Chronic Wound Care Clinical Lab: Introduction (19:24)
Physical therapist and wound specialist Cheryl Aaron describes the biological makeup of the epidermis and the dermis. The five different wound healing models are superficial, primary intention, delayed primary intention, partial thickness, and secondary intention wound healing; Aaron claims secondary intention is the most problematic to heal.
Proper Wound Healing (28:44)
Aaron describes the three phases of wound healing—the inflammatory phase, the proliferative phase, and remodeling phase; many biological events must occur within the wound during each phase. An epibole is when the edges of the wound bed curl under before completing epithelialization; Aaron describes ways to cauterize and reopen the wound when this occurs.
What Causes a Chronic Wound? (18:04)
A wound which fails to progress through all phases of wound healing is categorized as a chronic wound; chronic inflammation can be extended by cytotoxic agents such as iodine. Patient compliance is central to the healing of a chronic wound; Aaron describes the typical causes of wound dehiscence.
Wound Healing Process (19:19)
Aaron discusses possible causes of chronic wounds and how to remove the source of the trauma; protein and carb intake, malnutrition, and obesity can all contribute to chronic wounds. Vitamin E decreases collagen and should not be added to a wound bed, but amino acids such as glutamine do support wound healing.
Pressure Ulcers (21:16)
Aaron describes the startling statistics of pressure ulcer cases in the United States; pressure ulcers are caused by localized pressure and shear applied to the skin. Aaron explains how to stage a pressure ulcer stating full thickness wounds are automatically a stage three and maybe a stage four; pressure ulcers are named by the bone they are over.
Deep Tissue Injuries (19:12)
Aaron takes questions from the students about stageable and unstageable ulcers, and explains ulcers due to moisture and still caused by pressure, and can, therefore, be staged. An ulcer cannot be staged until the medical professional can visualize the entirety of the wound bed, but if the bone can be palpated then it is automatically a stage four wound.
Eschar and Risk Assessment (22:17)
Eschar, which impedes contraction, should be removed unless it is dry, stable eschar located on the heels; mucosal injuries are not staged, and nasal cannula can be staged behind ears but not in the nose. Medicare’s standards for providing this type of wound care include a full medical history and a nutrition assessment.
Patients Refusing Intervention (19:39)
Patient compliance is key to results, particularly with a chronic wound, interventions should be defined and implemented due to the patients' needs and goals; dementia and poor mental health can lead to non-compliance. Aaron presents several therapeutic interventions such as cushions and specialized beds like the Dolphin and Clinitron.
Diagnosing Arterial Disease (19:00)
Aaron describes the signs and symptoms of arterial disease including how to determine if a limb is venous or arterial; arterial disease on a lower limb will cause the skin to be thin, hairless, and flaky. Full-thickness arterial wounds and filled with slough and are painful, often requiring a narcotic intervention; surgical alternatives are bypass grafts, reconstruction Gore-Tex graphs, and ultimately amputation.
Diabetic Patient (36:42)
Neuropathy and foot ulcers are responsible for forty percent of all lower extremity amputations; arterial disease is the most common comorbidity associated with neuropathic ulcers. Medical professionals use Semmes Weinstein 5.07 Monofilament to determine if ten grams of pressure can be felt, if not, then the patient has officially lost protective sensation.
Alternative Diabetic Foot Healing (30:27)
Ninety percent of venous ulcers could be resolved if not for patient noncompliance; deep, superficial, and perforator veins make up the venous system. Workers of sedentary jobs are the most susceptible to venous disease, but wearing light compression can help lower risk factors; Aaron explains the benefits of using Doppler ultrasound on the affected veins.
Compression Methods (27:25)
Aaron discusses different compression techniques, emphasizing the importance of using different methods for varying diseases; compression combined with muscle activity is used to push fluid back in and up through the vascular system. Pocket Dopplers can be utilized by medical professionals as an aid to proper compression.
Diagnosing Lipedema and Lymphadema (10:48)
Lymph is fluid and protein pulled out of the blood, also known as blood plasma, and is not pressurized; blood flow occurs due to muscle movement and is unidirectional. Aaron explains how to diagnose lymphedema and lipedema which is a pathological disorder of the adipose tissue, the fat in the body, resulting in progressive migration and expansion of fat cells in the lower body that typically has a hormonal onset.
Practicing Toe Wrap Procedures (05:30)
A demonstrative video is shown of how to properly apply a toe wrap before putting on a four-layer compression stocking; antifungal powder must be applied to the foot before the first compression layer goes on.
Doppler Procedures and Toe Wraps (48:27)
The students are lead through a practical of how to properly apply the toe wrap and the four layer compression stocking; after applying the wraps, the students practice using the Doppler ultrasound machine.
Credits: Chronic Wound Care Clinical Lab (00:02)
Credits: Chronic Wound Care Clinical Lab
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