Surgical Wounds, Trauma Wounds and Debridement Flashcards Preview

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Flashcards in Surgical Wounds, Trauma Wounds and Debridement Deck (68)
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1

What are the Langer's Lines?

Lines surgical incisions should follow the natural skin direction

2

Classify a clean wound

Wounds made under aseptic surgical conditions, that do not enter the genitourinary, respiratory or alimentary tracts or oropharyngeal cavity.

3

Classify a clean contaminated wound

Wounds are contaminated by the resident flora or the cavities but there is no host reaction

4

Classify a contaminated wound

Contaminated by bacteria with no host reaction

5

Classify an infected wound

Clinical signs of infection present, with increase leukocyte and macrophage levels

6

What is primary intention?

Wound healing in which the edges are bought together by sutures, staples or glue.

7

What is delayed primary intention?

The would is left open for treatment with untied sutures insitu until deemed clean, in which it is then closed

8

What is secondary intention?

The would is left open to heal spontaneously with out mechanical intervention

9

Name the primary suture techniques

Simple square interrupted
Continuous subcuticular
Vertical mattress
Horizontal mattress
Steri-strips
Tension sutures

10

Why are tension sutures used?

To provide additional support by inserting sutures into deeper layers

11

What are the principles for wound healing by primary intention?

1) Protect from physical and pathological assult
2) Absorb exudate
3) Maintain wound and body temperature
4) Oxygenation
5) Avoid stress (analgesia)
6) Observe the suture line for complications

12

What are the indications for a drainage tube?

1) Abscessed cavity - prevent premature closure
2)Insecure intra-abdominal wound - compromised healing
3) Anticipated exudate - tissues that contain secretory glands
4) Risk of peritonitis - bowel, gastric and biliary
5) Extensive dissection
6) Traumatic Injury

13

Name three types of drains

1) Capillary Wicking
2) Negative pressure suction devices
3) Percutaneous

14

What are the indications for percutaneous tubes

Gastrostomy - feeding or decompression
Jejunostomy - Feeding
Nephrostomy - Draining urine
Suprapubic Catheter - Draining urine
Biliary - Draining bile

15

Identify three primary aspects of peri-tubular skin care

1) Keep skin dry and clean
2) Peri-tubular leakage indicated french gauge is too small
3) Hypergranulation around tube indicates tube friction

16

What are the principles of drain management?

Client support and education
Secure drain
Maintain patency
Maintain skin integrity
Contain exudate
Observe type & amount of exudate
Prevent infection
Observe for complications (discomfort, infection, dislodgement, blockage, loss of suction for VAC)

17

What are the primary surgical complications?

Haemorrhage
Haematoma
Seroma
Oedema
Infection
Occulsion of blood supply - necrosis
Dehisence
Evisceration
Adhesions

18

Define Dehisence

Seperation of a sutured would resulting in a cavity that requires either a second attempt at primary intention or will heal by secondary intention

19

What causes dehisence?

Trauma
Haematoma
Seroma
Infection

20

What is a fistula?

An abnormal track connecting one viscus to another viscus or to the skin

21

What causes a fistula?

1)Leaking surgical anastomosis
2)Spontaneous rupture due to obstruction, disease, trauma, radiotherapy damage
3) Mesenteric ischaemia
4) Sepsis - diverticulitis and appendicitis

22

What are examples of an internal fistula?

Vesicovaginal
Enterocolonic
Rectovaginal

23

What are examples of an external fistula?

Enterocutaneous
Buccul
Vesciocutaneous

24

What are the principles of fistual management?

1) Patient comfort and support
2) Fluid and electrolyte replacement
3) Nutritional assessment & supplementation
4) Prevention and management of infection
5) Maintenance of skin integrity
6) Containment of effluent & odur
7) Cost effective care

25

What medication management is involved with a fistula?

Anti-motility agents
Cholestyramine
Somastatin Analogues

26

Define fistulocysis

Re-feeding via a distal fistula

27

Define evisceration

A spontaneous rupture of the abdominal suture line and intestines protrude through the opening

28

4 types of abberant healing

1) Hypergrannulation
2) Contracture
3) Hypertrophic Scar
4) Keloid Scar

29

Define hyper grannulation

Raised granulation tissue above the level of the surrounding skin which commonly occurs as a result of friction, increased bacterial burden or infection

30

Define contracture

Abnormal scar formation that can inhibit movement or function due to excessive myofibroblast activity.