Woundcare Flashcards
(116 cards)
1
Q
specific measures that set payments/penalties in healthcare
A
quality measures
2
Q
3 parts of healthcare triple aim
A
- improved pt outcome
- improved pt satisfaction
- lower, efficient cost of care
3
Q
IMPACT quality measure domains are all related to _______________
A
therapy
4
Q
4 risk factors for pressure ulcers
A
- loss of continence
- immobility
- poor nutrition
- impaired mental awareness
5
Q
3 primary prevention guidelines for diabetics
A
- education
- physical activity
- lifetime wellness
6
Q
best treatment for wound care
A
prevention
7
Q
term to use instead of education
A
health literacy
8
Q
goal of healing a wound
A
create an ideal wound environment
9
Q
4 parts of an ideal wound environment
A
- moist not wet
- clean not sterile
- free from stress
- healing needs to occur from base up
10
Q
cellular migration is dependent on __________ for transportation
A
water
11
Q
wounds are not a ______ environment
A
sterile
12
Q
describe the difference between internal and external forces that cause trauma to tissue
A
internal: edema
external: shearing, pressure
13
Q
fluid that is stagnant in body
A
abcess
14
Q
infection vs colonization
A
infection: active destructive process
colonization: infection present but no longer causing damage
15
Q
9 types of wounds
A
- pressure ulcers
- venous stasis/arterial ulcers
- diabetic ulcers
- surgical sites
- burns
- traumatic wounds
- skin tears
- kennedy terminal ulcer
- deep tissue injury
16
Q
6 causes of wounds
A
- pressure
- shearing
- circulation probs
- infection
- trauma
- disease process
17
Q
pressure ulcers are not ____________
A
age-dependent
18
Q
how are pressure ulcers staged?
A
numbers
19
Q
pressure ulcers are usually located in these two places:
A
- bony prominences
2. between contracture sites
20
Q
non blanchable erythema is seen in…
A
stage I pressure ulcer
21
Q
in stage I of a pressure ulcer, the skin is usually _____
A
intact
22
Q
what layer of skin are stage II pressure ulcers primarily found in?
A
epidermis
23
Q
main diff between stage I vs II
A
skin breaks in stage II
24
Q
stage II often presents as a ______
A
blister
25
what stage of pressure ulcer would a skin tear fall under?
II
26
3 modalities used on stage II pressure ulcers
whirlpool, periwound, ultrasound
27
stage III ulcer = _________ skin loss
full thickness
28
stage III: damage or necrosis to ______ tissue
subcutaneous
29
depth of the wound in stage III commonly describe as a _____
crater
30
for stage III treatment, focus on cleaning the ______ of the wound
base
31
stage III modalities (3)
1. high volt pulse current aka stim
2. pulsed lavage
3. whirlpool
32
stage IV pressure ulcer presents with extensive _______ to bone, muscle or other underlying structures
destruction
33
is stage IV painful?
no
34
stage IV at high risk for _________
infection
35
stage IV may need this for treatment
graft to close wound
36
when you can't see the base of a pressure ulcer, what stage is it?
unstageable
37
a wound is deemed unstageable due to covering of _____________
necrotic tissue
38
name of wound that occurs in pts who are imminently dying
kennedy terminal ulcer
39
shape/characteristics of kennedy terminal ulcer
butterfly or pear
| transitions from red --> black very rapidly
40
location of kennedy terminal ulcer
sacrum
41
time span between kennedy terminal ulcer development and death of pt
8-24 hr
42
pressure-related injury to subcutaneous tissues under intact skin
deep tissue injury (DTI)
43
appearance of DTI
deep bruise
44
DTIs may cause development of a stage ________ pressure ulcer even with optimal treatment
III-IV
45
80-90% of LE ulcers
venous stasis ulcers
46
up to 1/3 of treated venous stasis pts experience...
4+ episodes of recurrence
47
cause of venous stasis
dec venous return from legs due to one-way valve failure
48
venous stasis ulcers are staged by....
description
| partial thickness vs full thickness
49
skin characteristics in pts with venous stasis
shiny, hairless, flaky skin
50
what increases venous stasis ulcer pts pain?
gait
51
what decreases venous stasis ulcer pts pain?
elevation
52
hallmark sign of longterm VS problems
hemosiderin deposits aka permanent black marks
53
cause of hemosiderin deposits
holes in arteries and veins that cause leakage of blood and permanent discoloration
54
contraindication to venous stasis ulcers
whirlpool
55
main VS treatment
edema reduction, mobility increase
56
arterial ulcers have what affect on the pedal pulse?
dec or diminished
57
what causes increased pain in arterial ulcer pts?
gait and elevation
decreased w rest
58
where are arterial ulcers normally located?
lower 1/3 of leg, toes, interdigital spaces
59
true arterial ulcers are _____
rare
60
what position would you not put an arterial ulcer pt in?
LE elevated - we want to position them in a dependent position
61
where are DPN ulcers found?
plantar aspect of feet
62
hugely important DPN ulcer treatment
education on skin inspection, disease process, and proper footwear
63
3 characteristics of DPN ulcers
callouses, thick toenails, hair loss
64
primary vs secondary intention closure
primary: wound completely closed up
secondary: wound left open to heal naturally
65
skin grafts have a ________ potential to heal
greater
66
_______ required for treating burns
special training
67
skin tears are common in geriatric pts with _________
"onion skin"
68
8 factors of wound eval
1. size (lengthxwidth)
2. depth
3. undermining/tunneling
4. necrotic tissue
5. exudate (type/amt)
6. periwound integrity
7. granulation tissue
8. epithelialization
69
allows for early detection and prevention of pressure ulcers
ultrasound scanning
70
uses computerized pad that measures surface and deep pressures in sitting/lying pts
pressure mapping
71
without _______, the would will not heal
inflammation
72
length of inflammatory phase
24-48 hr
73
purpose of vasoconstriction/vasodilation in inflammatory phase
VC: clotting
VD: migration of neutrophils, macrophages, GFs
74
neovascularization occurs during which phase of healing?
inflammation
75
4 parts of proliferation
1. GFs for collagen synthesis
2. wound contraction
3. granulation
4. epithelialization
76
proliferation length
5 days to 2-3 weeks
77
3 parts of maturation
1. collagen fiber reorination/remodeling
2. inc in tensile strength
3. scar reduction
78
how long does it take to regain 80% of original strength?
1-2 years
79
5 types of debridement
1. surgical
2. sharp
3. mechanical
4. enzymatic
5. autolytic
80
surgical debridement is necessary for which stages of wounds?
III and IV
81
how does surgical debridement accelerate healing?
restarting inflammatory phase of healing
82
surgical debridement usually requires:
anesthesia in OR
83
sharp debridement does not require:
anesthesia
84
sharp debridement is not recommended for these two populations
diabetics and pts on blood thinners - may cause bleeding
85
nonselective removal of tissue with wet to dry dressing, whirlpool
mechanical debridement
86
2 cons to mechanical debridement
1. significant time and delayed healing
| 2. painful to some pts
87
selective debridement using chemicals
enzymatic
88
is enzymatic debridement painful?
na
89
selective debridement by endogenous enzymes
autolytic
90
downside of autolytic debridement
v time consuming
91
dry wounds prevent _____________
migration of granulating tissue
92
alcohol ____ the skin and can cause _____
dries; breaking
93
rubbing a reddened area causes more ________________
ischemia and tissue destruction
94
colonization wounds will heal by.....
secondary intention
95
all open wounds are colonized by ______
bacteria
96
infection causes ____ but ______ cellular destruction
local; extensive
97
4 colonization wound characteristics
1. inflammation
2. periwound erythema
3. odor present before cleaning
4. exudate
98
4 steps to cleaning a wound
1. saline or sterile water
2. clean technique
3. hand washing technique
4. infection control procedures
99
4 things to not clean a wound with
1. Dakin's solution
2. povidone-iodine
3. acetic acid
4. hydrogen peroxide
100
name the modality:
application of electrical current through electrodes applied directly to the skin in close proximity to ulcer
high volt pulsed current
| HVPC
101
5 indications to use HVPC
1. III/IV ulcers
2. arterial ulcers
3. diabetic ulcers
4. venous stasis ulcers
5. wound sizes 1cmx1cm>
102
2 contraindications to HVPC
active cancers
| osteomyelitis
103
pulsed lavage is an example of which type of debridement?
mechanical
104
4 types of wounds that pulsed lavage can be used on
1. tunneling wounds
2. infected surgical sites
3. pressure sores
4. diabetic and venous stasis ulcers
105
what are the contraindications to pulsed lavage?
there are none
~trick question~
106
what phase of healing is whirlpool believed to affect?
inflammation phase
107
name dat modality:
use of high changing frequency electromagnetic fields to affect the polarized water molecules and enhance circulation to a small area
electromagnetic/diathermy
108
name dat modality:
mechanical vibration delivered at a frequency above the range of human hearing
ultrasound
109
effect of ultrasound on inflammatory phase
release of histamine --> attracts neutrophils and monocytes to injured site
110
effect of ultrasound on proliferative phase
stimulate collagen secretion from fibroblasts - increase tensile strength of tissue
111
ABI
ankle brachial index
112
ABI equation
systolic BP LE/systolic BP UE
113
if ABI <1...
ischemia - not a candidate for wraps
114
modality that removes interstitial fluid from wound bed and allows migration of granulation tissue
VAC
| vacuum assisted closure
115
pattern for edema wrapping
circumferential
116
during wrapping, every time you cross over, what does it do to the pressure?
doubles
