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e+i Flashcards

1
Q

how long must a wound be present before medicare will reimburse it as “chronic”?

A

30 days

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2
Q

what are 4 common barriers to wound healing?

A

inadequate microcirculation
prolonged pressure from interstitial edema
bacterial infection
absence of adequate electrical potential

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3
Q

presence of bacteria is called what?

A

bioburden

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4
Q

bioburden, perfusion defects, nonviable tissue, moisture, nutrients, and oxygen are considered what kind of factors in wound healing?

A

local/intrinsic

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5
Q

factors that affect whole body, cormorbid disease, nutritional status, age, obesity are considered what kind of factors in wound healing?

A

systemic/intrinsic

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6
Q

what four types of products maintain moisture in a wound?

A

films
hydrocolloids
hydrogel sheets
amorphous gels

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7
Q

what type of product helps add moisture to a wound?

A

biocellulose

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8
Q

what four types of products absorb moisture?

A

foams
collagen
alginates
superabsorbents

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9
Q

what types of products help manage fluid in wound healing?

A

hydropolymers

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10
Q

what does a retention product do in wound healing? examples?

A

holds dressing in place

film dressings, tapes, stretch gauze

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11
Q

what type of products are made to come in contact with the wound?

A

impregnated gauzes
perforated plastics
silicone coated meshes

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12
Q

what type of dressing touches the wound surface?

A

primary dressing

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13
Q

what type of dressing attaches a primary dressing to the patient?

A

secondary dressing

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14
Q

what type of dressing is constructed with something absorbent in the middle of something adhesive?

A

island dressing

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15
Q

what are 5 wound needs? as in what in common does all wound healing have?

A

optimal ph (slightly acidic), control of bacteria, freedom from necrotic tissue, thermal insulation, adequate hydration

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16
Q

frequent repositioning of the patient is required for what type of wound? how often?

A

pressure ulcer

every 2 hours

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17
Q

diabetic ulcers require what types of treatment?

A

offloading of pressure
good glucose control
test w hemoglobin, A1c

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18
Q

arterial ulcers require what type of treatment?

A

establishment of adequate circulation through movement and exercise

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19
Q

how are venous ulcers treated? is this reversible?

A

use of a compression system

no

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20
Q

what is stage 1 biofilm?

A

free-floating and solitary (planktonic) microorganisms

reversible

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21
Q

what is stage 2 biofilm?

A

bacteria multiple and become sessile

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22
Q

what is stage 3 bioflim?

A

bacteria secrete extracellular polymeric substance (eps) (slime)
components shed and attach to other parts of the wound bed or other wounds
develops within 6-12 hours and in 2-4 days =mature biofilm

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23
Q

what are 5 types of medication that impede healing?

A

nicotine
anti-neoplastics
anti-coagulants
corticosteroids

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24
Q

what constitutes a stage 1 pressure injury?

A

intact skin

area of non-blanchable erythema

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25
what constitutes a stage 2 pressure injury?
partial thickness loss of skin w exposed dermis wound bed: viable, pink, red, moist may be intact or ruptured serum-filled blister
26
what constitutes a stage 3 pressure injury?
full thickness loss of skin adipose is visible in ulcer granulation tissue and epibole are present
27
what constitutes a stage 4 pressure injury?
full thickness loss of skin | exposed fascia, muscle, tendon, ligament, cartilage or bone
28
what constitutes an unstageable pressure injury?
full thickness but cannot be assess due to obstruction by slough or eschar
29
what constitutes a deep tissue injury?
intact or non-intact skin w localized area of non-blanchable deep red, maroon, purple discoloration or epidermal separation
30
muscle pump failure, pericapillary fibrin deposits, which result in thrombosis, obstruction, dilation, and hemorrhage are from what kind of ulcer?
venous insufficient ulcer
31
what are some characteristics of a venous insufficient ulcer?
pain relieved w elevation irregular edge medial side of ankle hemosiderin staining: orange/brown, 6-8 mmm above medial malleolus
32
where are lymphatic ulcers found?
arms legs most common: ankle
33
how does one describe lymphatic ulcers?
firm, fibrotic surrounding skin small ulcers that ooze or are blistered usually bilateral
34
what is different about dressing arterial wounds than other types?
DRY dressings
35
What types of wounds have an inadequate blood supply, low ankle/brachial index of less .5 not likely to heal, 20/10 pain, pain decreases w dependent position, has eschar/necrosis?
arterial insufficient ulcer
36
where are arterial insufficiency ulcers found?
toes, fingers, interdigital spaces
37
what type of ulcers are generally found on the lateral side of the calf?
vasculitic ulcer
38
how can you identify a surgical wound?
straight wound margins
39
what are three characteristics of traumatic wounds?
generally irregular wound margins visible inflammatory response margin indurated wound margin
40
what is a plantar ulcer, a deep neutrotrophic ulcer of the sole of the foot, resulting from repeated injury because of lack of sensation or bony deformity seen with diseases, such as...?
diabetic foot ulcer
41
6 factors associated with diabetic foot ulcer?
``` peripheral neuropathy pressure friction and shear peripheral vascular disease limited joint mobility (foot deformities, decreased ROM in heel cord, decreased heel strike) loss of protective sensation ```
42
what is a way to describe the appearance of a dfu?
round punched out lesion w elevated rim
43
are dfu's painful?
no, not until bone is infected
44
what is a 0 on the wagner scale? what is the wagner scale for?
pre-ulcerative lesion, healed ulcers, presence of bony deformity
45
what is a 1 on the wagner scale measuring?
superficial ulcer w/o subcutaneous tissue involvement
46
what is a 2 on the wagner scale measuring?
penetration through subcutaneous tissue, may expose bone, tendon, ligament or joint capsule
47
what is a stage 3 on the wagner scale measuring?
osteitis abscess osteomyselitis
48
what is stage 4 of the wagner scale considered?
gangrene of digit
49
what is stage 5 of the wagner scale measuring?
gangrene of foot requiring disarticulation
50
what does serum albumin measure? what is a normal level? too little?
protein over 90 days | >3.5 g/dL, <2.5g/dL
51
what does prealbumin measure? normal? too little?
protein over a few days 15-43 mg/dL normal 0-5 mg/dL severe depletion
52
what is the normal range of hemoglobin for a female? `
12--15. gm/dL (males slightly higher)
53
what is the normal percent of hematocrit for a female?
37-48%, males slightly higher
54
what is an average lymphocyte count?
1000-4000mL
55
what vitamin levels are important to measure in determine wound care?
A, K, D
56
what two lower extremity locations should you check for pulses? are these biphasic or monophonic?
dorsalis pedis | posterior tibial
57
what are two tests to examine arterial insufficiency?
capillary refill | rubor of dependency
58
how is a capillary refill test conducted? what is the normal time associated with this test?
pinch great toes and count seconds for the skin to return to normal color should within 2 seconds
59
how is rubor of dependency determined?
lie your patient supine, elevate foot to a 30 degree angle, if skin pales (palor on elevation), it is a positive sign of arterial insufficiency have your patient sit upright w foot in dependent position, dramatic red color change indicates severe tissue ischemia -color changes should occur within 30 sec
60
What is the thresh hold for an emergency ABI? (according to Professor Unger)
.5 | patient seen by specialist that day
61
What are 5 locations in the ankle that are used for circumferential measurements?
arch figure 8 ankle 10 cm above medial malleolus 20 cm above medial malleolus
62
what is one test to examine the risk of diabetic foot ulcers (lops)? how much force does it utilize?
5.07 semmes-weinstein monofilament | 10 grams of force to bend it when you touch a patient's skin
63
what are three high risk persons at risk for friction injuries?
agitated spastic sliding down in bed
64
how often should a bed-bound individual be be repositioned?
every 2 hours
65
how often should a chair-bound individual be repositioned?
every 15 min
66
how many degrees should a person be turned to remove pressure from the sacrum?
40 degrees
67
what height should a hospital bed be kept to reduce friction and shear?
avoid more than 30 degrees of head-of-bed elevation unless medically needed
68
what are four ways to reposition a patient that do not include a bed covering?
teach individual to reposition using trapeze use lifting devices to move individuals who cannot assist place pillows or wedges between knees and ankles (top leg in front of bottom) heels elevated off bed, but avoid hyper-extension of knees
69
what constitutes a dmerc category 1 support surface? who qualifies?
static overlays mattresses: foam, air, gel patients who are RISK of pressure injury
70
what constitutes a dmerc category 2 support surface
alternating pressure and air floatation
71
what constitutes a dmerc category 3 support surface? what kind of injury qualifies?
stage 4 pressure injury on multiple surfaces or skin graft | $200/day for rental
72
what are four things to check when assessing the performance of a support surface?
bottoming out (surface totally compressed) memory foam shape remains bunching in gels deflation in air filled
73
what is one way to measure the size of a pressure injury? what parts of the body do you use for these determinants?
longest length * width, cm squared | head as reference to determine which is length and which is height
74
what is one way to measure the size of a pressure injury using a clock? benefit?
top of pressure injury is 12 oclock, etc acetate tracing can describe locations of specific type of tissues within injury
75
what are four aspects of a wound you will evaluate?
size color odor consistency
76
what is the odor of anaerobic organisms?
fecal
77
what is the odor of aerobic organisms?
various including fish
78
what is the color of a pseudomonas?
aquamarine
79
how would you describe slough?
stringy runny nose of small child that is extended w a wipe | soft yellow or tan
80
how would you describe eschar?
thick black or brown | avascular
81
how would you describe granulation?
bumpy | shiny red
82
how would you describe epithelial tissue?
dry | usual skin color
83
how would you describe fibrin tissue?
white that won't come off to touch
84
when describing skin surrounding pressure injury, what factors are you taking into account?
``` erythema maceration edema tape injury induration crepitus pain warmth fluctuance ```
85
What is tunneling? How to do you document it?
tissue loss parallel to the skin surface may or may not have exit site document clock location and depth of undermining
86
what is a fistula?
abnormal passage between two organs or between and organ and the outside of the body
87
what can permeate a semi-occulsive dressing?
not bacteria and liquids oxygen and carbon dioxide can moisture vapor can
88
what are 5 benefits of semi-occulsive dressings?
``` help create optimal local wound environment increase healing rates decrease cost of care reduce pain improve cosmesis ```
89
what is a popular type of semi-occulsive dressing?
hydrocholid
90
what are 7 potential way to do harm to a pressure injury?
``` dehydration reinjury hypergranulation (too much fluid) maceration granuloma skin stripping contact dermatitis ```
91
what are 5 things a wound needs?
``` adequate hydration thermal insulation freedom from necrotic tissue control of bacteria optimal ph ```
92
is the ideal ph for a wound acidic or alkaline?
acidic
93
what are 6 materials used to make dressing?
``` water polymer collagen cellulose hydropolymer "top secret" patented ingredient ```
94
what three wound contact layers in a dressing?
impregnated gauzes perforated plastics silicone coated meshes
95
what types of dressings maintain moisture?
films hydrocolloids hydrogel sheets amorphous gels
96
what are three physiological benefits of response to gentle pulsatile lavage?
increased granulation tissue formation increased rate of wound closure and resolution of fibrosis decreased wound bioburden
97
when taking tegaderm off, how should you remove it?
lift corner and pull towards you
98
how does an autolytic dressing cause debridement?
uses body own processes to remove devitalized tissue
99
what are four types of autolytic dressings?
transparent films hydrocolloids hydrogels
100
what are two benefits to using an autolytic dressing?
minimal trauma | less frequent dressing changes
101
what is one contraindication for wound debridement?
several arterial insufficiency
102
order of preparing for wound debridement?
1. wash hands 2. prep skin first with betodine 3. flush w saline 4. if part of medical order, can use analgesic 5. 1/4 strength betodine 6. debride

unit 9 (4 decks)

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