Week 6

Question 1

what information should be obtained in a wound examination?

Answer 1

-general demographics
-lifestyle and functional status
-past and current medical histories (medical conditions, meds affecting healing, allergies)
-past and current wound history (etiology, POC, prognosis, past or currently successful/unsuccessful treatments)

Question 2

what is a systems review

Answer 2

series of questions for the PT to identify symptoms that may be attributed to medical conditions that require a referral for further investigation

Question 3

what special systems should be included in a wound systems review?

Answer 3

gastrointestinal (nutrition intake, continence (could affect sacral wound dressing), body mass index) and urogenital (incontinence affects dressings, poorly controlled diabetes, UTI)

Question 4

what is included in a cardio/pulmonary system review?

Answer 4

heart rate, blood pressure, respiratory rate, edema, and pulse oximetry

Question 5

what is included in a musculoskeletal system review?

Answer 5

structure, posture, range of motion, strength

Question 6

what is included in a neuromuscular system review?

Answer 6

mobility, transfers, gait, and balance

Question 7

what is included in an integumentary system review?

Answer 7

brief screen, skin integrity, skin color, scar formation, hair and nail growth

Question 8

what is the clock method?

Answer 8

-method for measuring wound size
-3:00-9:00 and 12:00-6:00
-if on the foot 12:00 if towards the heel

Question 9

what is undermining?

Answer 9

-usually involved subcutaneous tissues and follows fascial planes
-erosion of tissue close to the wound edge (cave)
-result in a large wound with small openings

Question 10

what is tunneling?

Answer 10

-narrow passageway within a wound bed (subway)
-usually will form when a wound has been infected
-common in all types of wound except venous ulcers

Question 11

what is a sinus tract?

Answer 11

-tunnel
-elongated cavity or abscess that drains to the body surface
-common in neuropathic wounds

Question 12

what is a fistula?

Answer 12

tunnel that connects with a body cavity or organ

Question 13

what is granulation?

Answer 13

temporary scaffolding of vascularized tissue that fills the hole

Question 14

what does it mean if granulation tissue is pale?

Answer 14

doesn’t have a good bloody supply or it is infected and will heal more slowly or not at all

Question 15

what is the difference between eschar and slough?

Answer 15

eschar: black, soft or hard
slough: yellow or tan, stringy like snot

Question 16

what is occurring when a wound is red?

Answer 16

ready to heal appearance with definite borders; granulation tissue is present and revascularization is apparent

Question 17

what is occurring when a wound is yellow?

Answer 17

pus, debris, fibrin, slough, and yellow exudate present which may require cleansing and minor debridement to promote healing; may require use of a topical antimicrobial if wound is unusually contaminated

Question 18

what is occurring when a wound is black?

Answer 18

necrotic tissue/eschar may be present; may include pus, fibrin, and other cellular components that inhibit granulation tissue

Question 19

what is the difference between slough and fibrin?

Answer 19

slough: produced by autolysis, soft and mushy, product of inflammatory phase, snot like consistency, yellow or white
fibrin: yellow but more fibrous in appearance, can be mistaken as connective tissue, yellow or white

Question 20

what are the 4 things included in a drainage examination?

Answer 20

-type: serous, sanguineous, serosanguinous, purulent, seropurulent
-color
-consistency/viscosity: thin, watery, thick
-amount: none, minimal, moderate, copious

Question 21

Describe the scoring of pitting edema

Answer 21

1+ = barely perceptible depression; < 2mm
2+ = easily identifiable depression, rebounds < 15 seconds; 2-4mm
3+ = depression rebounds 15-30 seconds; 5-7mm
4+ = depression last > 30 seconds; >7mm

Question 22

what are the signs of infection?

Answer 22

-erythema disproportionate to the size of the wound
-poorly defined erythema boarder
-fever
-warmth disproportionate to the size of the wound
-could have induration

Question 23

what are the stages of healing?

Answer 23

-inflammatory
-proliferation
-maturation and remodeling

Question 24

what are the positive indicators of wound prognosis?

Answer 24

-A1C, ABI, previous healing, compliance with compression
-20-40% decrease in wound surface area within 2-4 weeks

Question 25

what are the negative indicators of wound prognosis?

Answer 25

-A1C, smoking, ABI
-no decrease in size or signs of improvement within 2 weeks

Question 26

what are some interventions for wound care?

Answer 26

education, debridement, dressing selection and modification, biophysical agents, mobility training, referrals

Question 27

what can a PTA not do?

Answer 27

-certain interventions which require immediate and continuous examination and evaluation throughout the intervention
-sharp debridement