Chronic conditions (contra and indications)

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Wolfgar007
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251644
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Chronic conditions (contra and indications)
Updated:
2013-12-08 13:18:01
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Chronic conditions contra indications
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Sondra's class
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  1. What are the contra indications for heat modalities?
    • Acute Inflammation?????
    • Recent or potential hemorrhage
    • Thrombophlebitis
    • Impaired sensation
    • Impaired mentation
    • Malignancy
    • IR irradiation of the eyes
    • Illness with fever
    •         Acute Inflammation?????
    •         Recent or potential hemorrhage
    •         Thrombophlebitis
    •         Impaired sensation
    •         Impaired mentation
    •         Malignancy
    •         IR irradiation of the eyes
    •         Illness with fever
  2. What are precautions for heat modalities?
    • Precautions
    •         Acute injury or inflammation
    •         Pregnancy
    •         Impaired circulation
    •         Poor thermal regulation
    •         Edematous areas
    •         Cardiac insufficiency
    •         Metal
    •         Open wound
    •         Topical counterirritants
    •         Demyelinated nerves
  3. What are the precautions and contraindications for use of Whirlpools in wound care?
    • Precautions/contraindications
    • Clean granulating wounds
    • Epithelializing wounds
    • New skin grafts: too fragile to subject to this it can damage the graft
    •  
    • Contraindications:
    • Contraindication for generic whirlpool
    • Cancer pt: can heat up area and cause it to spread faster , so don’t heat up area with active tumor
    • Preg pt
    • Infection systemic (fever)
    • Blood pressure meds or issues with BP
  4. What are general contraindications for hydrotherapy?
    • Superficial heat or cold
    • Bleeding
    • Maceration around a wound
    • Cardiac instability
    • Infectious condition
    • Bowel/bladder?  incontinence
    • Severe epilepsy
    • Suicidal
    • Severe  fear of the water
    • Recent  skin graft
    • Allergy to chemical used in the water
  5. Name the contra indications and precations for estim?
    • Contraindications
    • Demand type cardiac pacemaker/implanted stimulators
    • Unstable cardiac arrythmia-to the chest area
    • Over the carotid sinus
    • Over acute venous or arterial thrombii
    • Over abdomen or low back of pregnant 

    • Precautions
    • Cardiac disease
    • Wounds or skin irritation
    • ↓ sensation/mentation
    • Malignant tumor
    • Iontophoresis after other physical agents
  6. Name the specific contraindications and precautions for estim use in wound care?
    • Contraindication
    • Osteomyelitis: (big one)
    • Wounds with heavy metal ions
    •  
    • Precautions:
    • Sensory deficits: can use on pt with no sensation but must check for damage. Still looking for a little bit of motor contraction but need to palpate watch there since they can’t tell you it hurts
    • Skin irritations: rare but it can happen
    • Pain: can hurt if does is not tx of choice
    • Young kids
    • A.      Osteomyelitis: (big one)
    • B.      Wounds with heavy metal ions
    •  
    • Precautions:
    •  Sensory deficits: can use on pt with no sensation but must check for damage. Still looking for a little bit of motor contraction but need to palpate watch there since they can’t tell you it hurts
    •  Skin irritations: rare but it can happen
    • Pain: can hurt if does is not tx of choice
    • Young kids
  7. Name the contraindications and precautions for Ultrasound?
    • Specific to wound care
    • Osteomyelitis or other acute wound
    • infections: don’t want to cause closer of infected area. Or other wound
    • infections. Or particularly Osteomyelitis in wound with tunneling in it.
    • Profuse bleeding: US increases blood flow
    • to the area so if lot bleeding don’t do US to area
    • Severe arterial insufficiency (shouldn’t
    • be an issue with no thermal, but if any risk of heat can be problem, also if
    • increase blood flow to area and there is not enough blood drainage you will
    • have an issue)
    • Acute DVT: don’t want to increase blood
    • flow to area

    • Non-wound related contraindications
    • Pregnant uterus
    • Gonads
    • Malignancies and precancerous lesions
    • Vascular abnormalities: DVT, Emboli,
    • thrombophlebitis
    • Cardiac area, if heart disease or
    • pacemaker or implanted defibrillator
    • Over the eye
    • CNS tissue
    • Joint cement
    • Irradiated tissue

    • Precautions
    • Acute infections
    • Fractures
    • Bony prominences
    • Epiphyseal plates
    • Subcutaneous major nerves
    • Sensation deficits
  8. Precautions and contraindications for use of a wound vacuum?
    • Contraindications
    • Wounds with >30% necrotic tissue: don’t
    • use this on wounds with a lot of necrotic tissue can remove necrotic tissue
    • then use with modalities or sharp debridement or enzymatic ointments. Never
    • over hard black eschar.
    • Untreated osteomyelitis: same as above
    • Malignancies : due to increased blood flow
    • to area
    • Exposed blood vessels: not contra for
    • their modalities but if blood vessel is close to the surface and is oozing
    • blood then the vac will pull blood out of blood vessel.
    • Excessive bleeding: pulls blood out of opening
    • Coagulation disorder: so hemophilia, or
    • things that put them at high risks of bleeding like being on anticoagulation.
    • If surgeon suggests it raise concern to MD about anticoagulants it could be the
    • dose is small enough that not a risk but that is MD decision.
    • Fistulas: abnormal opening between two
    • parts of the body so don’t know what on the other side so don’t want to pull fluid from there.

    • Precautions
    • Bleeding
    • Proximity to major vessels
    • Anticoagulants
    • Infections: not prob unless major deep
    • infection that needs to be treated
  9. Name the precautions for Pulsed (Pulsatile) Lavage with Suction?
    • Precautions
    • Insensate patients: can’t tell you if there is pain and hence damage
    • Anticoagulants: bleeding like wound vac  
    • Bleeding
    • Tracts, tunnels: be aware of it make sure don’t close them off but good for getting fluid out because don’t want fluid to stay in undermined area.   
    • Wound near a major vessel or very fragile tissue (grafts, flaps)
    • Abscess: same as with wound vac
  10. Contra indicaitons for the UNA boot?
    • Contraindication
    • Acute Pulmonary edema: are you going to reduce edema so much it can cause back up into the lungs.
    • Cellulitis: don’t cover this with una boot
    • Infected ulcer: take care infection and then you can use this
    • DVT: just risk of moving the clot further upward
    • Phlebitis: inflammation of veins won’t cover this
    • Arterial insufficiency: causing in reduction in swelling. Puts compression on initial which is more of the issue because don’t want to compress arterial ulcer.
  11. Name the precautions and contraindications for casting?
    • Contraindications
    • Cellulitis: skin infection which can spread.
    • Palpable tender nodules: this is why we don’t cast
    • over area with deep pain
    • Deep sinus tract
    • Profuse drainage: casting does not work well when wet, particularly plaster cast which can’t be put into water because it will dissolve.
    • Patient is febrile: due to risk of infection
    • Osteomyelitis, or other infection
    • Fluctuating edema
    • Arterial insufficiency: this is more of a precaution
    • because you can do casting on a pt with poor circulation but you risk
    • decreasing blood flow further.

    • Precautions: if pt has a precaution don’t leave the cast on as long, so usually just few days
    • Sensory deficit: pt can’t tell you if something is in or wrong in the cast area,
    • however if you cast properly this should not be an issue.
    • Fragile skin:
    • if skin tear or bruises easily you have to be careful when casting
    • Heel ulcer

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