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Flashcards in Wound Care Deck (52):
1

What is an acute wound?

Wound that heals quickly (typically healed within 4 weeks)
Examples: bites, scrapes, minor lacerations, punctures, burns, etc

2

What is a chronic wound?

A wound that fails to progress through normal healing within 4 weeks. Healing is delayed or impaired
Requires referral
Examples: pressure ulcers, diabetic ulcers, etc.

3

What are the three phases of the normal healing process?

Phase 1: inflammatory phase (begins immediately after homeostasis is completed)
Phase 2: proliferative phase (begins to rebuild with new granulation tissue)
Phase 3: maturation phase (also called the remodelling phase as the dermal tissue strengthens)

4

Describe the inflammatory phase

Immune system reaction: complex process with multiple cells involved
Characteristics: starts at the time if injury and continues for 24-48 hours
Appearance: redness, oedema, production of exudate

5

Describe the proliferative phase

Immune system reaction: granulation tissue formed, wound contraction and new epithelium formed (still sensitive to further injury)
Characteristics: rebuilding phase which can last from 4 to 24 days
Appearance: bright red tissue and raised, scar tissue is starting to be formed

6

Describe the maturation phase

Immune system reaction: collagen forms early scar tissue and continues to be deposited to increase strength of the tissue
Characteristics: starts approximately 3 weeks after injury and complete healing can take up to 2 year
Appearance: changes from pink or red to white

7

What are factors that affect wound healing

DIDNT HEAL
Diabetes (decreased circulation, long term condition)
Infection (prolongs inflammatory phase delaying healing)
Drugs (steroids, ASA, anticoagulants, cancer medications)
Nutritional problems (normal wound healing impaired)
Tissue necrosis
Hypoxia (inadequate tissue oxygenation)
Excessive tension on wound edges (drying)
Another wound
Low temperature (slower healing in the extremities)

8

What are some patient factors that need to be assessed that could lead to referral?

Tetanus immunization status
Medical conditions that affect healing (e.g., diabetes, immunocompromised)
Factors that delayed healing
Bleeding is over 10 minutes
Age?

9

What are some causes that need to be asses that could lead to referral?

Animal or human bite?
Second or third degree burn?

10

What are some red flags?

Wound is over 2 cm
Lacerations on the face or hand where edges do not fall together
Wound is deep
Patient is unable to move injured part
Dirt and debris cannot be removed without scrubbing
Wound in infected

11

What are signs of infection of a wound?

Redness extending from wound after two days
Pus or yellow discharge
Area around the wound is red, swollen and warm to touch
Abnormal smell

12

What is some basic wound care management steps?

1. Cleanse the wound (remove dirt and debris, wash wound with water)
2. Stop the bleeding (use a clean dressing or gauze to apply pressure to the wound for 10 minutes)
3. Protect the wound (apply a dressing to protect the wound and improve healing process)
4. Debridement (removal of dead or contaminated tissue; only done by a health care professional)

13

What is recommended for cleaning the wound?

Drinkable water used to remove dirt and debris (lukewarm water)
Normal saline used to remove dirt and debris
Both are equally as effective cleaning acute wounds

14

What is not recommended for cleaning the wound?

Hydrogen peroxide 3% (may impair healing and cause tissue toxicity)
Isopropyl alcohol 70% (may dry and irritate the skin)
Iodine (may irritate tissue and impair healing)
Povidone-iodine (may impair healing)

15

What are signs of skin infection?

Localized erythema
Localized pain
Warm to touch around affected area
Oedema
Drainage/pus
Fever

16

How are topical antibiotics used in wound management?

Treatment (superficial, mildly infected wounds only)
Prophylaxis (wound that are high risk for infection, chronic wounds or those that have not been cleaned properly)
Concern with prolonged use (resistance or secondary fungal infection)

17

What are some antibiotics that are used topically?

Bacitracin
Gramicidin
Polymyxin B
Neomycin
Fusidic acid
Mupirocin

18

What is the spectrum, dosage and adverse effects of bacitracin?

Spectrum: active against gram positive, minimal gram negative
Dosage: apply 1 to 3 times daily
Adverse effects: common sensitizer, itching, burning, redness
Cross-sensitivity potential with neomycin and polymyxin

19

What is the spectrum, dosage and adverse effects of gramicidin?

Spectrum: active against gram positive
Dosage: apply 1 to 3 times daily
Adverse effects: low risk of sensitivity, itching, burning
Damages sensory epithelium of nose. Do not apply to nasal membranes

20

What is the spectrum, dosage and adverse effects of polymyxin B?

Spectrum: active against gram negative
Dosage: apply 1 to 3 times daily
Adverse effects: low risk sensitivity, itching, burning
Contact allergy uncommon, cross-sensitivity with bacitracin

21

What is the spectrum, dosage and adverse effects of neomycin?

Spectrum: active against gram negative, partially active against gram positive
Dosage: apply 1 to 3 times daily
Adverse effects: low risk of sensitivity, itching, burning
Prescription only

22

What is the spectrum, dosage and adverse effects of fusidic acid?

Spectrum: active against gram positive
Dosage: apply 2 to 3 times daily for 7 to 10 days
Adverse effects: dryness, itching, burning, some local irritation
Number 1 choice for impetigo. Prescription only.

23

What is the spectrum, dosage and adverse effects of mupirocin?

Spectrum: active against gram positive including some strains of MRSA
Dosage: apply 2-3 times daily for 7 to 10 days
Adverse effects: dryness, itching, burning, some local irritation possible
Should not be used for more than 10 days

24

What are some combination topical anesthetics?

Polysporin complete
Polysporin triple

25

What is polysporin complete?

10 000 units Polymyxin B (as sulfate)
500 units bacitracin zinc
0.25 mg gramicidin
50 mg lidocain

26

What is polysporin triple?

10 000 units Polymyxin B (as sulfate)
500 units bacitracin zinc
0.25 mg gramicidin

27

What are monitoring parameters for wound care?

Bleeding should stop within 10 minutes for most people (within 15 minutes for those on anticoagulants)
Monitor daily for infection for 48 hours
Monitor wound healing daily for 4 to 14 days (or more). If not closing within 2 to 4 weeks, further assessment should be done

28

What is a primary dressing?

Placed directly on the wound, absorbs fluids, prevents infection and adhesion of the secondary dressing

29

What is a secondary dressing?

Placed over the primary dressing for protection, absorption, compression and occlusion

30

What are the different kinds of dressings?

Gauze
Transparent films
Hydrogels
Hydrocolloids
Alginates
Foams
Liquid tissue adhesives

31

What is the purpose, the types of gauze dressings and how should they be applied?

Purpose: absorbent and protectant, may be used for wet or dry wounds
Types: non-adherent (dose not stick to the wound), self-adherent (clings to itself)
Application:
-place directly on wound
-moisten with saline, wring out excess fluid and apply secondary dressing
-used as primary dressing

32

What is the purpose of transparent films?

Provide a moist environment, protective, waterproof
May be used for superficial, clean wounds where it is required to frequently view the wound
Example: Tegaderm transparent

33

How should transparent films be applied?

Gently lay dressing over the wound, avoid wrinkling and don't stretch
Overlap wound by 2.5 cm and apply tape

34

When should transparent films be avoided?

Moist wounds (does not absorb moisture)

35

What is the purpose of hydrogels?

High moisture content, some absorption properties
May be used for dry wounds, painful wounds, pressure ulcers, burns
Example: Restore, Tegaderm

36

How should hydrogels be applied?

Apply a moderate amount to the wound and cover with gauze
May require a secondary dressing
If self-adhesive, may be used as a primary dressing

37

When should hydrogels be avoided?

In gangrenous wounds
Weeping wounds

38

What is the purpose of hydrocolloid dressings?

Retains moisture
May be used for burns or small abrasions
Example: Duoderm

39

How should hydrocolloid dressings be applied?

Apply adherent side to skin and hold in place
Painless to remove

40

When should hydrocolloid dressings be avoided?

Dry wounds that are infected
Weeping wounds

41

What is the purpose of alginates?

Create a moist environment, highly absorbent
May be used for packing cavities and wounds, wound drainage, pressure ulcers
Can reduce pain
Example: Algisite, Tegaderm, Kaltostat

42

How should alginates be applied?

Apply dressing to area, cover with a secondary dressing and tape in place
May require a secondary dressing
Change 1-2 times a day for 3-5 days

43

When should alginates be avoided?

Dry wounds (can dry wound bed more)

44

What is the purpose of foam dressings?

Retains moisture, highly absorbent, protective
May be used for wounds with mild to moderate exudate, partial to full thickness wounds
Example: Allevyn

45

How are foam dressings applied?

Gently lay dressing over the wound, cover with gauze and tape in place and if necessary, may need a secondary dressing

46

When should foam dressings be avoided?

Dry wounds
Wounds that need to be frequently checked

47

What are the uses for liquid adhesives? How long do they last for? How should they be applied?

Used for minor cuts, paper cuts, skin cracks (don't use in deep wounds)
Lasts for 5-10 days
Wash cut first, apply pressure to stop bleeding then apply adhesive
Example: Nexcare liquid bandage, Band-Aid J&J Bandage, New Skin liquid bandage

48

What are the different types of adhesive tape?

Cloth tape
Plastic tape
Paper tape
Hypoallergenic tapes are preferred

49

Describe cloth tape use

Use over bone, difficult to tape areas or with bulky dressings due to high tensile strength

50

Describe plastic tape use

Stretched with movement, good for mobile areas

51

Describe paper tape use

Porous, light adhesive, good for tender or painful area and for wounds that should breathe
Tend to break with movement

52

Describe adhesive skin closures

Generally used to hold wounds closed after suture removal
Steri-strips (think strips of sterile, non-woven tape)
Butterfly closures (two sterile, waterproof strips connected by a non-adhesive bridge)