Wound Management

Question 1

what is the hemostasis timeline for full thickness wounds

Answer 1

occurs within minutes of injury

Question 2

what is the inflammatory phase timeline for full thickness wounds

Answer 2

occurs within the first several days

Question 3

what is the proliferative phase timeline for full thickness wounds

Answer 3

can last weeks overlapping with the inflammatory phase and ending at wound closure around 3-6 weeks

Question 4

what is the maturation phase timeline for full thickness wounds

Answer 4

starts around 3 weeks at wound closure and can last up to a year

Question 5

during which of the four phases of wound healing (hemostasis, inflammatory, proliferative, and maturation) is the wound most fragile

Answer 5

proliferative phase

Question 6

describe the pH of chronic wounds and how it affects healing

Answer 6

chronic wounds are more alkaline and tend to heal better in a neutral/slightly acidic environment

Question 7

should full thickness wounds be moist or dry at the wound bed?

Answer 7

moist

Question 8

should full thickness wounds be covered or uncovered?

Answer 8

covered to prevent infection

Question 9

what is the most common and serious complication of wound healing

Answer 9

bacterial infection

Question 10

what is a major characteristic that differentiates cellulitis from other bacterial infections

Answer 10

starts distally and moves proximally

Question 11

T/F: always clean a wound before measuring and applying a new dressing

Answer 11

true

Question 12

T/F: clean a wound prior to taking a culture

Answer 12

true

Question 13

describe wound cleansing technique (4)

Answer 13

1. standard precautions
2. choose appropriate cleanser
3. work outward from within the wound
4. clean 1 in around wound or 2 inches if not dressing

Question 14

what should be our first choice cleanser for wound management?

Answer 14

sterile saline

Question 15

what is a drawback to cleansing agents?

Answer 15

can be cytotoxic

Question 16

what are wound cleansing considerations for healthy, clean wounds (2)

Answer 16

1. use normal saline

2. avoid antimicrobial solution or cleansers

Question 17

what are wound cleansing considerations for infected wounds

Answer 17

1. use normal saline or 10-14 day antimicrobial regime

Question 18

what is the best cleanser choice for green, infected wounds

Answer 18

acetic acid followed by saline

Question 19

what are two inappropriate cleansing agents

Answer 19

providone-iodine and hydrogen peroxide

Question 20

what are two appropriate wound cleansers (to be used sparingly) for infected wounds

Answer 20

Dakin’s solution (dilute NaOCl) and acetic acidm clean and rinse

Question 21

T/F: scrubbing is an appropriate wound cleaning technique

Answer 21

T: for burns
F: for other wounds - can cause microabrasions

Question 22

what are the four non-selective mechanical debridement methods

Answer 22

irrigation, pulsed lavage with suction, hydrotherapy, and dressing removal

Question 23

what are the four selective debridement methods

Answer 23

sharp, autolytic, enzymatic, and biosurgical

Question 24

when is non-selective debridement indicated

Answer 24

severely necrotic wounds with minimal or no healthy tissue present

Question 25

when is non-selective debridement contraindicated

Answer 25

clean wounds with granulation and epithelialization tissues

Question 26

what are the two devices used for irrigation and what are their pressure differences

Answer 26

bulb syringe/pouring: < 4psi | 35mL syringe with 19G: 4-25 psi

Question 27

how frequently should a patient undergo pulsed lavage

Answer 27

1x/d if <50% necrotic tissue | 1-2x/d if >50% necrotic tissue

Question 28

when should you stop pulsed lavage (3)

Answer 28

1. if the patient complains of pain 2. if there is no increase in epithelialization/granulation in 1 week 3. if there is no decrease in necrotic tissue in 1 week

Question 29

what are parameters for PT to provide sharp debridement?

Answer 29

need to have an active MD order and can only perform it on nonviable tissue

Question 30

under what three conditions should you stop sharp debridement

Answer 30

1. pain 2. tendon/bone/nerve/vascular tissue revealed 3. fistula or tunnel revealed

Question 31

what is the process for debriding an eschar

Answer 31

1. soften with occlusive dressing and enzymatic agent 2. cross hatch/score eschar 3. debride

Question 32

what should you do if the patient starts bleeding during sharp debridement

Answer 32

apply pressure with calcium alginate and elevate the wound

Question 33

what is santyl

Answer 33

only current collagenase on the market for enzymatic debridement

Question 34

how does enzymatic debridement work

Answer 34

topical enzymes lyse collagen, fibrin, and elastin but harmless to normal tissue

Question 35

describe the four step technique for enzymatic debridement

Answer 35

1. cross hatch/score eschar with scalpel 2. apply thin film of enzyme with tongue depressor to devitalize the tissue 3. cover with saline soaked gauze 4. 1-2x/d for a few days - several weeks

Question 36

describe autolytic debridement

Answer 36

the MOST SELECTIVE natural debridement by the body's own WBCs

Question 37

what is a risk associated with autolytic debridement

Answer 37

risk of maceration to surrounding skin

Question 38

describe the technique for autolytic debridement

Answer 38

1. cross hatch/score with scalpel 2. apply hydrogel or hydrocolloid 3. apply occlusive (moisture-retentive) dressing

Question 39

what is the primary contraindication for autolytic debridement

Answer 39

if the wound requires quick elimination of necrotic tissue

Question 40

what is the biggest disadvantage of autolytic debridement

Answer 40

the odor

Question 41

what is the biosurgical debridement technique? biggest disadvantage?

Answer 41

apply 10 per sq cm sterile larvae for 3 days yuck factor

Question 42

what are the 7 antimicrobial classes of topicals/dressings

Answer 42

1. silver 2. iodosorb/iodoflex 3. hydrofera blue 4. medihoney 5. sorbact 6. PHMD gauze 7. antibiotic solutions

Question 43

what are the concerns with using antimicrobials

Answer 43

can inhibit fibroblasts and keratinocytes or lead to microbial resistance

Question 44

what is the recommended use (2) of antimicrobials

Answer 44

1. infected wounds esp if compromised circulation to wound | 2. noninfected but difficult area to clean (perineal) and no healing after 2-4 weeks of optimal care

Question 45

T/F: corticosteroids can/should be applied to the wound bed to prevent inflammation

Answer 45

F: should be applied to the periwound if itchy/inflamed

Question 46

how do you most effectively use licocaine anesthetic

Answer 46

apply directly to the wound bed 15 min prior to intervention

Question 47

in what patient population are we most likely to see the use of growth factors? drawback?

Answer 47

DM foot ulcers, but expensive and requires refrigeration

Question 48

what dressing(s) would you choose to maintain adequate moisture

Answer 48

clear film and hydrocolloids

Question 49

what dressing(s) would you choose to absorb excess moisture

Answer 49

calcium alginates and foams

Question 50

what dressing(s) would you choose to add needed moisture

Answer 50

hydrogels

Question 51

describe hydrocolloids

Answer 51

occlusive dressing that is great for autolytic debridement and more absorptive than transparent film BUT contraindicated if the wound is infected

Question 52

describe hydrogels

Answer 52

used to donate moisture to a wound - requires a secondary dressing - often used in conjunction with a hydrocolloid for autolytic debridement

Question 53

describe calcium alginates

Answer 53

felt/rope - requires secondary dressing - option for heavily draining and infected wounds

Question 54

describe foam

Answer 54

versatile for infected or noninfected wounds that can act as a primary dressing which tends not to stick

Question 55

describe collagen matrix

Answer 55

high end, expensive option absorbed by the wound bed (requires secondary dressing) for healthy wounds we want to close faster

Question 56

autograft, allograft, and xenograft - two are temporary coverage, one is permanent. which has the goal of permanent coverage

Answer 56

autograft

Question 57

T/F: synthetic skin substitutes are used for temporary coverage

Answer 57

true

Question 58

what are compression options for wound coverage

Answer 58

non stretch (unna boot), short stretch (crepe style), and long stretch (ace wrap)

Question 59

what is an unna boot

Answer 59

paste impregnated with zinc that dries to form a semi rigid dressing changed every 7-10 days - used as a secondary dressing over a hydrocolloid, foam, or calcium alginate

Question 60

T/F: once ulcer has healed, compression is a lifelong, daily therapy for individuals with chronic venous insufficiency

Answer 60

true

Question 61

what is considered the gold standard for neuropathic wound care

Answer 61

total contact cast application

Question 62

what are two educational considerations for TCCs

Answer 62

1. keep the cast dry | 2. wear it whenever OOB

Question 63

what are the advantages and disadvantages of the removable walking boots versus TCC

Answer 63

advantages: cheaper, no special training, easily removed disadvantages: pt can remove it (adherence)

Question 64

what are considerations for half shoes

Answer 64

for met head wounds - careful with balance and ambulation in these patients