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MSK2 > Wound management > Flashcards

Wound management Flashcards

1
Q

In wound healing, when does the inflammatory phase occur?

A

Days 0-5

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2
Q

Outline the inflammatory phase of wound healing

A
  • Initiates inflammation of tissue
  • Haemorrhage followed by haemostasis
  • Produces heat, redness, swelling, pain
  • Localised vasodilation, oedema and serous-type ooze
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3
Q

When does the debridement phase of wound healing occur?

A

From day 0

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4
Q

Outline the debridement phase of wound healing

A
  • Migration of leukocytes
  • Phagocytosis removing and destroying bacteria
  • Cellular debris removed
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5
Q

When does the proliferative phase of wound healing occur?

A

Day 3 up to 4 weeks

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6
Q

Outline the proliferative phase of wound healing

A
  • Repair of damaged tissues
  • formation of a repair framework and granulation tissue
  • Wound contraction and epithelialisation
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7
Q

When does the remodelling phase occur in wound healing?

A

Day 20 to years

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8
Q

Outline the remodelling phase of wound healing

A
  • Repaired tissue is replaced by collagen
  • Wound continues to contract
  • Tissue regains some elasticity and protective barrier function
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9
Q

Discuss the rate of epithelialisation of a superficial wound in relation to the presence of a scab

A

Much slower to epithelialise when covered normally by a dry scab is present

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10
Q

What are the ideal properties of a dressing to promote granulation tissue formation?

A
  • Non-restrictive
  • Non-adherent
  • Sterile
  • Provides moist environment
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11
Q

Outline the desirable properties of a dressing in the case of chronic granulation tissue

A

Something that actively debrides the tissue and helps re-stimulate growth of healthy granulation tissue

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12
Q

List the broad types of wound dressing

A
  • Adherent
  • Non-adherent
  • Absorbent
  • Active
  • Antimicrobial
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13
Q

What is the primary function of adherent/debridement wound dressings?

A

Control wound infection and debride infected/neccrotic wounds

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14
Q

Give examples of adherent/debridement dressings

A
  • Wet-to-dry, dry-to-dry

- Saline soaked or dry sterile gauze applied directly on wound’s surface

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15
Q

Outline the management of adherent/debridement dressings

A
  • Change at least every 24hours
  • Should peel away necrotic tissue/debris
  • Fresh granulation tissue handled carefully to avoid compromising the progression of the wound
  • May need analgesia/sedation as removal can be painful
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16
Q

Give examples of non-adherent wound dressings

A
  • Perforated polyurethane membranes
  • Paraffin gauzes
  • Vapour permeable films
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17
Q

Give examples of perforated polyurethane membrane dressings

A
  • Melolin

- Primapore

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18
Q

What are the indications for use of a perforated polyurethane membrane dressing?

A

Post operative wound where the incision site and sutures require protection throughout the immediate post-op period

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19
Q

Explain the contraindications for use of a perforated polyurethane membrane dressing

A

Should not be used in granulating wounds as they lack the ability to provide the ideal healing environment for the granulation process, may disrupt healing on removal

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20
Q

What are paraffin gauze dressings?

A

Dressings comprising a thin, cotton netting impregnated with soft paraffin

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21
Q

Briefly describe the use of paraffin gauze dressings

A
  • Applied as primary layer over open wound

- Should have secondary layer over gauze to act as absorbent layer and draw exudate away from wound

22
Q

Explain the function of paraffin gauze dressings

A

Prevent dressing stickig to the wound and to support healing under moist and aseptic conditions

23
Q

What wounds is the use of paraffin gauze dressings most suited to?

A

Skin wounds, burns, skin graft sites, traumatic injuries where skin loss is evident

24
Q

Give example of vapour permeable film dressings

A

Opsite Flexigrid

25
Q

What is the main function of vapour permeable film dressings?

A

Promote moist wound healing and provide protective barrier, allows for vapour exchange at wound surface while maintaining moist environment

26
Q

Briefly describe the use of a vapour permeable film dressing

A

The thin membrane of the dressing should be stretched over the wound, with the edges sticking to the skin surface (can be tricky to apply)

27
Q

What wounds are vapour permeable films suited to?

A

Small or shallow wounds producing little exudate only, as this becomes trapped underneath the dressing

28
Q

What is the primary function of absorbent dressings?

A

Provide absorbent layer for wounds producing high volumes of exudate, such as large, extensive wounds undergoing the granulation process

29
Q

Give examples of absorbent dressings

A
  • Foams e.g. Allevyn, Tielle

- Super-absorbent dressings e.g. Eclypse

30
Q

Explain the use and properties of foam dressings

A
  • Absorb wound exudates while maintaining a moist environment suitable for granulation and epithelialisation to take place
  • Outer layer of dressing prevents strike through
  • Can absorb up to 10x their own weight
  • Protective barrier over wound
  • No debriding properties
31
Q

Explain the use and properties of super-absorbent wound dressings

A
  • Used for wounds experiencing large volumes of exudates and moisture management may be proving tricky
  • Contain polyacrylate polymers which have hydroactive properties so can hold and retain large volumes of fluid
32
Q

What is the function of active dressings?

A

Gently debride the wound’s surface, provide moist wound environment, encourage wound granulation

33
Q

Give examples of active dressings

A
  • Hydrocolloids e.g. Granuflex, Tegasorb

- Hydrogels e.g. Intrasite Gel and Nugel

34
Q

Outline the properties of hydrocolloid wound dressings

A
  • Microgranular layer of natural or synthetic polymers within adhesive polymer matrix
  • Usually semipermeable outer membrane and have antioxidant property by releasing small quantities of hydrogen peroxide
  • Absorb and hold wound exudates, pressure exerted on wound bed
35
Q

Give examples of the polymers found in hydrocolloid dressings

A
  • Gelatin
  • Pectin
  • Carboxymethylcellulose
36
Q

What is the benefit of the hydrogen peroxide released by hydrocolloid dressings?

A

Assists in minimising cellular metabolism and proliferation

37
Q

Which types of wounds are suited to use of a hydrocolloid dressing?

A

Chronic granulation tissue or necrotic tissue

38
Q

Which types of wounds are hydrocolloid dressings unsuitable for?

A

Care in presence of infection, therefore unsuitable for early stages of wound debridement

39
Q

Outline the care required when using a hydrocolloid dressing

A
  • Need to monitor closely for healthy granulation tissue to establish how it is reacting to these dressings
  • Wound may become enlarged slightly due to debridement properties
40
Q

Describe the use of hydrogel dressings

A

When applied to the wound, should be covered with a semi-permeable adhesive layer to maintain a moist environment

41
Q

Outline the advantages of hydrogel dressings

A
  • Debriding action of hydrogels is atraumatic compared to wet-to-dry or surgical debridement (less pain on application and removal)
  • Encourages formation of granulation tissue
  • Application provides analgesia
  • Debriding action means they can be used in infected wounds and actively assist in removal of bacteria and debris
42
Q

Give examples of antimicrobial wound dressings

A
  • Silver dressings
  • Manuka honey
  • Polyhexamethylene biguanide PHMB)
43
Q

What types of wounds are well suited to the application of silver dressings?

A
  • Chronic infeciton
  • Delayed healing
  • Large open wounds at risk of colonisation
44
Q

How should silver dressings be used?

A

Use with suitable secondary layer to absorb wound’s exudates

45
Q

Briefly characterise the antimicrobial activity of silver dressings

A

Powerful broad-spec antimicrobial with goof activity against Staphlococcus and Pseudomonas spp.

46
Q

Briefly characterise antimicrobial the activity of manuka honey as a wound dressing

A

Topical, broad spec antimicrobial effects including against resistant strains of bacteria

47
Q

Outline the properties of manuka honey dressings

A
  • Antimicrobial
  • Wound debridement
  • Anti-inflammatory
  • Optimal moist environment
48
Q

Which wounds are best suited to use of manuka honey?

A
  • Dirty, sloughing, necrotic wounds that require debridement and infection management
  • Abscesses, bite/puncture wounds and other grossly contaminated wounds
49
Q

Briefly describe the use of manuka honey dressings

A
  • Appropriate preparation and lavage of wound first

- Secondary sterile dressing placed on top to allow absorption of exudates

50
Q

When is the use of manuka honey contraindicated and why?

A
  • Arterial or actively bleeding wounds, as it may encourage further haemorrhage
  • Or if patient has a known anaphylactic response to bee venom
51
Q

Characterise and explain the antimicrobial properties of polyhexamethyl biguanide (PHMB) dressings

A
  • Antiseptic mode of action and effective against broad spectrum of bacteria
  • PHMB molecules insert into bacterial membrane, destroy bacterial integrity, rupture cell membrane
52
Q

What are the advantages of PHMB wound dressings?

A
  • Reduces wound associated pain
  • Increases formation of granulation tissue
  • Assists in removal of non-viable tissue

MSK2 (29 decks)

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