Wound Care

Question 1

contraindications to e stim over a wound

Answer 1

cancerous lesion
osteomyelitis
location of wound over contraindicated area
sensation
cognition

Question 2

current of injury

Answer 2

injured cells have an endogenous electrical current
this current circles around a wound bed’s edge as the wound causes electrical “leaking”
greater potential at greater distances from the wound center

Question 3

exogenous current’s effect on wounds:

Answer 3

neural tissue: pain relief and healing
wound epidermis
migratory mesenchyme cells: vimentin protein marker on fibroblasts - these cells can create epithelial tissue by organizing into polarized sheets, which can organize to close the wound
undifferentiated cells come to the wounfd and turn into collagen to scar down

Question 4

layers of the epidermis - where will cells migrate in electrical field?

Answer 4

upper layers - cells migrate to anode +
lower layers - cells migrate to cathode -, including monocytes, fibroblasts, macrophages

Question 5

current shown to affect cell migration

Answer 5

50-150 mV/mm

Question 6

desoluabolization

Answer 6

liquefied tissue that is necrotic can be easily removed with estim using negative current on the cathode

Question 7

stim currents used for improved blood flow and reduced inflammation

what specific effects does it have?

Answer 7

HVPC
increases blood flow at contraction levels
retard inflammation

Question 8

antibacterial effects of extim

Answer 8

cathode delivery -
gram negative and positive
low intensity
HVPC current
80 pps, 2 hrs, 4x week

Question 9

which pole is for what healing effect?

Answer 9

cathode for bacteria retarding
anode for healing and epithelial growth

Question 10

protocol with HVPC for wound healing

Answer 10

start w negative from cathode for 4 weeks
negative 3-7 then change to positive

Question 11

acute inflammation phase

Answer 11

hemorrhage, necrosis, erthemia, edema, exudate, red granulation forming

Question 12

how to resolve pt in chronic inflammation phase

Answer 12

move back into acute inflammation phase so pt can progress into proliferation phase

Question 13

acute proliferation phase

Answer 13

inflammation, wound starts reducing in size, red granulation tissue present, serous/serosanguineous exudate, may be odor, wound edges start to adhere and progress to epithelialization

Question 14

signs of chronic proliferation phase

Answer 14

hyper granulation, tissue growing out of wound bed as this is not effective at closing wound bed
pink granulation tissue

Question 15

causes of chronic proliferation phase

Answer 15

infection changing granulation tissue

Question 16

acute epithelialization phase

Answer 16

expected outcome is to resurface wound

Question 17

chronic epithelialization phase

Answer 17

rolled wound edges, fibrotic
could be caused by drying out, poor dressing choices

one cause?

Question 18

pt can be vulnerable to pressure ulcers on the sacrum if:

Answer 18

poor hygiene, B&B dysfx
poor pressure relief adherence
atrophy or scarred muscle not providing normal cushioning and blood supply
seated all day

Question 19

remodeling phase

Answer 19

should result in immature scar formation if optimal healing
helped with stimulation of migrating epidermal cells
happens after wound is closed
lasts 6 mo-2 years

Question 20

granulation tissue

Answer 20

red beefy tissue
+ sign of proliferation phase

Question 21

phases of healing

Answer 21

Acute inflammatory
acute proliferation
acute epithelialization (part of proliferation)
remodeling
any of these phases can turn chronic if healing is interfered with

Question 22

exudate

Answer 22

liquid drainage from wound bed, not clear

Question 23

transudate

Answer 23

liquid drainage from wound, clear and normal

Question 24

serosanguinous fluid

Answer 24

bloody/clear/pink fluid exudate

Question 25

maceration

Answer 25

surrounding tissue of wound is water logged risk for pressure ulcer/wound complications

Question 26

rolling edges

Answer 26

build up of epithelial tissue if it is impeded from moving forward on the wound bed tissue rolls under itself as a nodule at the wound edge

Question 27

tunneling

Answer 27

bottom of the wound bed breaks and wound progresses deeper into tissue important to visualize as it can become infected and reopen a closed wound

Question 28

undermining

Answer 28

space under superficial wound edge you can stick a probe under and lift up bc edge is not adhered down

Question 29

eschar

Answer 29

dark heavy scabbing comes off in chunks/pieces mainly dead tissue

Question 30

slough

Answer 30

heavy, stringy fibrotic tissue can be debrided

Question 31

ways to measure wounds

Answer 31

tracing tape measure depth

Question 32

measure wound: tracing

Answer 32

circle with radius trace wound shape and compare size to circle

Question 33

measure wound: tape measure

Answer 33

sterile, disposable, measure greatest vertical and horizontal lines to get area

Question 34

measure wounds: depth

Answer 34

place qtip in wound bed and mark level even with edges measure tunneling by going clockwise around wound bed to check

Question 35

pressure ulcer: stage 1

Answer 35

redness non blanchable

Question 36

pressure ulcer: stage 2

Answer 36

skin breakdown through epidermis only

Question 37

pressure ulcer: stage 3

Answer 37

dermal layer into fascial layer affected

Question 38

pressure ulcer: stage 4

Answer 38

bone and muscle impaired

Question 39

venous ulcer cause

Answer 39

PVD failure of veins to return blood to heart due to valvular dysfunction causing distal fluid accumulation

Question 40

characteristics of venous ulcers

Answer 40

large >10 cm irregular edge saucer shaped swollen leg dry/itchy skin painless unless elevated red/brown coloring can be infected

Question 41

arterial insufficiency wounds: cause

Answer 41

hardening/narrowing of arteries compromising blood supply to legs triggered by smoking, high BP, RA, DM, CV disease

Question 42

arterial insufficiency wounds characteristics

Answer 42

cold LE white/blue/shiny appearance hard distinct edges/punched out

Question 43

alginates

Answer 43

ABSORB lots of exudate by forming gel and maintaining optimal moisture levels used for infected or healthy wounds

Question 44

antimicrobial dressing

Answer 44

dressing with topical antiseptics silver as antiseptic

Question 45

collagen dressing

Answer 45

encourage healing, maintain moist environment, promote granulation tissue

Question 46

contact layer dressing

Answer 46

thin non adherent layer placed over a wound to protect fragile tissue from other dressings or topicals

Question 47

compression dressings

Answer 47

long stretchable cloth wrapped over a wound for compression

Question 48

composite dressing

Answer 48

multi layer primary or secondary dressings inner layer is non adherent middle layer absorbs moisture to prevent maceration with alginate, hydrocolloid, etc outer layer is antibacterial film for protection, semi permeable

Question 49

enzymatic debrider dressing

Answer 49

medicated dressing with enzyme to soften hard tissue for debridement

Question 50

foam dressing

Answer 50

sheets with small open cells to absorb fluid can be layered with other materials absorptive capacity depends on size and thickness of foam non adhesive area covers wound with adhesive border or overlying film for protection

Question 51

hydrofiber dressing

Answer 51

absorb exudate and promote healing transforms into gel when in contact with fluid

Question 52

hydrogel dressing

Answer 52

sheet, gel, or impregnated gauze 80-99% water and glycerin absorb minimal fluid but can moisturize a dry wound less effective at protecting from bacteria

Question 53

hydrocolloid dressing

Answer 53

contains hydrophilic colloidal substances with a strong film backing absorb fluid slowly turning into a gel mass protection against water, air, and bacteria

Question 54

absorptive wound dressings

Answer 54

alginates foams hydrocolloid hydrofiber minimal: composite hydrogel

Question 55

negative pressure wound therapy

Answer 55

sealed and fitted to skin so vacuum can draw pressure upwards pulls the wound edges towards spongy surface of flim