Chapter 35 Flashcards

Wound Care

1
Q

constrict

A

to narrow

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2
Q

dilate

A

to expand

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3
Q

skin tear

A
  • break / rip of outer skin layer
  • tearing top layer skin from lower tissue
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4
Q

ulcer

A

shallow / deep crater sore of skin / mucous membrane

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5
Q

wound

A

break in skin / mucous membrane; portal of entry

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6
Q

wounds are commonly from ?

A
  • surgery
  • trauma
  • constant pressure / friction
  • shearing
  • nerve damage
  • decreased blood flow
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7
Q

circulatory ulcers include ?

A
  • venous ulcers
  • arterial ulcers
  • diabetic foot ulcers
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8
Q

ischemic

A

reduced blood flow to body part

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9
Q

stasis

A

stopped / slowed fluid flow

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10
Q

venous ulcers

A

open stasis sores of lower legs / feet due to poor venous blood flow
- usually heels, inner ankles
- dull-aching pain

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11
Q

arterial ulcers

A

open ischemic wounds of lower leg / feet due to poor arterial blood flow
- usually between / top of toes, outside ankles
- extreme pain

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12
Q

diabetic foot ulcers

A

open wounds on foot due to diabetes complications
- lose sensation in feet

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13
Q

common foot problems of diabetic person ?

A
  • corns
  • blisters
  • ingrown / fungal toenail
  • bunions
  • plantar warts
  • hammer toe
  • dry / cracked skin
  • athletes foot
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14
Q

elastic stockings

A

put pressure on veins to promote venous blood flow; help prevent thrombi
- compression stockings
- anti - embolism stockings

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15
Q

thrombus

A

blood clots in leg veins

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16
Q

embolus

A

blood clot that travels

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17
Q

pulmonary embolism

A

embolus that is lodged in the lungs

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18
Q

persons at risk for thrombi ?

A
  • heart / circulatory / lymphatic disorders
  • bed rest
  • older
  • pregnant
  • had surgery
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19
Q

anti embolism / thrombo embolic deterrent (AE stockings / TED hose)

A
  • prevent blood clot formation
  • common after surgery
  • not long term use
20
Q

compression socks

A
  • improve blood flow
  • prevent leg swelling
  • long term use
21
Q

how to wash elastic stockings

A

wash 1 pair while other is being worn
- hand wash w/ mild soap
- hang to dry

22
Q

how should elastic stockings be worn ?

A
  • toe opening is either on top / bottom of toe
  • no twists / creases / wrinkles
23
Q

when should elastic stockings be worn / taken off ?

A
  • applied before getting out of bed (dry legs)
  • taken off when in bed
24
Q

how should stockings be applied

A

turned inside out then rolled back / pulled back properly up the leg

25
Q

elastic bandages

A

same purpose as elastic stockings; provide support / reduce swelling of injuries

26
Q

applying elastic bandages ?

A

apply firmly / evenly starting from distal to proximal end of extremity (furthest to closest)
- loose end of bandage is the bottom
- expose toes / fingers if possible
- wrap around twice for first / last spiral
- spirals should cover 1/2 - 3/4 of previous spiral
- each spiral is equal

27
Q

when should elastic bandages be changed ?

A

if moist / soiled; only reapplied if loose

28
Q

wound dressing functions ?

A
  • protect wound
  • absorb drainage
  • remove dead tissue
  • provide comfort / pressure
  • cover unsightly wounds
  • moist environment for healing
29
Q

common types of materials to secure dressing ?

A
  • paper
  • plastic
  • cloth
  • elastic tape
  • adhesive; less common due to more complications (irritation, skin tears, etc.)
30
Q

three methods of securing dressings ?

A

depends on dressing / wound
- tape top, middle, bottom
- tape edges
- tape entire dressing

31
Q

how should taping never be secured ?

A

fully circling body part w/ tape; can lead to impaired circulation

32
Q

montgomery straps

A

used for large wounds / persons w/ frequent dressing changes
- one end tape other has cloth ties

33
Q

how are montgomery straps applied ?

A

1) clean away from wound each side; starting with one side going to the next
2) clean top to bottom of wound; starting from center of wound outward each side
3) apply to each side of dressing
3) tie cloth straps together over dressing

34
Q

binders

A

wide bands of elastic fabric; support wounds / hold dressing in place

35
Q

abdominal binders

A

provide abdominal support / hold dressing in place
- top part at waist
- lower part over hips
- secured w/ velcro / hook and loop

36
Q

breast binder

A

provide breast support after surgery
- secured w/ velcro / padded zippers

37
Q

compression garments

A

garments of tight stretchy fabric common after plastic surgery
- reduce swelling
- keep skin against body
- prevent fluid buildup
- achieve desired shape

38
Q

heat applications help what problems ?

A

musculoskeletal injuries / problems
- relieve pain / swelling
- relax muscle
- promote healing
- decrease stiffness
dilates area; constricts after too long

39
Q

heat is never applied to what ?

A
  • implant areas (peacemakers, joint replacements)
  • pregnant women’s abdomen (can affect fetal growth)
40
Q

cold applications help what problems ?

A

treat sprains / fractures
- reduce pain
- prevent swelling
- decrease circulation / bleeding (constricts arteries / veins)
constricts; after too long dilates

41
Q

moist application

A

water contact w/ skin
- moist heat = lower temps.
- dry heat = higher temps.

42
Q

dry application

A

no water contact w/ skin

43
Q

hot temp

A

99°-106°F

44
Q

warm temp

A

93°-98°F

45
Q

tepid temp

A

80°-92°F

46
Q

cool temp

A

65°-79°F

47
Q

cold temp

A

50°-64°F