Knes Unit 2 exam (ch 5-6)

true/false: In the management of an acute soft tissue injury, protected rest means cessation (stopping) of all physical activity involving the injured area.

false

Vasoldilation

1) slowing of blood flow; increase blood viscosity; statis 2) release of chemicals -increase swelling -increase capillary permeability

You are a fitness specialist. A 35 year old client comes to a training session having sustained a grade II hamstring strain one week earlier. He is very inquisitive and asks you to explain what is taking place at the injured site. How would you explain the healing process to your client in a manner that makes sense to him?

1st inflammation takes place, blood flows to site of injury. Edema (swelling) and pooling of blood take place 0-6 days, blood starts to clot. WBC move to area and begin removing cellular debris. Repair phase begins 3 days after injury and lasts 3-8 weeks. fibroblasts start laying down collagen after hematoma reduces size to allow for tissue growth. Increase of blood flow to area, and initial scar formation

The stage of cold sensation that includes a burning and aching feeling occurs

2 to 7 mins

The tensile strength of a wound 6-8 weeks post-injury is approximately ___ % of normal.

30%

Which of the following is the appropriate temperature for a cold bath?

55-60 degrees

Which of the following statements is true? A. A compression wrap should be applied in a proximal to distal direction. B. A compression wrap should be applied in a distal to proximal direction. C. A patient should not feel any firmness from a compression wrap. D. A wet compression wrap is contraindicated in managing an acute injury.

B

Which of the following statements is true? A. In developing the emergency plan, the plan should be limited to emergency conditions. It does not need to address injuries that are mild or moderate. B. One single emergency plan should be able to satisfy the needs of every institution. C. The emergency plan should be a written document that is comprehensive, yet flexible enough to adapt to any emergency situation at any activity venue. D. An emergency plan is a well-developed process that defines the policies and procedures to be used in the management of an acute injury to a participant. The plan does not need to be put into writing.

C

Explain the significance of granulation tissue in the repair phase of healing?

Granulation tissue: fibroblasts that come into the area and lay down collagen

In managing an acute injury, the options available to the coach should include I. Standard acute care with no physician referral, but providing the individual with a written instruction sheet II. Standard acute care with physician referral prior to return to activity III. Standard acute care with immediate physician referral IV. Summon EMS

I, II, III

in developing an emergency plan, several areas must be addressed, including I. Population being served II. Potential injuries/ conditions III. Personnel IV. Availability of medical/ first aid equipment V. Communication VI. Documentation

I, II, III, IV, VI

In the process of cleansing an open wound, what conditions would require the coach to recommend immediate physician referral?

If the coach cannot clean the wound completely and having a fear of infection.

In developing an emergency plan for an institution/ facility (e.g., high school athletic program; commercial fitness facility), why it is essential to address the topic of determining "when and who" will make a 911 call and make the call to the emergency contact person (e.g., parents of the injured adolescent; spouse of injured individual)?

If there is a designated person calling there wont be multiple calls to EMS, and there will be no confusion in what to say

One of your clients sustains an ankle sprain. You explain that an ice bag should be applied to the area. The individual has never had an (cold) treatment. What would you tell the individual to expect to feel (senastions) while the ice bag is applied?

In the first 0-3 mins there will just be a little bit of a cold sensation, then following will be a burning and aching sensation that will last about 2 to 7 mins, and following that they will feel a numbing sensation that occurs around 5 to 12 minutes with the ice on

• Why is it important to understand the healing process?

Knowing what is going on inside the body gives us a basis for making decisions regarding return to play, rehabilitation and immediate management

The beginning of the acute inflammatory phase of healing involves processes which

Promote vasodilation; increase of bloodflow to the wounded area

Describe scar tissue. What is the significance of movement in the remodeling phase?

Scar tissue is fibrous, inelastic, and nonvascular. Overall it is less strong and less functionable than original tissue

Describe the strength of the healing tissue at 3-4 weeks post-injury and 3-4 months post-injury?

Strength of tissue 3-4 weeks: 25% of normalStrength 3-4 months post: 70%

Why is it important for a coach, physical educator, and fitness specialist to understand the healing process?

Understanding each phase is essential because it helps determine the appropriate management of an injury and how to monitor the healing process

phagocytosis

activity encourages leukocytes to come into the area to come to the area, WBC

definition of trauma

acute/chronic disruption of oxygen supply leads to cell death

The repair phase of healing includes which of the following processes? I) phagocytosis II) angiogenisis III) fibrous tissue formation IV) wound contraction V) decreased fibroblast activity

all of the above

In the management of an acute injury, a compression wrap should be worn

all the time

how long does repair phase last?

approx. 3 days following injury- 6/8 weeks

primary injury zone

area of injured tissue prior to vasodilation

maturation/remodeling phase

continues recession of fibroblasts

Universal precautions of open wounds

control bleeding with direct pressure and elevation or indirect pressure, clean, determine whether emergency call is required, dress the wound

An individual sustains an open wound that results in bleeding. Explain the management of this condition.

control the bleeding with direct or indirect pressure, if bleeding does not stop call EMS

Elevation of an injured site can

decrease capillary pressure, decreases swelling

What are physiological effects of application of heat?

decrease in joint stiffness and muscle spasms

elevation following an acute injury physiological effects how

decreases swelling

The application of a compression following an acute soft tissue injury can

decreasing swelling

fibrin

deposits an irregular meshwork of short fibers, clot formation begins

The best method for controlling bleeding of an open wound is

direct pressure

Hypoxia refers to the

disruption of oxygen supply

compression application following an acute injury physiological effects how to apply how long

elastic bandage- distal to proximal, all day

What is phagocytosis?

encourages leukocytes to come into the area, line up WBC around the perimeter of the damaged area

Explain (in detail) the role of movement in the inflammatory phase of the healing process. (Make reference to the nature of the movement with regard to time and physiological responses.)

encourages venous return, encourages fluid resorption, encourages phagocytosis, and prevents contracture and loss of range of motion

Identify five local factors (not systemic) that can delay the healing of a soft tissue injury.

extent (size) of injury, inflammation, infection, extent (amount) of hemorrhage and edema, muscle spasm

True or False? Ecchymosis is a fluid with high protein content and cellular debris that forms in the area of injury.

false that is exudate

True or False? Neutrophils and macrophages are immature connective tissue cells released into the injured area by the exudate.

false: that are fibroblasts

True or False? Local factors at the site of a wound can delay the healing process; in comparison, systemic factors are not cause for concern as they cannot impede the healing process.

false; the systemic factors play a role in the healing process based on how healthy and young the body is

true/false: Following an acute soft tissue injury, the application of superficial heat during the inflammatory phase of healing can be beneficial as a means for increasing blood to the area.

false; use exercise

vasoconstriction

few seconds - 10 minutes marks beginning of coagulation...initiates clotting

An individual sustained a grade 2 ankle sprain during a 6:00am workout. Which of the following movements would be appropriate for the individual to perform that evening?

flexion and extention, wiggling toes

What is exudate?

fluid with cellular debris and high protein content (fluid containing clotting factors and antibodies)

exudate

fluid with cellular debris and high protein content

management of open wounds

follow universal precautions and infection control standards

Why should the emergency/accident plan be a written document?

for reference and legal purposes

What type of movements should take place in the inflammatory phase

gentle controlled ADL movements

During the inflammatory phase of healing, which of the following is an advantage of movement?

heat

cold vs heat Use in the management of an acute soft tissue injury?

heat in the version of exercise will cause an increase of ROM and creating blood flow to that area. cold causes a decrease in swelling and can help starting the process of vasoconstiction.

Who should be involved in the development and approval of an emergency plan?

higher authorities, personnel at facility, medical personnel, legal personnel

An individual sustains a grade 2 contusion to the quadriceps. Two days after the injury, which of the following would be most advantageous?

ice bag

fibroblasts

immature connective tissue cells released into area by the exudate -lay down collagen -initial scar formation

What are potentially "good" or advantageous physiological effect of heat?

increase in bloodflow, decrease in joint stiffness and muscle spasm.

Beneficial effects of heat? (when and how)

increase in bloodflow, decrease in joint stiffness, decrease in muscle spasms, increase in collagen extensibility

angiogenesis/capillary budding

increase in capillaries in the area, increase blood supply for healing

What are the three phases in the healing process?

inflammatory phase (0-6days), repair/proliferative phase (3-8weeks) , maturation/remodeling phase (up to a year)

diapedesis

ingestion of cellular debris

You are a high school physical education teacher. A sophomore student comes to class on Monday using crutches, having sustained a 2nd degree ankle sprain. The inquisitive student asks you why she needs to be on crutches. Based on your understanding of the healing process, how would you respond to the student?

limiting the movement of injured area to control bleeding but also allows for movement for collagen fibers to be set AKA remodeling

What concerns are associated with complete immobilization of a body part following a soft tissue injury? Why?

loss of ROM, repair will be less functional, delays healing

What determines the strength of scar tissue in the repair phase?

movement establishes stress that directs optimal placement of collagen

Explain the role of movement in the healing process.

movement establishes the line of stress so fibroblasts know where to lay the collagen .

What type of movements should take place in the repair phase? Why?

movement that increases intensity and complexity; for example a light jog in a straight line, then broad S shape, then light cutting movements

In developing an emergency plan for a fitness facility, what individuals should be involved in the process? Why?

personnel of facility, higher authorities, medical personnel, legal personnel. To all make sure this plan covers all ground

fluid

plasma and water

In developing an emergency plan, what general areas should be addressed? Why?

populations being served, potential injuries/conditions, personnel, availability of medical/first aid equitment, facility access, communication, documentation

What are the physiological effects of appropriate movement in the inflammatory phase

prev

cold application following an acute injury physiological effects how to apply how long what temperature

put bag of ice on the injury 20 mins on and 1 hour off, at 55-60 degrees

Why is the application of compression equally as important as the application of cold in the immediate management of a majority of acute soft tissue injuries?

reduction in subcutaneous temperatures

secondary injury zone

region of tissue damage following vasodilation

Why is the application of cold the appropriate course of action in the immediate management of an acute musculoskeletal injury (i.e., what are the physiological effects of cold)?

the cold causes the process of vasoconstriction to begin faster, as well as decrease swelling and pain; capillary permeability,

Phagocytosis refers to

the ingestion of cellular debris and waste products

Why should a plan be rehearsed on a regular basis?

the personnel on the scene will know what to do and the procedure will go more smoothly

macrophages

tolerate low oxygen conditions ingest dead neutrophils, cellular debris

In the immediate management of a muscle strain, cold should be applied

true

True or False? The repair phase begins when the hematoma's size decreases enough to permit room for growth of new tissue.

true

true/false: The application of cold is more important than the application a compression wrap in the management of an acute soft tissue injury.

true

When can movement be initiated in the Inflammatory phase

when bleeding stops: has to be gentle controlled movement

neutrophilis

destroy bacteria only

edema

large amounts of fluid and exudate in the interstitial spaces increase capillary permeability and increase in osmotic pressure

Conditions that warrant immediate referral of open wounds

life threatening wounds, uncontrolled bleeding, inability to clean all the debris, a wound that might require stitches, or a penetrating wound.

Can the actions of the coach, physical educator, and fitness specialist as the first responder to an acute soft tissue injury influence the primary or secondary injury zone? Why?

yes you can adjust the local factors

How long does inflammatory phase last?

0-6 days

What is the significance of vasoconstriction in the first phase of the healing process?

happens within few seconds-10 minutes after injury and marks beginning of coagulation... initiates clotting

Why should universal precautions be followed in the management of an open wound?

so there wont be infection

how long does maturation phase last?

up to one year