth Factors 269

Platelet-Derived Growth Factor (PDGF) 259

Alternative Growth Factor Options 270

Biological Skin Substitutes 271

Apligraf 272

TransCyte 273

Integra 275

Dermagraft 276

Chapter 13 Management of Wound Pain 278

Physiology and Pathophysiology of Wound Pain 279

Function of Pain 279

Neuroanatomy and Mechanisms of Pain 279

Pruritus (Itch) 283

Persistent (Neuropathic) Pain 284

Mixed Pain Categories 285

Chronic Wound Pain Perceptions 285

The Chronic Wound Pain Experience 285

Sibbald Chronic Wound Pain Algorithm 285

Wound Pain Problems at Dressing Changes 285

Behavioral Studies of Wound-Related Pain 286

Wound Etiology 287

Arterial Ulcers 287

Diabetic Foot Ulcers 287

Venous Leg Ulcers 287

Pressure Ulcer Pain 288

Assessment of Wound Pain 291

Patient History 291

Initial Wound Pain Assessment 292

Neuropathic Wound Pain Assessment 293

Pain Scales 293

Use of Pain Scales with Special Populations 295

Management of Wound Pain 296

Nonpharmaceutical Options 297

Psychological Interventions 299

Pharmaceutical Interventions 300

Reasons for Referral 303

Self-Care Teaching Guidelines 303

Understanding Patients and Caregivers 303

Collaborative Wound Management: Patient, Caregiver, and Health-care Provider 303

Chapter 14 Management of Scar 309

Formation of Scar Tissue 309

Complications of Scar Formation 310

Tests and Measurement 311

Interventions for the Treatment of Scar 313

Surgical 313

Pharmaceutical 313

Pressure Therapy 314

Massage 315

Silicone 315

Splinting 316

Positioning 316

Physical Agents 316

Patient Education and Self-Care 317

Part III Management by Wound Etiology 319

Chapter 15 Acute Surgical Wound Management 322

Acute Surgical Wound Definition 322

Factors Affecting Healing in Acute Wounds 322

Extrinsic Factors 322

Intrinsic Factors 324

Assessment of the Acute Surgical Wound 326

The Inflammatory Phase 327

The Proliferative Phase 328

The Remodeling Phase 328

Management of the Acute Surgical Wound 328

Secondary and Tertiary Intention Wound Healing 329

Outcome Measures 329

Postoperative Day 1 through Day 4 329

Postoperative Day 5 through Day 9 329

Postoperative Day 10 through Day 14 330

Postoperative Day 15 through 1-2 Years 330

Referral Criteria 331

Self-Care Teaching Guidelines 332

Chapter 16 Pressure Ulcers: Pathophysiology and Prevention 336

Pressure Ulcer Definition 336

Pressure Ulcer Significance 336

Pressure Ulcer Pathophysiology 337

Time and Pressure 337

Intensity and Duration of Pressure 337

Clinical Presentation of Pressure Ulcers 338

Location 340

Pressure Ulcer Staging 341

Pressure Ulcer Prediction; Risk Factor Assessment 342

Pressure Factors 343

Extrinsic Factors 343

Intrinsic Risk Factors 345

Risk Assessment Tools 345

Risk Stratification and Risk Adjustment 352

Pressure Ulcer Prevention: Early Interventions 353

Immobility, Inactivity, and Sensory Loss 353

Moisture 365

Outcome Measures 367

Referral Criteria 368

Self-Care Teaching Guidelines 368

Chapter 17 Management of Pressure by Therapeutic Positioning 374

Need for Therapeutic Positioning 374

Applying the Diagnostic Process to Therapeutic Positioning 375

Reason for Referral 375

Medical History 375

Systems Review and Examinations 375

Intervention in the Sitting Position 382

Sitting Posture Examination and Evaluation 386

Intervention Using the Principles of Seating 386

Working with Suppliers 396

Intervention in the Recumbent Position 396

Effects on Pressure Ulcer Formation 396

Choosing Equipment 397

Positioning Supplies 398

Self-Care Treatment Guidelines 399

Chapter 18 Diagnosis and Management of Vascular Ulcers 405

Vascular Anatomy of the Lower Extremities 406

Arterial System 406

Venous System 407

Lymphatic System 407

Occlusive Peripheral Vascular Disease 408

Intermittent Claudication 408

Nocturnal Pain 409

Rest Pain 409

Ulceration and Gangrene 409

Risk Factors 410

Diabetes and Foot Ulceration 410

Venous Stasis Ulcers 413

The Swollen Leg 413

Pathophysiology of Venous Ulceration 414

Medical Treatment of Venous Stasis Ulcers 415

Differential Diagnosis of Venous Stasis Ulcers 415

Atypical Nonatherosclerotic Ulcers 417

Chapter 19 Management of the Neuropathic Foot 421

Pathogenesis 422

Medical History 422

Diabetic Neuropathy 423

Systems Review and Examination 424

Neuromuscular System 424

Vascular System 425

Musculoskeletal System Examination 426

Integumentary System Examination 427

Further Visual and Physical Assessments 430

Footwear Assessment 430

Wound Assessment 430

Sensation Testing 432

Body Temperature Testing 435

Pressure Testing 435

Charcot Joint Examination 436

Osteomyelitis Examination 437

Interventions 438

Orthotics and Adaptive Equipment 438

Total-Contact Casting 441

Orthotic Dynamic System Splint 442

Neuropathic Walker 443

Total-Contact Ankle-Foot Orthosis 444

Other Devices 444

Off-Loading of Foot Ulcerations 444

Plastazote Healing Sandals 446

Prefabricated Off-Loading Alternatives 446

Wound Healing System 447

Surgical Management 447

Documentation 450

Care of the Skin and Nails of the Neuropathic Foot 450

The Skin 450

The Nails 450

Noninvasive Skin and Nail Care 450

Heel Fissures 451

Self-Care Teaching Guidelines 457

Foot Inspection 457

Precautions and Risk Reduction Methods 457

Compliance Issues 458

Chapter 20 Management of Common Foot Problems 463

Tinea Pedis 463

Signs and Symptoms 464

Diagnosis 464

Management 465

Prevention 466

Plantar Fasciitis 466

Signs and Symptoms 467

Diagnosis 467

Management 467

Prevention 468

Onychomycosis 469

Signs and Symptoms 469

Diagnosis 470

Management 470

Prevention 471

Miscellaneous Conditions 471

Xerosis and Anhidrosis 471

Hyperhidrosis 471

Cellulitis 472

Maceration 472

Hyperkeratotic Lesions 472

Fissures 473

Onychauxis 473

Self-Care Teaching Guidelines 473

Chapter 21 Management of Malignant Cutaneous Wounds and Fistulas 476

Significance of Malignant Cutaneous Wounds 476

Pathophysiology of

Malignant Cutaneous Wounds 476

Malignant Cutaneous Wound Assessment 477

Malignant Cutaneous Wound Management 478

Infection Control: Wound Cleansing and Debridement 478

Management of Exudate and Odor Control 479

Controlling Bleeding 481

Minimizing Pain 482

Other Management Options 482

Malignant Cutaneous Wound Outcome Measures 482

Patient and Caregiver Education Related to Malignant Cutaneous Wounds 483

Significance of Fistulas 483

Pathophysiology of Fistula Development 484

Fistula Assessment 485

Fistula Management 485

Outcome Measures for Fistulas 488

Patient and Caregiver Education for Fistulas 491

Part IV Management of Wound Healing with Biophysical Agent Technologies 495

Relationships Between Interventions Based on Components of the Electromagnetic Spectrum 495

Medical Applications 496

Therapeutic Use of Biophysical Agents 496

Practical Patterns 496

Candidacy for Intervention 497

Reasons for Referral 497

Functional Diagnosis for Wound Healing 498

Prognosis 498

Primary or Adjunctive Therapy 498

Choosing Between Interventions 498

Functional Wound Cost Outcomes Management 501

Utilization Review and Cost Outcomes Management 502

Plan of Care/Treatment 503

Chapter Organization 503

Chapter 22 Electrical Stimulation for Wound Healing 505

Evaluating the Evidence 505

Meta-Analysis 506

Efficacy and Reimbursement 506

Capacitive Coupling 507

Polarity 507

Amplitude and Voltage 507

Amperage 507

Waveforms 507

Reporting of ES Parameters 508

Direct Current 508

Phase, Phase Duration, and Interpulse Interval 508

Frequency or Pulse Rate 509

Duty Cycle 509

Pulsatile Currents 509

Alternating/Biphasic Current 510

Phase Charge and Charge Density 511

Transcutaneous Electrical Nerve Stimulation 512

Theory and Science of Electrical Stimulation 512

Bioeletrical Systems 512

Sodium Current of Injury 513

Galvanotaxis and Polarity 513

Blood Flow, Oxygen, and Edema 516

Debridement, Thrombolysis, and Thrombosis 523

Antibacterial Effects 523

Pain 524

Sensony Nerve Activation 524

Scar Formation 525

Comparison of Monophasic and Biphasic Stimulation Effects 525

Clinical Studies 525

Low-Voltage Microamperage Direct Current Studies 526

Modified Biphasic Stimulation Studies 526

High-Voltage Pulsed Current Studies 527

Low-Voltage Pulsed Electrical Current Studies 529

Biphasic Stimulation Studies 529

Meta-Analysis of Effect of ES on Chronic Wound Healing 530

Choosing an Intervention: Clinical Reasoning 532

Applying Theory and Science to Clinical Decision Making 532

Precautions 533

Contraindications 533

Equipment 534

Electrodes 535

Wound Healing Protocol Selection for Electrical Stimulation 538

Aspects 538

Selecting the Device and Treatment Protocol 539

Sussman Wound Healing Protocol 539

Self-Care Teaching Guidelines 545

Selecting the Candidate for Self Care 545

Chapter 23 Induced Electrical Stimulation: Pulsed Radio Frequency and Pulsed Electromagnetic Fields 555

Electromagnetic Fields 556

Units of Measurement 556

Carrier Frequency and Waveforms 556

Pulse Rate and Pulse Duration 557

Duty Cycle 558

Amplitude 558

Comparison of Electromagnetic Field Devices 558

Comparison of PSWD and PRFS Equipment 559

PRFS and High-Voltage Pulsed Current Fields 560

Theory and Science 560

Thermotherapy 561

Continuous Short-wave Diathermy 561

Pulsed Short-wave Diathermy 562

Basic Science of Nonthermal PRFS and PEMF 564

Hematoma and Thrombolysis 566

Effects on Attributes of the Inflammatory Phase 566

Circulatory Effects 567

Wound Healing Clinical Studies 568

Applying Theory and Science to Clinical Decision Making 578

Selection of Candidates 578

Safety Issues 579

Equipment 580

Regulatory Approval 580

Devices 580

Procedures 582

Protocols 582

Expected Outcomes 582

Wound Healing Phase Diagnosis: Acute or Chronic Inflammation 582

Wound Healing Phase Diagnosis: Subacute Inflammation 582

Protocols for PSWD 583

Change Moist Dressing during PSWD Treatment 583

Setup for Treatment with Pulsed Short-wave Diathermy 584

Aftercare for Pulsed Short-wave Diathermy 584

Pulsed Radiofrequency Stimulation Protocol 584

Setup Treatment with Pulsed Radiofrequency Stimulation 584

Adjunctive Treatments 585

Self-Care Teaching Guidelines 585

Documentation 585

Chapter 24 Phototherapy in Wound Management 591

Historical Perspective 591

Radiant Energy Definitions 592

Therapeutic Radiant Energy Forms 593

Physical Science of Phototherapy Radiant Energy Forms 593

Phototherapy Delivery Systems 594

Light-Emitting Diodes 594

Laser Diodes 594

Super Luminescent (Luminous) Diodes 594

Cluster Probes 594

Ultraviolet Energy 595

Biologic Effects of Ultraviolet Energy 595

UV Preclinical Studies 598

UV Clinical Studies 598

UVC: Current Recommended Treatment Approaches 599

Self-Care and Teaching Guidelines 603

Documentation 604

Lasers, LEDs, and SLDs 604

Biologic Effects of Lasers 604

Biologic Effects of LEDs 605

Preclinical Studies 605

Clinical Studies 605

Current Recommended Treatment Approaches for Laser 606

Self Care 608

Documentation 608

Chapter 25 Therapeutic and Diagnostic Ultrasound 612

Evaluating the Evidence 612

Ultrasound 613

Frequency 613

Attenuation 613

Half-Value Thickness 614

Wavelength 614

Equipment for Generating Ultrasound 614

The Ultrasonic Field 615

Equipment Selection 615

Intensity 615

High-Resolution Diagnostic Ultrasound 619

Imaging 619

Visual Details 619

New High-Resolution Diagnostic Scanners 619

Practical Implications 619

Theory and Science of Ultrasound's Effect on Wound Healing 621

Effect on the Phases of Healing 622

Pain and Edema 623

Circulation 623

Thrombolysis and Fibrinolysis 624

Bruising, Hematoma, and Deep Tissue Injury 624

Bactericidal Effects 624

Ultrasonic Wound Debridement 625

Clinical Studies of Wound Healing 626

Choosing an Intervention: Clinical Reasoning 632

Candidacy for the Intervention 632

Procedures 633

Protocol Considerations 633

Expected Outcomes 633

Typical Protocol 634

Setup for Treatment 636

Aftercare 637

Adjunctive Treatments 637

Verhage Policy and Procedure for Use of the Sonoca 180 637

Self-Care Teaching Guidelines 639

Documentation 639

Chapter 26 Whirlpool 644

Evaluating the Evidence 644

Physical Principles and Physiological Effects of Whirlpool Therapy 644

Physical Principles 644

Physiological Responses 645

Evidence of the Effect of Whirlpool on Wound Healing 648

Clinical Studies 649

Debridement, Cleansing, Wound Decontamination, and Infection 652

Whirlpool-associated Risks 652

Risks to Cardiac, Vascular, and Pulmonary Systems 652

Risk of Tissue Damage 652

Risk of Wound Infection 652

Choosing an Intervention: Clinical Reasoning 654

Candidacy 654

Precautions 655

Contraindications 656

Personnel Safety 656

Delivery of Care 656

Equipment 656

Whirlpool Tanks 657

Tank Selection 657

Procedure 657

Frequency and Duration 657

Water Temperature 657

Monitoring Vital Signs 658

Infection Control 658

Aftercare 659

Infection Control for Whirlpool Equipment 659

Expected Outcomes 660

Self-Care Teaching Guidelines 660

Chapter 27 Pulsatile Lavage with Suction 665

Theory and Science of the Therapy 665

Management of Infection 666

Mechanical Debridement 667

Negative Pressure 667

Indications for Therapy 667

Patient Benefits 667

PT Benefits 669

Facility Benefits 669

Precautions 669

Outcome Measures 670

Frequency and Duration 670

Cautions 670

Vacuum-assisted Closure 671

Performance of PLWS 671

Procedures for PLWS 671

Jet Lavage 675

How to Use Different Equipment Models 676

Davol Simpulse VariCare Procedure 676

Stryker SurgiLav Plus and InterPulse Procedure 677

Zimmer Pulsavac Plus LP Procedure 677

DeRoyal Jetox-ND Procedure 677

DeRoyal Jetox-HDC Procedure 677

Documentation 678

Chapter 28 Management of the Wound Environment with Negative Pressure Wound Therapy 683

Negative Pressure Wound Therapy 683

History of NPWT 684

The Wound Environment 684

Theory and Science of NPWT Therapy 685

Indications for

Therapy 688

Contraindications for Therapy 688

Expected Outcomes 690

Cost of Therapy 690

Application of Therapy 690

V.A.C Instill 690

V.A.C. GranuFoam Silver 692.

Notes:

Includes bibliographical references and index.

ISBN:

0781774446

9780781774444

OCLC:

84723092