Wk 4 Wound Management Flashcards

1
Q

What is a potential cause of fragile skin?

A

A patient who has been on long-term systemic steroids

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2
Q

What is an example of decreased circulation and oxygen as a cause of impaired wound healing?

A

peripheral vascular disease

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3
Q

What are 9 factors that affect wound healing?

A

Age

Loss of skin turgor

Skin fragility

Decreased circulation and oxygenation

Slower tissue regeneration

Decreased absorption of nutrients

Decrease in collagen

Impaired immune function

Dehydration

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4
Q

What 3 types of medications can affect wound healing?

A

Chemotherapy

Anti-inflammatories

Steroids

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5
Q

What 2 labs can affect wound healing?

A

Decreased WBC

Low hemoglobin levels

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6
Q

What 3 lifestyle factors can affect wound healing?

A

Obesity

Smoking

Malnutrition

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7
Q

Wound impair skin __

A

Integrity

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8
Q

What is inflammation?

A

A localized protective response to injury or destruction of tissue

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9
Q

What are the 3 components of managing a patient’s wound?

A

Assessment

Cleansing

Protection

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10
Q

What does red color typically mean on a wound?

A

Healthy regeneration of tissues

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11
Q

What does yellow typically mean concerning wounds?

A

Purulent

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12
Q

What does black typically mean for wounds?

A

Eschar

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13
Q

What is eschar?

A

A dry, dark scab or falling away of dead skin, typically caused by a burn

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14
Q

Eschar __ wound healing

A

impairs

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15
Q

What should be noted when assessing a patient’s wound?

A

L x W x D

Sinus tracts

Tunnels

Redness/swelling around the wound

Drains

Pain

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16
Q

Closed wounds that are healing by primary intention, skin edges should be…

A

Well approximated

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17
Q

What are 3 ways skin edges are together by way of primary intention?

A

Staples

Sutures

Tissue adhesives

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18
Q

What does approximated mean?

A

Edges are budding together (like a surgical incision)

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19
Q

How do you measure tunneling?

A

Take q-tip and see if it goes into the wound (measure)

20
Q

What is undermining?

A

When there is a “lip” or a hangover of the wound

21
Q

What phases of healing does wound drainage accumulate?

A

Inflammatory and proliferative phases

22
Q

What should be documented about wound drainage? (5)

A

Amount

Odor

Consistency

Color

Integrity of surrounding skin

23
Q

If asked to measure drainage, how much is 1 ml of drainage?

A

1 gram

24
Q

What is copious amount?

A

Large area or volume

25
Q

Portion of serum that is watery and clear, or slightly yellow in appearance (like what is in blisters)

A

Serous exudate

26
Q

Serum + red blood cells, appears thick and red

A

Sanguineous exudate

27
Q

Exudate that contains serum and blood, watery, looks pale pink

A

Serosanguinous

28
Q

Describe purulent drainage

A

Result of infection

thick

contains WBC

tissue debris and bacteria

yellow, tan, green, brown

29
Q

Without adequate __ a wound will not heal

A

nutrition

30
Q

A patient with a wound will need what type of diet?

A

High protein, high carbohydrate

High vitamin

Moderate fat intake

31
Q

What two labs to monitor nutritional status?

A

Albumin

Pre-albumin

32
Q

What is something you may want to do before changing a wound dressing?

A

Administer analgesics and monitor for pain management

33
Q

What does a wet-to-dry wound dressing do?

A

You put it on the wound wet, and when it is dry and you remove it, it mechanically debrides the wound

34
Q

Example of a self-adhesive, transparent dressing

A

Tegaderm

35
Q

What is a hydrocolloid dressing?

A

Occlusive dressing that swells in the presence of exudate

36
Q

What is an example of a hydrocolloid dressing?

A

Duoderm

37
Q

What is a hydrogel wound dressing?

A

Mostly water, gels after contact with exudate

Promotes autolytic debridement, rehydrates and fills dead space

38
Q

What are hydrogel wound dressings used for?

A

Infected, deep wounds, or necrotic tissue

39
Q

What are hydrogel wound dressings not used for?

A

Wounds that drain a lot

40
Q

What are 2 advantages of hydrogel wound dressings?

A

Provides moist wound bed and can reduce pain

Prevents skin breakdown in high-pressure areas

41
Q

What are alginate wound dressings?

A

Nonadherent dressing that conform to wounds shape and absorb exudate

42
Q

What are collagens?

A

Powders, pastes, granules, gels

43
Q

What is a wound vac?

A

Use of foam strips into the wound bed with occlusive dressing, creates negative pressure to occur once the tubing is connected

44
Q

What does a wound vac help with?

A

Tissue generation

Decrease swelling

Enhance healing in moist, protective environment

45
Q

What are two advantages of wound vacs?

A

Can infused antibiotics

Counts output