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MC III > wound care study guide > Flashcards

wound care study guide Flashcards

1
Q

layers of skin

A
  • stratum corneum
  • stratum lucidum
  • stratum granulosum
  • stratum spinosum
  • stratum basale
  • basement membrane
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2
Q

stratum corneum

A
  • horny layer
  • tough outer layer
  • protection from mechanical and chemical injury
  • constantly sloughing
  • 15-20 layers of dead keratinized cells
  • can also indicate hydration
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3
Q

stratum lucidum

A
  • transparent, thin layer
  • only at stress points – palms, soles of feet
  • transition layer
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4
Q

stratum granulosum

A
  • metabolically active
  • keratinocytes (develop keratin) and Langerhands cells (immune function - macrophage)
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5
Q

stratum spinosum

A
  • contain desmosomes - function as cell to cell junction
  • contains spiky/spiny projections
  • also contain Langerhands cells (immune cells)
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6
Q

stratum basale

basal layer, stratum germinativum

A
  • innermost and most continuous layer of epidermis
  • typically 1-3 layers of active keratinocytes - regenerates epidermis
  • Merkel cells - touch receptors
  • melanocytes - pigment
  • cells take 2-3 weeks to mirgrate from basal layer
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7
Q

general risk factors that impact wound healing

A
  • comorbidities
  • nutrition
  • obesity
  • smoking
  • alcohol/drug use
  • sedentary or limited mobility
  • impaired sensation
  • risk-prone behavior
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8
Q

extrinsic factors that may impact wound development and/or healing

A
  • shoes
  • orthotics/prosthetics
  • seating
  • positioning
  • posture
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9
Q

cardiovascular conditions that may increase risk of chronic wound development

A
  • venous insufficiencies
  • arterial insufficiency
  • lymphedema
  • emboli
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10
Q

neuromuscular conditions that may increase risk of chronic wound development

A
  • spinal cord injury
  • stroke
  • multiple sclerosis
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11
Q

musculoskeletal conditions that may increase risk of wound development

A
  • fracture
  • osteomyelitis
  • osteopenia
  • bony deformities
  • muscle weakness and atrophy
  • congenital deformities
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12
Q

what kind of wound is this

A
  • stage I pressure injury
  • red, non-blanchable
  • no openings
  • no DTI (not maroon or purplish skin)
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13
Q

stage II pressure injuries vs arterial

A
  • stage II over bony prominence
  • both can be punched out
  • arterial are typically very dry
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14
Q

DTI

A

purplish or maroon coloration and location over buttocks/sacrum

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15
Q

contraindications for conservative sharp debridement

A
  • stable heel eschar
  • gangrene
  • unidentified structures - nerve, tendon, ligament, fungating wound
  • terminally ill
  • artial insufficiency (ABI < 0.8)
  • coagulopathy
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16
Q

correct order before sharp debridement

A
  • MD order
  • chart review
  • cleanse
  • measure
17
Q

purpose of cross-hatching

A
  • increases surface area when utilizing topicals like santyl, medihoney, etc
  • allows you to get a free edge when doing conservative sharp debridement
18
Q

film dressings

A
  • indicated for: woudns with little or no exudate, wounds with necrosis, cover donor sites/lacerations/abrasions
  • contraindicated for: wounds with moderate to heavy exudate, not ideal for infected wounds
  • requires intact periwound skin
  • may cause maceration
19
Q

autolytic debridement

A
  • hydrocolloid
  • hydrogel
  • transparent non-occlusive
  • medihoney

santyl is an enzymatic debrider

20
Q

role of layers in a composite dressing

A
  • inner layer: non-adherent contact layer
  • middle layer: absorbs moisture and wicks it away from wound, can help prevent maceration while maintaining moisture
  • outer layer: bacterial barrier, commonly semi-permeable
21
Q

interventions of DTI

A
  • positioning/offloading
  • patient and staff education
  • moisture control
22
Q

interventions for arterial wounds

A
  • progressive graded exercise program
  • compression if ABI > 0.5
  • do NOT compress if ABI < 0.5
23
Q

interventions for diabetic foot ulcers

A
  • patient education
  • footwear recommendations
  • debridement
  • moiture control
24
Q

why is Neosporin not recommended

A
  • overused
  • not recommended for chronic wounds
  • ~14% alelrgy to neomycin
  • dermatitis with increased use
  • overgrowth of resistant bacteria
25
Q

JP drains

A
  • need to be compressed to work
  • good to pin to gown for mobility
  • if over 1/2 full, have RN empty prior to mobility
26
Q

as PTs, how can be best avoid shear and friction forces

A
  • position
  • HOB < 30 degrees
  • patient and staff education
  • surface recommendations
  • assess cushion fit
  • strengthening exercises to improve functional mobility
27
Q

autolytic debridement

A
  • dressings: occlusive/hydrocolloid, non-occlusive/transparent, hydrogel, medihoney
  • indications: for minor or moderate debridement
  • contraindications: per lecture (What the hell)
  • considerations: requires moist environment, functional immune system, not ideal for infected wounds
  • slowest, most conservative option
28
Q

enzymatic debridement

A
  • product: santyl
  • indications: can be used on slough and eschar
  • considerations: cross-hatching eschar before application to increase effective, not indicated for highly infected wounds
29
Q

biosurgical debridement

A
  • indications: large wounds with significant necrotic tissue
  • free range work at least 2x faster than biological bag
30
Q

sharp/surgical debridement

A
  • forceps, slapel, scissors, curette
  • indications: fastest option, highly selective, good for large areas
  • considerations: risk of bleeding, debride non-viable tissue only
31
Q

dry wound dressing

A
  • goal: increase moisture
  • dressing option: hydrogel, impregnated gauze, semi-permeable film
  • avoid: gauze, foam
  • additional considerations: NA
32
Q

excessive drainage dressing

A
  • goal: absorption
  • dressing option: semi-permeable foam, alginate, hydrofiber, super-absorbant, gauze
  • avoid: hydrogel, film
  • additional considerations: NPWT (wound vac), multi-layer compression if venous
33
Q

granulating wound dressing

A
  • goal: protection
  • dressing option: depends on amount of drainage
  • additional considerations: e-stim, NPWT
34
Q

infected wound dressing

A
  • goal: address infection
  • dressing option: topical antimicrobials, depends on amount of drainage
  • additional considerations: e-stim, NPWT
35
Q

stalled wound dressing

A
  • goal: cell stimulation
  • dressing option: collagen. extra-cellular wound matrix, topical antimicrobial
  • additional considerations: e-stim, NPWT, pulsed lavage

MC III (12 decks)

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