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Special Topics 1 > Woundcare 2b/c > Flashcards

Woundcare 2b/c Flashcards

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1
Q

Critical colonization

A

Point at which the host immune response is no longer able to control microorganisms in wound bed

Bacteria not yet invaded soft tissue
Arrested wound healing and unhealthy appearance of granulation tissue

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2
Q

Topical treatments

A

Cadexomer iodine
Silver
Xeroform
Hypchlorous acid soak

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3
Q

Infection

A

Invasion and multiplication of microorganisms in body tissue
Results in local cellular injury
Host defenses are overwhelmed

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4
Q

Infection equation

A

(# organisms x virulence)/host resistance

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5
Q

Host resistance

A

Immune repsonse
Blood supply
General health status
Local factors

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6
Q

S/s of infection local

A 
Erythema
Edema
Warmth
Increase pain
Purulent
Induration
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7
Q

S/s infection systemic

A

Fever
Elevated WBC
Red streaks from wound
Confusion or agitation

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8
Q

S/s infection chronic

A 
New/increased slough
Friable granulation tissue
Foul odor
Increased wound breakdown
Sudden high glucose in diabetics 
Increase/changes in exudate
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9
Q

Clinical diagnosis of infection

A

Bacterial load 10^5-10^6 (will not heal)

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10
Q

NERD and STONEES

A

Sibbalds cute for superficial and deep compartment infection/inflammation
Symptoms and theranostic test

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11
Q

NERDS

A

Add picture

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12
Q

STONEES

A

Add picture

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13
Q

Gold standard for indicated dx

A

Tissue biopsy

Not w/in PT scope

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14
Q

Tx infection

A 
Cleansing/ irrigation
Debridement
Topical anti microbial
Topical antiseptics
Abx
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15
Q

Topical antiseptics

A 
Acetic acid
Alcohol
Chlorhexidine gluconate
Dakins solution
Gentian violet
Hydrogen peroxide 
Povidone iodine
**Hypochlorite acid - safe
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16
Q

Microorganism defenses

A

Toxins
Anderence of organism
Biofilms
Invasive factors (protease)

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17
Q

Endotoxins

A

Lipids and polysaccharides related by lysis of gram negative bacteria
Causes destruction of growth factors, receptors, tissue components
Decrease collagen deposition and cross linking, affecting tensile strength
Associated w/ surgical wound dehiscence

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18
Q

Extotoxins

A

Proteins related by both gram positive and negative bacteria during proliferation —> generalized tissue necrosis at wound surface

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19
Q

Biofilms

A

Structured community of bacteria cells enclosed in self produced polysacchardie matrix

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20
Q

Quorum sensing

A

Comm processes among cells in biofilm —> perceive how many other bacteria are in close proximity, regulation of many different processes

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21
Q

Disadvantage of biofilm

A 
Resistance to anti microbial, abx, phagocytes
Ability to enter into latent states
Increasing species diversity
Persister cells 
Altered gene expression
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22
Q

Biofilm tax

A 
Wound cleansing/irritation
Serial debridement
Cadexomer iodine
Flouroquinolone abx
Pulsed, low dose abx
Xylitol
Lactoferrin
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23
Q

Biofilm irrigation

A

35 ml syringe w/ 18 gauge angiocatheter 8-12 psi

Water as effective as normal saline except immunocompormised or poor water quality

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24
Q

Hydrotherapy

A

Pulsed lovage w/ or w/out suction

Whirlpool

Softening necrotic tissue, reduce bioburden, remove debris, promot granulation, treatments of tunnels and undermining

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25
Pulsed lavage setup
8-12 psi 2-6 at tunnels 60-200 mm hg suction 1 bag of irritant
26
Pulsed lavage precautions
``` Insensate pts Anticoagulant meds Wound near major vessels Wounds near a cavity lining Bypass graft sites Exposed structures Grafts Flaps Facial ```
27
Whirlpool
Necrotic tissue - softens, reduce bioburnder, remove debris 92-96 deg, 5-20 mins, monitor Precautions: edema, CHF, heart conditions Contras: new skin graft/flap, suture, IV sites
28
Wound bed moisture balance
Too much exudate: maceration, pooling Too little: desiccation Too wet, absorb Too dry, moisten
29
Benefits of moist wound healing
- Optimal enviro - Reduces number of dressing changes (time and cost) - reduces potential for infection - less painful - decrease healing time - stronger scar formation
30
Ideal dressing characteristics
- barrier to bacteria - adequate gaseous exchange - thermal insulation - free from contaminants - manages excess exudate - facilitates nontraumatic removal
31
Dressings - absorption
Alginate Foam Hydrocolloid Hydrofiber
32
Dressing - hydration/moisture maintenance
- hydrogel - impregnated gauze - hydrocolloid - transparent film
33
Dressings - antimicrobial
- cadexomer iodine - silver - honey
34
Enzymatic debridement
Collagenase santyle
35
Protection of periwound
Ointments Creams Films Hydrocolloid
36
Alginate
Non - woven pad of seaweed fibers, non occlusive, conformable, slow bleeding, forms gel when filled w/ fluid Ad:highly absorbent;packing;easy to use; hemostasis properties Ind: mod to heavy exudate, contaminated or infected, slough or granulation
37
Foam
Absorption High density polyurethane Ad: nonadhesive, friable periwound, large variety Indication: minimal to heavy exudate, not recommended for infected wounds
38
Hydrocolloid
Absorption, hydration/moisture Ad: adhesive, absorptive, conformable, promotes autolysis, also able to maintain most wound bed Indications: dry to minimal exudate, aloud or granulation
39
Hydrofiber
Absorption Packing agen, easy, 33% more absorbent than alginate Moderate to heavy exudate, contaminated or infected, slough or granulation
40
Hydrogel
Hydration, moisture maintain Cooling effect,amorphous, promotes autolysis, keeps structures moist Dry to minimal exudate, eschar, slough, granulation; deep structures exposed
41
Impregnated gauze
Hydration, moisture Highly confomrative, maintains moisture, nonadherent, promotes autolysis Keeps structures moist Dry to minimal exudate, eschar, slough, granulation, deep structures exposed
42
Transparent film
Mosture Promotes autopsies, reduces surface tension *may hold in too much moisture Dry to minimal exudate, partial thickness wounds or as secondary dressing
43
Cadexomer iodine
Iodine Released over 72 hours, starch beads absorb exudate Absorptive and odor reducing Moderation to easy exudate, infected, malodorous wounds Contras: hyperthyroid, iodine sensitivity
44
Silver
Antimicrobial, reduces inflammation Critically colonized/infected wounds or those at risk of becoming infected Contra: use w/ enzymatic debridement, some not compatible w/ saline
45
Honey
Antimicrobial, draws fluid from wound by osmotic pressure, reduces odor, aids in debridement For critically conolized/infected wounds, those at risk for infection, necrotic Not for use w/ enzymatic debridement
46
Collagenase santyl
Debriding ointment w/ enzymes derived from bacteria Desires collagen anchors to wound bed For wound w/ necrotic tissue Contra: use w/ silver dressings, pt hypersensitivity to substance
47
Ointments, creams, liquid films
Protect periwound, provides a barrier, smooth irritated skin
48
Physical agents for epithelial advancement
``` Electrical stim Non contract US UVC light Negative pressure Hyperbaric oxygen Compression ```
49
E-stim
Most nonhealing wounds Reimbursement: must have received evidence based wound care for at least 4 weeks w/ little to no progress
50
Estimate - high volt pulsed current
3-5x/week Active electrode to wound, dispersal pad to intact skin w/ list cause or washcloth
51
Non contact US
Most nonhealing wounds, all healing phases, not generally reimbursed Saline as conduit Contras: eclectic implants, low back/abs during pregnancy, over malignancy Increased healing rate in non diabetic foot ulcer, ischemic wounds
52
UVC
Infection, impaired wound healing Benefit: increased epithelial migration, local cutaneous blood flow, bactericides effects, inhibit growth of MRSA and VRE Perpendicular to wound surface, 2.5cm away, 90 seconds daily
53
UCV contras
``` Skin CA Graft photosensitivity Skin conditions Keep X-ray therapy Local erythema AIDS/HIV Eye No CHF, TB, DM, hyperthyroid, fever ```
54
Hyperbaric oxygen wound indications
osteomyelitis, diabetic wounds, necrotizing soft tissue infections, osteoradionecrosis, soft tissue radionecrosis, compromised grafts and flaps, acute thermal burns, crush injury, compartment syndrome and other acute traumatic ischemias
55
Hyperbaric oxygen benefits
Increase oxygen concentration in tissue | Stimulates new blood vessel growth
56
Negative pressure indications
``` Nonhealing/chronic wounds Post sx/ traumatic wounds As a bridge to tertiary closure Skin grafts and flaps Enterocutaneous fistula ```
57
Negative pressure precuations
``` Anticoagulants Elevated IRN Low platelets Active bleeding Poor tolerance of VAC therapy ```
58
Negative pressure contras
Malignancy Untreated osteomyelitis Nonenteric and unexplored fistulas Majority of wound necrotic
59
Negative pressure challenges
Wounds w/ enterocutaneous fistulas In proximity to external fixations, moist areas, sacrum/coccyx/perineum Tubing Exposed structures
60
Negative pressure solutions
``` Bridging Ostomy pouches in conjunction w/ NPWT Ostomy paste strips Benzoin tincture Adaptic/merited/white foam ```
61
7 types of edema in legs
``` Venous Cardiac Lymphedema Inflammatory Idiopathic Hypoproteinaemic renal ```
62
Edema tax
``` Meds Treatment of medical cause Manual lymph drainage ELEVATION COMPRESSION ```
63
Compression physio
Reduce diameter of veins -> endothelial cells to become tighter-> reduce fluid leakage from veins Increase in BF toward heart and reduces venous reflux
64
Degree of compression determined by
``` Elasticity of bandage Number of bandage layers Shape and size of limb Skill and technique of bandage Nature of physical activity by pt ```
65
Laplace law
For bandage pressure Pa-Pb= (2y/r) ``` Pa = internal Pb = external Y = tension r = radius ```
66
Increased bandage tension
Increased sub bandage pressure
67
Increased # bandage layers
Increased sub bandage pressure
68
Increased leg circumference
Decreased sub bandage pressure
69
Increased bandage width
Decreased sub bandage pressure
70
2 pain bandage types
Long stretch (more aggressive compression) Short stretch (safer due to less extensibility -> less tension to limb)
71
Long stretch bandage
``` High resting pressure Low working pressure Higher risk of damage >140% ext Polyurethane ```
72
Short stretch bandage
``` Low resting pressure High working pressure Lower risk of damage ~60% ext Made from cotton fibers ```
73
Resting pressure
Pressure bandage exerts on tissue at rest
74
Working pressure
Pressure bandage exerts against working musculature
75
Compression precautions
``` DM PVD/arterial insufficiency Acute cellulitis/infection Neuropathy Lymphedema Acute CHF Low ejection fraction Fragile skin ```
76
Compression contras
ABI <0.6 High compression (30-40 mmHG) W/ ABO <0.8
77
Compression progression - wounds
Open: wraps, maybe Velcro compression garment Closed: stockings or compression garments
78
Pt instructions for compression stockings
Wear during waking hours when OOB Do not moisturize prior to applying Wound recalcitrance Elevation of LE above heart when sitting Importance and purpose of wraps/stockings Monitoring for changes such as CHF, cellulitis, vascular status
79
Red flags - refer to MD
``` Worsening cellulitis Cellulitis in diabetic or elderly population Unusual exudate from any wound Increase in depth, bone/tendon exposure Deep compartment infection Purple coloration Digits eschar Sig area of eschar of foot/hand Nonhealing wound after 2-3 mo ```

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