Chap 83 Wound Care Flashcards Preview

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Flashcards in Chap 83 Wound Care Deck (26):
1

List causes of non-healing wounds and name one method of investigation for each.

Venous hypertension--Plethysmography/Doppler

Arterial insufficiency--NIVs (macro), tcPO2/biopsy (micro)

Bacterial colonization--wound culture or biopsy

Malignancy--biopsy

Lymphatic obstruction--clinical, lymphangiography

Hematological disorders--B/W

Collagen vascular disorders--serum markers

Excessive pressure---vibratory sensation (>25mV)

2

What are the stage of normal wound healing.

inflammatory
proliferative
epithelialization and remodelling

3

Describe the inflammatory phase.

Mediated by Mast cells, neutrophils, macrophages
Release cytokines that recruit fibroblast and epithelial cells
Within 24hours

4

Describe the proliferative phase.

Macs---growth factors that begin angiogenesis
Finroblast and cytokines synthesize collagen and proteoglycans---granulation tissue

5

Describe the Epithelialization and remodelling phase

Epithelial cells migrate into the wounds, secret MMP to degrade nonviable tissue
Remodeling long-term procee where type III collagen replaces type I

6

List mechanisms of abnormal wound healing

Inflammation
Inflam cause up regulation of cytokins and MMP which has a detrimental effect because they are present persistently

Cytokines
Upregulation of THN-alpha, IL-1, IL-6

Cell senescence
Cells have diminished response to agonist-induced proliferation

7

What is the National Pressure Ulcer Advisory Panel Staging of ulcers?

Stage I Non-blacheable erythema
Stage II partial thickness (partial dermis)
Stage III Full thickness skin loss
Stage IV full thickness tissue loss (bone, tendon, muscle)
Unstageable--until eschar comes off)

8

List forms of non-vaible tissue.

callus
eschar
fibrinous material
slough

9

List methods of debridement and examples.

mechanical--surgical, best
chemical-collagenase
larval-maggots
US

10

When to treat bacterial colonization?

when counts are > 10 5th power counts per cubic millimeter

11

Give an example, advantages/disadvantage and e.g. of when to use gauze.

kerlix

debridement
absorptive
cheap

may dehydrate wound
damage granulation tissue
frequent changes

infected wounds

12

Give an example, advantages/disadvantage and e.g. of when to use film.

tegaderm
opsite

semipermeable
retains moisture
waterproof
visualization of wound

can't use on infected wounds
may tear skin

post-surgical wounds

13

Give an example, advantages/disadvantage and e.g. of when to use hydrogel.

nu-gel

rehydrate wound
extends time b/w dressing changes
fills dead spar

may be difficult to secure secondary dressing
may macerate skin

diabetic foot ulcers
minimally exudative wounds

14

Give an example, advantages/disadvantage and e.g. of when to use hydrocolloid.

duoderm
tagasorb

impremeable to bacteria
facilitates autolytic debridement
self-adhesive

not for infected or exudative wounds
may cause skin tears

patialthickness wounds
low-exudative pressure ulcers

15

Give an example, advantages/disadvantage and e.g. of when to use foam.

allevyn

highly absorptive
protective

may macerate
secondary dressing
not effective for dry wounds

highly exudative wounds
venous ulcers

16

Give an example, advantages/disadvantage and e.g. of when to use alginate.

algisite

forms moist gel in wound
highly absorptive
controls heavy exudate

can dehydrate wound
secondary dressing

heavily exudative wounds
venous ulcers

17

what are diabetic wounds best treated with?

donate moisture like hydrogels

18

What are draining wounds best treated with

alginates

19

what is the evidence for silver impregnated dressing for colonized wounds?

does not heal better then without

20

What is the evidence for compression and pentoxifylline for leg ulcer?

MA.
combo results in faster healing

21

What is the evidence for vein stripping in leg ulcers?

RCT showed at 4 years, stripping + compression 31% had recurrence, vs 56% with compression alone
Venous stripping reasonable when superficial venous reflux is a prominent compoenet (30-50%)

22

What is the evidence for skin grafting?

there is non to show better
can get recurrence

23

What is evidence for VAC therapy?

RCT--accelerates wound healing

24

Hoe does VAC therapy work?

negative pressure
Removal of exudate, stimulation of senescent cells, mobilization of macrophages, stimulation of angiogenesis

25

How does hyperbaric O2 therapy work?

100% oxygen at elevated atmospheric pressure
increase partial pressure of oxygen in tissues
improve oxygen supply, reduction of inflammation and edema, inhibition of infection, stimulate angiogenesis, enhance fibroblast function
one treatment daily for total of 20-40 treatments

26

What is the evidence for hyperbaric O2 therapy?

limited for ischemic limbs