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Acute Care Module 4 > Wound Management > Flashcards

Wound Management Flashcards

1
Q

what is the hemostasis timeline for full thickness wounds

A

occurs within minutes of injury

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2
Q

what is the inflammatory phase timeline for full thickness wounds

A

occurs within the first several days

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3
Q

what is the proliferative phase timeline for full thickness wounds

A

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

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4
Q

what is the maturation phase timeline for full thickness wounds

A

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

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5
Q

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

A

proliferative phase

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6
Q

describe the pH of chronic wounds and how it affects healing

A

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

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7
Q

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

A

moist

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8
Q

should full thickness wounds be covered or uncovered?

A

covered to prevent infection

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9
Q

what is the most common and serious complication of wound healing

A

bacterial infection

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10
Q

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

A

starts distally and moves proximally

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11
Q

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

A

true

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12
Q

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

A

true

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13
Q

describe wound cleansing technique (4)

A
  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
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14
Q

what should be our first choice cleanser for wound management?

A

sterile saline

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15
Q

what is a drawback to cleansing agents?

A

can be cytotoxic

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16
Q

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

A
  1. use normal saline

2. avoid antimicrobial solution or cleansers

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17
Q

what are wound cleansing considerations for infected wounds

A
  1. use normal saline or 10-14 day antimicrobial regime
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18
Q

what is the best cleanser choice for green, infected wounds

A

acetic acid followed by saline

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19
Q

what are two inappropriate cleansing agents

A

providone-iodine and hydrogen peroxide

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20
Q

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

A

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

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21
Q

T/F: scrubbing is an appropriate wound cleaning technique

A

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

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22
Q

what are the four non-selective mechanical debridement methods

A

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

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23
Q

what are the four selective debridement methods

A

sharp, autolytic, enzymatic, and biosurgical

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24
Q

when is non-selective debridement indicated

A

severely necrotic wounds with minimal or no healthy tissue present

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25
Q

when is non-selective debridement contraindicated

A

clean wounds with granulation and epithelialization tissues

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26
Q

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

A

bulb syringe/pouring: < 4psi

35mL syringe with 19G: 4-25 psi

27
Q

how frequently should a patient undergo pulsed lavage

A

1x/d if <50% necrotic tissue

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

28
Q

when should you stop pulsed lavage (3)

A
  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
29
Q

what are parameters for PT to provide sharp debridement?

A

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

30
Q

under what three conditions should you stop sharp debridement

A
  1. pain
  2. tendon/bone/nerve/vascular tissue revealed
  3. fistula or tunnel revealed
31
Q

what is the process for debriding an eschar

A
  1. soften with occlusive dressing and enzymatic agent
  2. cross hatch/score eschar
  3. debride
32
Q

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

A

apply pressure with calcium alginate and elevate the wound

33
Q

what is santyl

A

only current collagenase on the market for enzymatic debridement

34
Q

how does enzymatic debridement work

A

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

35
Q

describe the four step technique for enzymatic debridement

A
  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
36
Q

describe autolytic debridement

A

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

37
Q

what is a risk associated with autolytic debridement

A

risk of maceration to surrounding skin

38
Q

describe the technique for autolytic debridement

A
  1. cross hatch/score with scalpel
  2. apply hydrogel or hydrocolloid
  3. apply occlusive (moisture-retentive) dressing
39
Q

what is the primary contraindication for autolytic debridement

A

if the wound requires quick elimination of necrotic tissue

40
Q

what is the biggest disadvantage of autolytic debridement

A

the odor

41
Q

what is the biosurgical debridement technique? biggest disadvantage?

A

apply 10 per sq cm sterile larvae for 3 days

yuck factor

42
Q

what are the 7 antimicrobial classes of topicals/dressings

A
  1. silver
  2. iodosorb/iodoflex
  3. hydrofera blue
  4. medihoney
  5. sorbact
  6. PHMD gauze
  7. antibiotic solutions
43
Q

what are the concerns with using antimicrobials

A

can inhibit fibroblasts and keratinocytes or lead to microbial resistance

44
Q

what is the recommended use (2) of antimicrobials

A
  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

45
Q

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

A

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

46
Q

how do you most effectively use licocaine anesthetic

A

apply directly to the wound bed 15 min prior to intervention

47
Q

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

A

DM foot ulcers, but expensive and requires refrigeration

48
Q

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

A

clear film and hydrocolloids

49
Q

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

A

calcium alginates and foams

50
Q

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

A

hydrogels

51
Q

describe hydrocolloids

A

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

52
Q

describe hydrogels

A

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

53
Q

describe calcium alginates

A

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

54
Q

describe foam

A

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

55
Q

describe collagen matrix

A

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

56
Q

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

A

autograft

57
Q

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

A

true

58
Q

what are compression options for wound coverage

A

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

59
Q

what is an unna boot

A

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

60
Q

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

A

true

61
Q

what is considered the gold standard for neuropathic wound care

A

total contact cast application

62
Q

what are two educational considerations for TCCs

A
  1. keep the cast dry

2. wear it whenever OOB

63
Q

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

A

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

64
Q

what are considerations for half shoes

A

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

Acute Care Module 4 (10 decks)

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