Wound Care 2

Question 1

Acute Wounds

Answer 1

induced by surgery or trauma

progress in predictable time and manner

Question 2

Chronic Wounds

Answer 2

Fail to progress through phases of healing

healing is prolonged

Question 3

Is it possible to accelerate normal healing?

Answer 3

No.

But it is possible to improve delayed healing by addressing factors complicating wound repair.

Question 4

What areas heal more slowly?

Answer 4

areas w/decreased vascularity
wounds over bony prominences
areas w/decreased # of epidermal appendages
areas where skin is thicker

Question 5

Which heals faster- larger or smaller wounds?

Answer 5

smaller wounds heal faster

Question 6

Circle, Square and linear wounds- which is slowest to heal?

Answer 6

circle is slowest

linear is fastest

Question 7

What is a good temp for wounds to heal?

Answer 7

98.6-100.4 F

This is because vasculature dilates, tissues are less vulnerable to infection, and oxygen levels are increased.

Question 8

At what temp will healing slow down?

Answer 8

68 F

Question 9

At 53.6 F what happens to tissue strength?

Answer 9

strength decreases and it becomes breakable

Question 10

Dry Wounds go through phases of inflammation more slowly why?

Answer 10

epithelial cell migration is slowed
if covered with 0.2-0.3mm thick crust on top it dries more slowly.
wound will be inflamed and painful

Question 11

Covered wounds trap wound fluids which…

Answer 11

stimulates collagen synthesis
induces angiogenesis
enhances wound contraction

Question 12

Too much moisture can delay wound healing how?

Answer 12

periwound becomes macerated

macerated skin is more fragile and friable

Question 13

Problems that may occur due to necrotic tissue

Answer 13

epithelial cells can only migrate over viable tissue
necrotic tissue provides food for microbes/promotes infection.
foreign bodies contribute to infection and perpetuate inflammatory response

Question 14

What implies infection?

Answer 14

colonization (presence of microbes) does not imply infection..when the amount reaches high enough level THEN healing will be impaired because they compete with body cells for O2 and energy & secrete cytotoxic cells

Question 15

What number of microbes implies infection?

Answer 15

greater than 10 to the 5th per gram of tissue.

Question 16

What does infection do to the healing process?

Answer 16

prolongs inflammation, contributes to wound dehiscence, increases scarring, slows wound healing.

Question 17

Circulation factors for wound healing

Answer 17

it’s possible to have normal macrocirculation but inadequate microcirculation. Diseases that impair microcirculation (PVD, diabetes) impair wound healing

Question 18

What can affect circulation?

Answer 18

conditions that promote sympathetic response (fight or flight)
cold, fear, pain

Question 19

Sensation and wound healing

Answer 19

deficits may cause failure to relieve pressure

can indirectly retard wound healing by leading to continued trauma

Question 20

Mechanical stress can cause

Answer 20

pressure ulcers
periwound edema can restrict blood flow and impede healing.
tension on wound edges may delay wound healing

Question 21

Age related changes that can change wound healing

Answer 21

slowed immune response
decreased collagen synthesis
thinner skin
dry skin
decreased pain perception
decreased inflammatory response
decreased vascular response
frequent comorbities

Question 22

Inadequate nutrition causes problems how

Answer 22

active cells require energy to fx
carbs are preferred source
if carbs aren’t present, body turns to burning amino acids and can lead to protein depletion—> impairs inflammation, immune response, proliferation, and maturation

Recent food intake more important than food consumed over past weeks or months

Question 23

Comorbidities that may affect wound healing

Answer 23

diseases affecting tissue perfusion or oxygenation impair wound healing such as:
PVD
COPD
anemia

Question 24

Immuno compromise increases risk of infection, for example..

Answer 24

HIV/AIDS
diabetes
hypothyroidism
aging
steroid use
malnutrition
chemo/radiation

Question 25

Medication that impairs wound healing is:

Answer 25

steroids impair all phases by suppressing inflammation and the immune system, decreasing angiogenesis, slowing cell proliferation, decreasing collagen synthesis Chemotherapy

Question 26

Smoking impairs wound healing by...

Answer 26

vasoconstriction increased platelet aggregation and clot strength reduced oxygen availability

Question 27

Inappropriate wound management by clinician

Answer 27

failure to refer to specialist failure to follow guidelines allowing wound to dry out (crust formation) exposing wound to environment wet-to-dry dressing (allowing dessication-dryness) inappropriate use of antiseptics overuse of whirlpool

Question 28

When is it ok to use whirlpool?

Answer 28

wounds w/ thick exudates, slough, or necrotic tissue

Question 29

When is whirlpool contraindicated and why?

Answer 29

contraindicated on clean wounds | because it increases edema, traumatizes granulation tissue, retards epithelialization

Question 30

How to measure wound size

Answer 30

longest length widest width deepest part not possible to detect depth with eschar covered wound

Question 31

Wound tracing

Answer 31

use transparent wrap and trace with a pen

Question 32

Photographic measurement

Answer 32

not effective because it's time consuming and costly | hard to get same angle and lighting each time

Question 33

volumetric measurement of wound

Answer 33

measuring either the amount of molding or saline required to fill wound void

Question 34

Molding

Answer 34

time consuming can be painful molding material may have detrimental effect on wound healing

Question 35

Saline

Answer 35

must assure good removal of exudates or saline prior to filling wound must be perpendicular to gravity can't be used on wounds that extend into body cavity or fascial planes

Question 36

Tunneling

Answer 36

narrow passage created by separation or destruction to fascial planes (CT that bind tissue) measured by inserting probe into passage position described in clock terms

Question 37

Undermining

Answer 37

erosion of tissue under wound edges, resulting in large wound w/small opening measured by inserting probe almost parallel to wound surface under wound edge. clock terms used to identify area

Question 38

Granulation tissue: healthy vs unhealthy

Answer 38

healthy-beefy red appearance | poor blood supply or infected-pale or dusky and friable

Question 39

Necrotic tissue types/amounts

Answer 39

slough-yellow or tan and stringy or mucinous eschar-black. can be soft or hard. adherent or nonadherent- greater the depth of destruction, the more adherent

Question 40

Chronic wounds often have what type of wound edges?

Answer 40

rolled edges

Question 41

Wounds due to diabetes or peripheral neuropathy often have...

Answer 41

hyperkeratosis