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Special Topics 1 > Woundcare 2b/c > Flashcards

Woundcare 2b/c Flashcards

1
Q

Critical colonization

A

Point at which the host immune response is no longer able to control microorganisms in wound bed

Bacteria not yet invaded soft tissue
Arrested wound healing and unhealthy appearance of granulation tissue

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2
Q

Topical treatments

A

Cadexomer iodine
Silver
Xeroform
Hypchlorous acid soak

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3
Q

Infection

A

Invasion and multiplication of microorganisms in body tissue
Results in local cellular injury
Host defenses are overwhelmed

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4
Q

Infection equation

A

(# organisms x virulence)/host resistance

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5
Q

Host resistance

A

Immune repsonse
Blood supply
General health status
Local factors

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6
Q

S/s of infection local

A 
Erythema
Edema
Warmth
Increase pain
Purulent
Induration
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7
Q

S/s infection systemic

A

Fever
Elevated WBC
Red streaks from wound
Confusion or agitation

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8
Q

S/s infection chronic

A 
New/increased slough
Friable granulation tissue
Foul odor
Increased wound breakdown
Sudden high glucose in diabetics 
Increase/changes in exudate
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9
Q

Clinical diagnosis of infection

A

Bacterial load 10^5-10^6 (will not heal)

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10
Q

NERD and STONEES

A

Sibbalds cute for superficial and deep compartment infection/inflammation
Symptoms and theranostic test

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11
Q

NERDS

A

Add picture

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12
Q

STONEES

A

Add picture

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13
Q

Gold standard for indicated dx

A

Tissue biopsy

Not w/in PT scope

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14
Q

Tx infection

A 
Cleansing/ irrigation
Debridement
Topical anti microbial
Topical antiseptics
Abx
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15
Q

Topical antiseptics

A 
Acetic acid
Alcohol
Chlorhexidine gluconate
Dakins solution
Gentian violet
Hydrogen peroxide 
Povidone iodine
**Hypochlorite acid - safe
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16
Q

Microorganism defenses

A

Toxins
Anderence of organism
Biofilms
Invasive factors (protease)

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17
Q

Endotoxins

A

Lipids and polysaccharides related by lysis of gram negative bacteria
Causes destruction of growth factors, receptors, tissue components
Decrease collagen deposition and cross linking, affecting tensile strength
Associated w/ surgical wound dehiscence

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18
Q

Extotoxins

A

Proteins related by both gram positive and negative bacteria during proliferation —> generalized tissue necrosis at wound surface

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19
Q

Biofilms

A

Structured community of bacteria cells enclosed in self produced polysacchardie matrix

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20
Q

Quorum sensing

A

Comm processes among cells in biofilm —> perceive how many other bacteria are in close proximity, regulation of many different processes

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21
Q

Disadvantage of biofilm

A 
Resistance to anti microbial, abx, phagocytes
Ability to enter into latent states
Increasing species diversity
Persister cells 
Altered gene expression
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22
Q

Biofilm tax

A 
Wound cleansing/irritation
Serial debridement
Cadexomer iodine
Flouroquinolone abx
Pulsed, low dose abx
Xylitol
Lactoferrin
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23
Q

Biofilm irrigation

A

35 ml syringe w/ 18 gauge angiocatheter 8-12 psi

Water as effective as normal saline except immunocompormised or poor water quality

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24
Q

Hydrotherapy

A

Pulsed lovage w/ or w/out suction

Whirlpool

Softening necrotic tissue, reduce bioburden, remove debris, promot granulation, treatments of tunnels and undermining

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25
Q

Pulsed lavage setup

A

8-12 psi
2-6 at tunnels
60-200 mm hg suction
1 bag of irritant

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26
Q

Pulsed lavage precautions

A 
Insensate pts
Anticoagulant meds
Wound near major vessels
Wounds near a cavity lining
Bypass graft sites
Exposed structures
Grafts
Flaps
Facial
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27
Q

Whirlpool

A

Necrotic tissue - softens, reduce bioburnder, remove debris
92-96 deg, 5-20 mins, monitor

Precautions: edema, CHF, heart conditions
Contras: new skin graft/flap, suture, IV sites

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28
Q

Wound bed moisture balance

A

Too much exudate: maceration, pooling

Too little: desiccation

Too wet, absorb

Too dry, moisten

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29
Q

Benefits of moist wound healing

A
  • Optimal enviro
  • Reduces number of dressing changes (time and cost)
  • reduces potential for infection
  • less painful
  • decrease healing time
  • stronger scar formation
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30
Q

Ideal dressing characteristics

A
  • barrier to bacteria
  • adequate gaseous exchange
  • thermal insulation
  • free from contaminants
  • manages excess exudate
  • facilitates nontraumatic removal
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31
Q

Dressings - absorption

A

Alginate
Foam
Hydrocolloid
Hydrofiber

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32
Q

Dressing - hydration/moisture maintenance

A
  • hydrogel
  • impregnated gauze
  • hydrocolloid
  • transparent film
33
Q

Dressings - antimicrobial

A
  • cadexomer iodine
  • silver
  • honey
34
Q

Enzymatic debridement

A

Collagenase santyle

35
Q

Protection of periwound

A

Ointments
Creams
Films
Hydrocolloid

36
Q

Alginate

A

Non - woven pad of seaweed fibers, non occlusive, conformable, slow bleeding, forms gel when filled w/ fluid

Ad:highly absorbent;packing;easy to use; hemostasis properties

Ind: mod to heavy exudate, contaminated or infected, slough or granulation

37
Q

Foam

A

Absorption
High density polyurethane

Ad: nonadhesive, friable periwound, large variety

Indication: minimal to heavy exudate, not recommended for infected wounds

38
Q

Hydrocolloid

A

Absorption, hydration/moisture

Ad: adhesive, absorptive, conformable, promotes autolysis, also able to maintain most wound bed

Indications: dry to minimal exudate, aloud or granulation

39
Q

Hydrofiber

A

Absorption

Packing agen, easy, 33% more absorbent than alginate

Moderate to heavy exudate, contaminated or infected, slough or granulation

40
Q

Hydrogel

A

Hydration, moisture maintain

Cooling effect,amorphous, promotes autolysis, keeps structures moist

Dry to minimal exudate, eschar, slough, granulation; deep structures exposed

41
Q

Impregnated gauze

A

Hydration, moisture

Highly confomrative, maintains moisture, nonadherent, promotes autolysis
Keeps structures moist

Dry to minimal exudate, eschar, slough, granulation, deep structures exposed

42
Q

Transparent film

A

Mosture

Promotes autopsies, reduces surface tension *may hold in too much moisture

Dry to minimal exudate, partial thickness wounds or as secondary dressing

43
Q

Cadexomer iodine

A

Iodine Released over 72 hours, starch beads absorb exudate

Absorptive and odor reducing
Moderation to easy exudate, infected, malodorous wounds

Contras: hyperthyroid, iodine sensitivity

44
Q

Silver

A

Antimicrobial, reduces inflammation

Critically colonized/infected wounds or those at risk of becoming infected

Contra: use w/ enzymatic debridement, some not compatible w/ saline

45
Q

Honey

A

Antimicrobial, draws fluid from wound by osmotic pressure, reduces odor, aids in debridement

For critically conolized/infected wounds, those at risk for infection, necrotic

Not for use w/ enzymatic debridement

46
Q

Collagenase santyl

A

Debriding ointment w/ enzymes derived from bacteria
Desires collagen anchors to wound bed
For wound w/ necrotic tissue

Contra: use w/ silver dressings, pt hypersensitivity to substance

47
Q

Ointments, creams, liquid films

A

Protect periwound, provides a barrier, smooth irritated skin

48
Q

Physical agents for epithelial advancement

A 
Electrical stim
Non contract US
UVC light
Negative pressure 
Hyperbaric oxygen
Compression
49
Q

E-stim

A

Most nonhealing wounds

Reimbursement: must have received evidence based wound care for at least 4 weeks w/ little to no progress

50
Q

Estimate - high volt pulsed current

A

3-5x/week

Active electrode to wound, dispersal pad to intact skin w/ list cause or washcloth

51
Q

Non contact US

A

Most nonhealing wounds, all healing phases, not generally reimbursed
Saline as conduit
Contras: eclectic implants, low back/abs during pregnancy, over malignancy

Increased healing rate in non diabetic foot ulcer, ischemic wounds

52
Q

UVC

A

Infection, impaired wound healing

Benefit: increased epithelial migration, local cutaneous blood flow, bactericides effects, inhibit growth of MRSA and VRE

Perpendicular to wound surface, 2.5cm away, 90 seconds daily

53
Q

UCV contras

A 
Skin CA
Graft photosensitivity
Skin conditions
Keep X-ray therapy
Local erythema
AIDS/HIV
Eye
No CHF, TB, DM, hyperthyroid, fever
54
Q

Hyperbaric oxygen wound indications

A

osteomyelitis, diabetic
wounds, necrotizing soft tissue infections,
osteoradionecrosis, soft tissue radionecrosis,
compromised grafts and flaps, acute thermal
burns, crush injury, compartment syndrome and
other acute traumatic ischemias

55
Q

Hyperbaric oxygen benefits

A

Increase oxygen concentration in tissue

Stimulates new blood vessel growth

56
Q

Negative pressure indications

A 
Nonhealing/chronic wounds
Post sx/ traumatic wounds
As a bridge to tertiary closure
Skin grafts and flaps
Enterocutaneous fistula
57
Q

Negative pressure precuations

A 
Anticoagulants
Elevated IRN
Low platelets
Active bleeding
Poor tolerance of VAC therapy
58
Q

Negative pressure contras

A

Malignancy
Untreated osteomyelitis
Nonenteric and unexplored fistulas
Majority of wound necrotic

59
Q

Negative pressure challenges

A

Wounds w/ enterocutaneous fistulas
In proximity to external fixations, moist areas, sacrum/coccyx/perineum
Tubing
Exposed structures

60
Q

Negative pressure solutions

A 
Bridging
Ostomy pouches in conjunction w/ NPWT
Ostomy paste strips
Benzoin tincture
Adaptic/merited/white foam
61
Q

7 types of edema in legs

A 
Venous
Cardiac
Lymphedema
Inflammatory 
Idiopathic
Hypoproteinaemic renal
62
Q

Edema tax

A 
Meds
Treatment of medical cause
Manual lymph drainage
ELEVATION
COMPRESSION
63
Q

Compression physio

A

Reduce diameter of veins -> endothelial cells to become tighter-> reduce fluid leakage from veins

Increase in BF toward heart and reduces venous reflux

64
Q

Degree of compression determined by

A 
Elasticity of bandage
Number of bandage layers
Shape and size of limb
Skill and technique of bandage
Nature of physical activity by pt
65
Q

Laplace law

A

For bandage pressure

Pa-Pb= (2y/r)

Pa = internal 
Pb = external
Y = tension
r = radius
66
Q

Increased bandage tension

A

Increased sub bandage pressure

67
Q

Increased # bandage layers

A

Increased sub bandage pressure

68
Q

Increased leg circumference

A

Decreased sub bandage pressure

69
Q

Increased bandage width

A

Decreased sub bandage pressure

70
Q

2 pain bandage types

A

Long stretch (more aggressive compression)

Short stretch (safer due to less extensibility -> less tension to limb)

71
Q

Long stretch bandage

A 
High resting pressure
Low working pressure
Higher risk of damage
>140% ext
Polyurethane
72
Q

Short stretch bandage

A 
Low resting pressure
High working pressure
Lower risk of damage
~60% ext
Made from cotton fibers
73
Q

Resting pressure

A

Pressure bandage exerts on tissue at rest

74
Q

Working pressure

A

Pressure bandage exerts against working musculature

75
Q

Compression precautions

A 
DM
PVD/arterial insufficiency 
Acute cellulitis/infection
Neuropathy
Lymphedema 
Acute CHF
Low ejection fraction
Fragile skin
76
Q

Compression contras

A

ABI <0.6

High compression (30-40 mmHG) W/ ABO <0.8

77
Q

Compression progression - wounds

A

Open: wraps, maybe Velcro compression garment

Closed: stockings or compression garments

78
Q

Pt instructions for compression stockings

A

Wear during waking hours when OOB

Do not moisturize prior to applying

Wound recalcitrance
Elevation of LE above heart when sitting
Importance and purpose of wraps/stockings
Monitoring for changes such as CHF, cellulitis, vascular status

79
Q

Red flags - refer to MD

A 
Worsening cellulitis 
Cellulitis in diabetic or elderly population
Unusual exudate from any wound
Increase in depth, bone/tendon exposure
Deep compartment infection
Purple coloration
Digits eschar
Sig area of eschar of foot/hand
Nonhealing wound after 2-3 mo

Special Topics 1 (12 decks)

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