Wound Management Flashcards
(272 cards)
1
Q
describe an incised wound
A
clean edges, usually surgical
2
Q
describe a laceration
A
jagged edge (e.g. barbed wire)
3
Q
describe an abrasion
A
graze, epithelial damage seen
4
Q
describe a contusion
A
bruising, develops over time
5
Q
describe a puncture wound
A
deep, entry wound often not indicative of extent of injury beneath
6
Q
where are bites commonly seen?
A
hindlimbs
7
Q
what is commonly associated with bites?
A
large wound, lots of tissue necrosis and infection
8
Q
what are other wound types seen commonly in practice?
A
burns
bites
9
Q
what is the main way to classify wounds?
A
time of presentation after injury
10
Q
what are the classifications of traumatic wounds?
A
class 1-3
11
Q
what is the time lapse since occurrence of a class 1 wound?
A
0-6 hours
12
Q
what is the level of contamination and tissue trauma of a class one wound?
A
minimal (fresh)
13
Q
what is the time lapse since occurrence of a class 2 wound?
A
6-12 hours
14
Q
what is the level of contamination and tissue trauma of a class 2 wound?
A
increasing levels of bacteria, more contamination present
microbial burden has not reached critical level
15
Q
what is the time lapse since occurrence of a class 3 wound?
A
more than 12 hours
16
Q
what is the level of contamination and tissue trauma of a class 3 wound?
A
wound infection present regardless of how wound was created
17
Q
does wound class affect the approach to treatment?
A
yes
18
Q
how may wound class affect treatment?
A
class 3 wound not suitable for wound closure
19
Q
what are some key considerations for a patient who has presented with a wound?
A
clinical exam for other injuries
assess wound location
concurrent disease
medication
temperament
nutrition status
pain level
owner intention
client compliance
costs
resources in practice
20
Q
what are the key considerations about wound location?
A
patient interference
infection risk (near butt)
any crucial structures near / affected by wound
21
Q
how does anatomy differ between dogs and cats with regards to wound healing?
A
dogs have higher density of collateral subcutaneous trunk vessels than cats
22
Q
how do primary closure incisions differ between dogs and cats with regards to wound healing?
A
strength 50% less at 7 days in cats than i dogs
equal at 14 days
23
Q
how does second intention healing differ between dogs and cats with regards to wound healing?
A
decreased skin perfusion during the first week of healing in cats
24
Q
how dos granulation differ between dogs and cats with regards to wound healing?
A
cats have less granulation tissue than dogs
tissue seen peripherally in cats and centrally in dogs
granulation tissue takes longer to appear and cover the wound in cats
25
how does epithelialisation differ between dogs and cats with regards to wound healing?
much slower in cats (13% in 14 days as opposed to 44% in dogs)
26
what is involved in the initial assessment of a patient with a wound?
general assessment and history
checking for trauma
analgesia
vital signs
give necessary first aid
regular monitoring to stabilise patient if necessary
27
what are the phases of wound healing?
inflammatory phase
debridement phase
repair / proliferative phase
remodelling phase
28
what phases of wound healing occur concurrently?
inflammatory
debridement
29
when does the inflammatory phase of wound healing occur?
0-5 days
30
when does the debridement phase of wound healing occur?
0 onwards
31
when does the repair/proliferative phase of wound healing occur?
day 3 - 4 weeks
32
when does the remodelling phase of wound healing occur?
day 20 - ongoing
33
what happens during the inflammatory phase of wound healing?
haemorrhage
vasodilation
increase in vascular permeability
34
what happens during the debridement phase of wound healing?
phagocytosis
migration of WBC
removal of cellular debris
35
what happens during the repair/proliferative phase of wound healing?
fibroblasts proliferate
collagen synthesis
epithelialisation
contraction
wound bed rises - scar tissue formed
36
what happens during the remodelling phase of wound healing?
wound contraction (SA becomes smaller)
remodelling of collagen fibres
37
during the inflammatory phase of wound healing what is the purpose of vasodilation and increased vascular permeability?
cells and enzymes needed for debridement can access wound site more easily
38
what tissue is seen on the wound bed?
granulation
39
what does granulation tissue look like?
dark red
40
what does epithelialisation tissue look like?
pink
41
what will be performed on all wounds no matter the chosen closure technique?
lavage
42
what is the purpose of wound lavage?
reduction of bacterial load
reduce and remove debris
visualisation and assessment of wound
43
how effective is wound lavage at reducing bacterial load?
up to 50% lower for every hour earlier wound is lavaged
44
what must be considered about wound lavage?
fluid used
pressure
volume of fluid
45
what volume of fluid is recommended for wound lavage?
50-100ml per cm
46
what equipment will ensure correct pressure for wound flushing?
50ml syringe
green needle (18G)
47
what is the average suggested wound lavage pressure?
8-12 lbs/square inch
48
what is the risk of applying too much pressure during wound lavage?
push infection / debris further in
49
what solution should be used for wound lavage?
isotonic saline
owners could use cooled boiled water if needed
50
what should not be used for wound lavage?
chlorhexidine
povidine iodine
-potential for cell damage
51
what temperature should fluids for wound lavage be?
body temp
52
what are the main options for wound closure?
primary / first intention
delayed primary closure
secondary closure
second intention
53
what are the main considerations for second intention healing?
topical agents
dressings
types of bandage material
client complience
cost
expertise
54
what are the 5 main principles of wound management suggested by Esmarch?
non-introduction of anything harmful
tissue rest
wound drainage
avoidance of venous stasis
cleanliness
55
what is involved in tissue rest?
allow area to rest
minimal dressing changes
reduced patient movement
56
what is a crucial part of wound healing?
drainage
57
what is the benefit of negative pressure wound therapy (NPWT)?
reduced oedema
reduced exudate accumulation in wound
bandage strikethrough reduced as wound fluid is evacuated into collection canister
increased central wound perfusion and vascularisation
rapid contraction and wound healing
reduction in dressing changes
58
what is the benefit of reduced strikethrough in NPWT?
fewer bandage changes so tissue can rest
59
in what phase of wound healing is increased central wound perfusion and vascularisation vital?
inflammatory
60
how does NPWT reduce bacterial burden?
removal of infectious material
61
how does NPWT protect against infection?
provides protected wound healing environment
62
how does NPWT reduce excess exudate?
removal
63
how does NPWT reduce oedema?
removal
64
how does NPWT manage absence of moisture?
provides moist environment
65
how does NPWT manage lack of adequate blood flow?
promotes perfusion
66
how does NPWT manage lack of granulation tissue formation?
promotes formation and draws wound edges together
67
what can be used topically in wounds?
honey
silver
68
what types of honey can be used in wounds?
table honey
medical grade
69
why is honey being used more commonly?
broad spectrum antimicrobial activity
anti-inflammatory
effective against MRSA and pseudomonas
70
what type of wounds is honey especially effective for?
chronic non-healing
71
is medical grade or table honey better for wound management?
table honey had range of microbial species
and lower antimicrobial activity than medical grade
medical grade also sterile
72
is regular honey or manuka honey better for wound management?
manuka better as no hydrogen peroxide better antimicrobial
73
how does manuka honey promote wound healing?
pH of wound is lowered by honey (more acidic)
proteases which break down proteins involved in fibrin matrix of granulation tissue are denatured/less effective
granulation is more efficient and epithelialisation can occur
74
what are the main considerations when using honey?
higher level of exudate so may need more dressing changes / different dressings
may be cellular damage in healthy granulating wounds
need to stop using honey after a certain time to prevent proud flesh due to excessive granulation
75
why does use of honey on wounds lead to higher level of exudate?
honey has high sugar content so osmolarity is higher than fluid in wound - increased exudate
76
why should use of honey be stopped once granulation tissue has developed?
over production of granulation tissue may prevent epithelialisation
77
what is the role of granulation tissue?
creation of new tissue bed to enable epithelialisation
78
what forms can silver be applied to wounds in?
cream
dressing
79
what is the primary benefit of silver in wound healing?
antimicrobial properties
80
what phase of wound healing is silver best used in?
inflammatory
81
what wounds is silver not indicated for use in?
chronic non-healing
82
what is the purpose of wet to dry bandages?
macerate (overhydrate) wound and then desiccate wound bed
83
what happens when wet to dry dressings are removed?
non-selective mechanical debridement so that some of the cells and tissue essential for wound healing are removed along with necrotic tissue
84
what are the downsides of wet-to-dry dressings?
environmental bacteria can penetrate gauze
pain when removed
remnants of gauze fibre remain in wound resulting in inflammation
increase wound care total costs
85
what is a wet to dry dressing?
saline soaked swabs are packed into the wound
dry placed on top
removed after a number of days once swabs are dry
debridement
86
what is an example of a moisture retentive dressing?
allyven
87
what is the benefit of moisture retentive dressings?
removal of exudate while keeping wound moist to provide optimal healing environment
wound does not dry out as in a wet to dry
less frequent bandage changes
88
what are the main dressing types available?
hydrogel
hydrocolliod
vapour-permeable films and membranes
foam
89
what are examples of hydrogel dressings?
intrasite
90
what are hydrogel dressings made of?
water-based, amorphous, cohesive application that is applied to the wound bed
91
what are hydrogel dressings covered with?
secondary, non-absorbent dressing
92
what is the role of hydrogel dressings?
moist and warm environment created for wound healing
93
what is an example of a hydrocolloid dressing?
aquacel
94
what are hydrocolloid dressings made of?
carboxymethylated cellulose, pectin and geletine
95
how are hydrocolloid dressings applied to the wound?
non-adherent gel formed on contact with the wound
96
when are hydrocolloid dressings used commonly?
closed wounds
uncommon in open wound managment
97
what is an example of a vapour permeable membrane dressing?
primapore or melolin
98
what are vapour-permeable dressings made of?
a sheet of absorbent material between two thin layers of film that contains small pores for the movement of gas and fluid
99
when are vapour permeable dressings commonly used?
end stage wound healing as not as absorbent
surgical wounds
100
what is an example of a foam dressing?
allevyn
101
what are foam dressings made of?
polyurethane foam
102
what forms can foam dressings come in?
adhesive
non-adhesive
with or without breathable film backing
103
what is the role of allevyn?
absorb exudate as hydrophillic
104
what are the considerations when choosing a bandage for a patient?
location of wound (is bandaging possible)
client compliance
finance
prognosis
is surgery a likely outcome
105
when are tie-over dressings used?
hard to bandage areas
106
how is a tie over dressing performed?
sutures placed into healthy tissue around wound edge
swabs packed into wound
once sufficiently padded, sutures used to thread ties through and secure bandage to patient
107
what are the downsides of tie-over dressings?
strike through
risk of bacterial contamination
GA for dressing changes needed
108
how often do tie over dressings need to be changed?
every 5 days
109
how can wound healing be monitored?
photos
measure
record subjective assessment
110
what should be assessed if a wound is not healing?
swab taken for culture
patient considerations: interfering, nutrition
client factors: complience
111
when should swabs of wounds be taken?
at initial presentation
every dressing change?
if any concerns
112
what is the benefit of swabbing wounds?
targeted antibiotics
113
what is involved in a good bandage?
toes padded if included
dressing secured but comfortable
even tension
not too tight
neat
2/3 to 1/2 overlap for each throw
(check bandage lectures)
keep it dry!
114
is laser therapy beneficial for wound healing?
evidence base unclear
115
what are some of the claimed benefits of laser therapy?
pain relief
increased vascular activity
anti-inflammatory
faster wound healing
nerve regeneration
rapid cell growth
116
define avulsion
injury where tissue is separated from underlying tissues
117
define debridement
removal of necrotic or damaged tissue
118
define degloving
tissue is removed from a limb like a glove
119
define desiccation
dried out
120
define eschar
scab
121
define excoriated
where the skin has been abraded / is raw /irritated
122
define hygroma
soft fluidy mass found on bony prominances
123
define laceration
deep cut/tear to the skin
124
define maceration
breakdown of skin due to prolonged exposure to moisture
125
define peracute
extremely sudden onset
126
define plexus
network or web
127
define seroma
a fluid filled swelling often associated with dead space after surgery
128
define shearing injury
when tissue is damaged as layers move over the top of each other
129
define tissue viability
a measure of whether tissue is healthy
130
what are the main wound closure options?
primary
delayed primary
secondary
second intention healing
131
what are the downsides of second intention healing?
can be painful
expensive
can lead to contracture
may need revision
132
what is primary closure?
wound is sutured closed immediately
133
what is delayed primary closure?
wound is closed but may need to wait for space on the list or patient to be stable so will be managed for a short period beforehand
134
what is secondary closure?
wound and patient managed long term before surgical closure
e.g. skin graft
135
what is second intention healing?
wound is not sutured closed and heals on its own
136
what are the surgical wound closure techniques available?
'simple' closure
subdermal plexus / pedicle flap
axial pattern flap
free skin graft
137
what is often included in simple closure of wounds?
light surgical debridement
138
what skin closure technique should be used first?
the simplest possible
139
what are the benefits of simple suturing for wound closure?
simple
quick
easy
140
what are the disadvantages of simple suturing for wound closure?
relies on accurate wound assessment
failure to assess correctly leads to wound breakdown
may be non-viable tissue left behind
excess tension on wound
inappropriate suturing can cause issues
141
what types of closure is simple suturing most suitable for?
primary
delayed primary
142
what wound aetiology is simple suture most suitable for?
full thickness skin defect (shallow)
sharp incisional injury (e.g. shard of glass)
143
what wound is most suitable for closure by simple suture?
class 1 injury (no infection present) - clean or clean/contaminated
fresh wound
not a big wound, not much skin lost during injury
minimal debridement needed if any
144
what is involved in the treatment plan of a patient undergoing simple suture wound closure?
GA or sedation and local
basic surgical kit only
staples if only skin involved
may or may not bandage
145
what is a subdermal plexus flap?
skin is undermined (elevated and dissected away from underlying musculature) and plexus of small arteries and veins sitting in the subdermal tissue are preserved
this skin is then moved to cover a large defect
146
where can a subdermal plexus flap be placed?
using skins elasticity either advanced in a straight line or rotated into place depending on would location and skin tension
147
what must be understood when forming a subdermal plexus flap?
skin tension lines
148
why is a subdermal plexus flap called that?
subdermal plexus of small arteries and veins under the skin which are used to keep flap viable
149
what are the named subdermal plexus flaps?
flank fold flap (inguinal wounds)
elbow fold flap (axillary wounds)
150
what wound closure type is a subdermal plexus flap most useful for?
primary
delayed primary
secondary
151
what are the benefits of subdermal plexus flap?
simple yet versatile
good for medium sized wounds
reduces tension
152
what are the downsides of subdermal plexus flap?
relies on accurate wound assessment
has size limitations as only small blood vessels
damage to plexus possible
infected tissue may be left behind
153
what is the issue if too large a subdermal plexus flap is raised?
blood supply is inadequate and can lead to vascular necrosis
154
what is the issue if the person forming the subdermal plexus flap has poor technique?
plexus damage leading to vascular necrosis
155
what wound aetiologies can subdermal plexus flap be used for?
wide variety
156
what age of wound can subdermal plexus flap be used for?
fresh
delayed primary and so bandaged for a while
157
what class of wound can subdermal plexus flap be used for?
clean if primary closure
may have been contaminated / dirty if surgery is delayed primary or secondary but should be 'clean' at time of surgery
158
what site or size of wound is appropriate for subdermal plexus flap?
anywhere on the body
medium sized defects
reduce tension
159
what level of surgical debridement may be needed for a wound closed with subdermal plexus flap?
may have been significant thus increasing the final skin deficit that requires closing
160
what is involved in the treatment plan of a subdermal plexus flap?
basic surgical kit only
may bandage post op (more likely than for simple)
161
how does an axial pattern / pedicle flap differ from a subdermal plexus flap?
axial pattern / pedicle flap incorporates a direct cutaneous artery and vein capable of providing blood to large area rather than just the plexus of small vessels
162
what is the main advantage of a axial pattern / pedicle flap over a subdermal plexus flap?
can cover large defects with less chance of breakdown due to vascular necrosis
163
what is required prior to axial pattern / pedicle flap surgery?
planning
assessment of skin tension
measurement
mapping
164
what are the benefits of axial pattern / pedicle flap?
good blood supply
longer and wider flaps possible than subdermal
can offer rapid healing of chronic wound
165
what are the disadvantages of axial pattern / pedicle flap?
steep learning curve
flap necrosis would be catastrophic
good post op care vital
owner must be warned about cosmetic result
166
what wound healing method is axial pattern / pedicle flap most appropriate for?
secondary
167
what wound aetiology should axial pattern / pedicle flap be used for?
pretty much any!
168
what class of wound can an axial pattern flap be used for?
secondary closure
usually bandaged for a while
must be clean at time of surgery
169
what site size of wound is an axial pattern flap good for?
only specific areas
large skin deficits
170
what is involved in the treatment plan of a wound being closed with an axial pattern flap?
advanced surgical kit
good post op care vital to avoid major complications
171
what is a significant risk of axial pattern flaps?
seroma
172
what is required within a wound before a free skin graft can be placed?
healthy bed of granulation tissue
173
what are the techniques used for free skin grafting?
sheet
punch
174
what is involved in punch free skin grafting?
skin grafted using biopsy punch
sutured into place on the wound
175
what is involved in sheet free skin grafting?
skin taken in a sheet from another area and sutured to cover wound
releasing incisions made which reduce risk of seroma formation and mean smaller tissue needed from donor site
176
how should the donor site of a free skin graft be closed?
primary wound, may need a subdermal plexus flap
177
what wounds is a free skin graft useful for?
distal limb defect where subdermal flap or APF is not an option
178
what are the downsides of free skin grafts?
lower success rate
sheet graft is complex surgery
good post op care vital
partial or complete failure not uncommon
needs talented surgeon, committed nursing and committed owner
179
what is required before a free skin graft can be performed?
healthy granulation bed
180
what type of wound closure is free skin graft appropriate for?
secondary only
181
what are the advantages of free skin grafts?
punch grafts simple
sheet grafts good for large extremity defects
offer rapid healing of chronic wound
182
what wound aetiology can free skin grafts be used for?
pretty much any
secondary surgical repair
if axial pattern flap has failed
183
describe an abrasion
superficial wound caused when skin moves parallel to a rough surface at speed
does not extend deep into demis
184
what happens during an avulsion injury?
tissue (ligaments, muscles, skin) is torn from attachment
185
what are the main types of burn?
thermal (dry/wet)
chemical
radiation
electrical
186
how does degloving differ from avulsion?
degloving is severe avulsion that affects extremities e.g. legs/tails
187
what are the types of degloving injury?
mechanical
physiological
188
what is a mechanical degloving injury?
skin is pulled from subdermal attachments
189
what is a physiological degloving injury?
skin necroses and sloughs due to damage to blood supply
190
how may an incision injury be caused?
surgical or traumatic
191
describe an incision
caused by sharp object
typically skin deep and a clean cut
192
describe a laceration
tearing injury which damages skin and deeper tissues
irregular edges
193
what are the main types of open wounds?
incision
laceration
puncture
abrasion
avulsion
degloving
burn
pressure sore
shearing
194
describe a puncture wound
object creates a relatively small hole (e.g. bite, gunshot, penetrating foreign bodies)
195
how does a shearing injury differ from degloving?
similar aetiology
usually involves the loss of deeper tissues
may expose joints/bone
196
what are the main types of closed wound?
contusion
crush injury
haematoma
hygroma
197
describe a contusion
area of injury where capillaries have been damaged
198
how are crush injuries caused?
prolonged period of compression
leads to direct tissue injury and secondary injury from damage to blood supply
199
what issues with casts/bandages can cause wounds?
over tight
inadequate padding
excess exercise
wet/dirty
200
what should be assessed about a wound itself when initially deciding on treatment?
size of defect
is there missing skin
is the defect likely to get bigger (tissue death)
are there multiple wounds
201
what about wound aetiology may stop it from healing simply?
level of contamination
infection likely?
infection already present
depth of wound and so depth of potential infection
202
what may a wound be contaminated with?
micro-organisms
debris
203
what should be assessed about a patient as a whole when they present with a wound?
signalment
comorbidities
204
what should be considered about patient signalment when deciding on wound management?
very young or very old - immunity
species (cats are not small dogs)
breed - amount of excess skin, skin strength
temperament
205
what should be considered about patient comorbidities when deciding on wound management?
pre existing conditions
conditions associated with injury
anything that may affect healing
206
what factors can affect wound healing?
immunosuppressive conditions
endocrine issues: cushings, hypothyroid, DM
poor nutrition
drug therapy
stress
207
what should be considered about infection when deciding on wound management?
likely?
is it present already
can wound just be flushed to clean
do you need topical or systemic antibiotics
swab for culture
208
what should be considered about surgery timing when deciding on wound management?
when will the patient be stable for GA
does the wound need to stabilise before surgery
what closure option is being used
infection
209
what should be considered about wound location when deciding on wound management?
what is it near
are there structures in the way
how much spare skin is available
how mobile is the area
210
what is important to consider about cost with wound management?
bandaging not necessarily cheaper
211
what are the main phases of wound healing?
inflammation (debridement)
proliferation
maturation
212
what occurs during the inflammation phase of wound healing?
haemorrhage
vasoconstriction to cause haemostasis
vasodilation to allow inflammatory cells and enzymes to area for debridement
213
what occurs during the proliferation phase of wound healing?
fibroblasts arrive
granulation tissue formed
wound contracts
epithelialisation leading to skin healing
214
what occurs during the maturation phase of wound healing?
collagen maturation
scar forms and area is stronger
215
what are the objectives for patient management for patients admitted with a wound?
assess - other injuries? comorbidities?
stabilise
216
how should a wound be managed if the patient is unstable?
protect wound from further damage while stabilising patient
217
how should a wound be managed if the patient is stable?
full assessment
decide best course of action
218
what are the main client factors which may affect patient wound management?
cost - bandaging vs surgery
complience - revisits, bandage management, medication
is it practical - regular trips for bandage change vs POC for surgery
219
what are the areas of a wound that should be monitored at each bandage change?
tissue
infection/inflammation
moisture
epithelialisation
220
what does TIME stand for in wound management?
tissue
infection/inflammation
moisture
epithelialisation
221
what is the aim of TIME wound monitoring?
remove non-viable tissue
treat infection or factors predisposing to infection
ensure optimal moisture balance
identify delayed healing
222
what tissue types are viable?
epithelial
granulation
223
how does epithelial tissue appear?
healthy pale pink
224
how does granulation tissue appear?
red and moist
bleeds easily
225
what tissue types are non-viable?
sloughing
necrotic
226
how does sloughing tissue appear?
yellow
grey
brown
227
how does necrotic tissue appear?
hard
dry
balck
228
how can tissue viability be assessed?
can take a number of days to be sure if tissue viable or not
229
why should necrotic tissue be removed?
promotes infection
230
when may debridement be performed?
at presentation (primary repair)
delayed - patient unstable, wound managed with bandaging (delayed primary or secondary repair)
231
what amount of debridement may be performed?
all at once (primary closure)
gradual over bandage changes and then surgery
232
what is promoted by removal of necrotic tissue?
healthy granulation tissue formation
233
what can debridement be used for as well as removal of necrotic tissue?
removal of gross contamination
234
what method of debridement may be used?
surgical
bandaging
combination of both
235
what must you be cautious of during debridement?
not taking too much tissue so that wound healing or closure is affected
need as much tissue as possible
236
if a wound is thought to be clean and free of infection what measures should be taken?
monitor
swab to be sure
may need antibiotics
237
if a wound is thought to have a level of bacterial colonisation what measures should be taken?
debridement (e.g. bite/high risk wound)
238
if a wound seems to have local infection what measures should be taken?
topical antibiotics
239
if there appears to be systemic infection due to a wound what measures should be taken?
systemic, targeted antibiotics
240
what may indicate pre-existing wound infection?
age of wound
discharge
smell
241
what can increase wound infection risk?
site (e.g. near butt)
wound aetiology
degree of contamination
wound lavage
242
what will be seen if a wound is unhealthy?
infection
243
what will be seen if a wound is healthy?
granulation and healing
244
what effect can too much moisture have on a wound?
macerated
excoriated
pus
245
what effect can too little moisture have on a wound?
desiccated
eschar present
246
if a wound is too wet what is required?
dressing which absorbs moisture
247
if a wound is too dry what is required?
dressing to add moisture
hydrogels
248
will a wound always require the same level of moisture while healing?
no - will change
249
how can epithelialisation and so wound healing be assessed?
wound edges
measurements
photos
drawings
look at surrounding tissues
250
how can wound edges be assessed for healing?
should be pink and smooth not dark red and uneven
251
what about wound measurements can assess healing?
look at width, length and depth
will contract in a circle
252
what should the tissues surrounding the wound be assessed for when looking at healing?
oedema
cellulitis
skin changes
253
how can epithelialisation be monitored?
looking for progression and reasons if not
promote epithelialisation with TIME
protect new tissue with bandageing
254
what is the purpose of wound lavage?
rehydrate necrotic tissue
remove foreign material
reduce bacterial contamination
remove toxins and cytokines
255
what needle and syringe is best used for wound lavage?
20ml and green needle (18G)
256
what fluid should be used for wound lavage?
isotonic fluid (probably Hartmanns)
tap water initially if massive contaminated wound
257
when should wound lavage be performed?
any traumatic wound
258
is wound lavage a sterile procedure?
aseptic as possible
perform clip and sterile prep
use gels to fill wound while clipping
259
how should wound lavage be performed?
lavage wound with warmed isotonic fluids
care with pressure
large volume needed for dilution of contaminants
260
what are the main types of debridement?
surgical
non-surgical - physical or chemical
261
what is involved in surgical debridement?
sharp dissection to remove all contaminated, necrotic tissue
avoid damage to normal tissue
262
what is involved in non-surgical physical debridement?
adherent dressings that remove tissue when dressing is removed
263
what is involved in non-surgical chemical debridement?
using chemical substances to remove dead tissue e.g. intrasite
264
when is non-surgical debridement seen?
during bandaging
265
what does a bandage provide protection from?
self-trauma
contamination
desiccation
266
what can be provided to the patient through placement of a bandage?
pian relief
immobilisation of sort tissue and any concurrent ortho injuries
pressure to reduce swelling / haemorrhage
deliver topical medications
267
what can be used to perform chemical debridement?
hydrogels
enzymatic / other agents
268
what can be used to provide physical debridement?
wet to dry
dry to dry
larvae
269
what can be used to provide moisture to wounds?
hydrogels
270
what should be allowed to access wounds whenever possible?
air
271
what is the nurses role in wound managememt?
continuity of patient and client care
advocacy
nurse clinics
clinical audits to flag issues in clinic
272
what is involved in the nurses role of advocacy during wound management?
client - costs and practicalities, emotional support
patient - physical and mental, enrichment, change in direction of care needed, recognition of complications
antimicrobial stewardship - swabs and cultures, targeted antibiotic use, topical use, course length appropriate and kept to by owner
