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Applied Clinical Veterinary Nursing > Wounds > Flashcards

Wounds Flashcards

1
Q

List and define the wound types.

A

Incision = clean straight line e.g. surgical procedure
Laceration = jagged edges, cuts to skin surface
Abrasion = damage to epithelial surface e.g. graze
Contusion = bruising
Puncture = deep, penetrating, infectious e.g. cat bite

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2
Q

Describe the wound classifications.

A

Class 1 = 0-6hrs, minimal contamination
Class 2 = 6-12hrs, microbial burden has not reached critical level
Class 3 = 12hrs+, wound infection (do not want to surgically close these!)

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3
Q

What considerations should we have when a patient presents with an open wound?

A

History, pre-existing conditions
Medications e.g. steroids
Breed, species, age
Position, type, cause of wound
Time since incident
First aid? Haemorrhage?
Owner compliance
Cost/insurance
Practice resources and expertise

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4
Q

List the stages of wound healing.

A

Inflammatory phase (0-5 days)
Debridement phase (day 0+)
Repair/proliferation phase (day 3 - 4 weeks)
Remodelling phase (day 20+)

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5
Q

Describe the inflammatory phase of wound healing.

A

Haemorrhage, vasodilation, increased vascular permeability

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6
Q

Describe the debridement phase of wound healing.

A

Phagocytosis, migration of WBCs, removal of cellular debris

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7
Q

Describe the repair/proliferative phase of wound healing.

A

Fibroblasts proliferate, collagen synthesis, epithelialisation and contraction

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8
Q

Describe the remodelling phase of wound healing.

A

Wound contraction and remodelling of collagen fibres

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9
Q

Why do we carry out wound lavage?

A

Reduce bacterial load - for every hour earlier lavaged, bacterial load halved!
Allows for visualisation of underlying tissues

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10
Q

How do we carry out wound lavage?

A

Use 35/40ml syringe and 19G needle
Too much pressure can penetrate debris further into tissues!
Use isotonic saline to avoid damage to cells (never chlorhex!)

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11
Q

What options do we have for allowing a wound to heal?

A

Primary wound closure (first intention)
Delayed primary closure (third intention
Contraction and epithelialisation (second intention)

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12
Q

What considerations should we have when deciding to allow a wound to heal by second intention?

A

Topical agents?
Dressings
Types of bandage material
Client compliance
Cost
Expertise

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13
Q

Why would we consider using negative pressure wound therapy (NPWT)?

A

Reduced oedema and exudate accumulation
Elimination of strikethrough because wound fluid is evacuated into collection canister
increased central wound perfusion and vascularisation
Rapid contraction and wound healing
Reduction in dressing changes

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14
Q

Why do we use manuka honey in practice?

A

Broad spectrum antimicrobial activity
Anti-inflammatory properties
Shown to be effective against MRSA and Pseudomonas

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15
Q

What considerations should we have when using honey for wound healing?

A

Higher level of exudate so consider dressings
Consider initial use to aid granulation then switch to hydrogel
Great for granulation but must stop using when sufficient to avoid over-granulation (excess scar tissue)

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16
Q

Describe the use of silver in wound healing.

A

Topical agent in various forms e.g. creams/dressings
Primary benefit is antimicrobial effects - indicated for inflammatory phase

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17
Q

Why would we use a wet-to-dry dressing?

A

Useful for debridement
Wet swabs on wound surface removed at change debrides surface of wound

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18
Q

What are the cons of wet-to-dry dressings?

A

Environmental bacteria
Strikethrough
Discomfort
Gauze fibres left behind

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19
Q

Describe hydrogel dressings.

A

E.g. Intrasite gel, GranuGel
Water-based, amorphous, cohesive
Applied to wound bed and covered with secondary, non-absorbent dressing

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20
Q

Describe hydrocolloid dressings.

A

E.g. Aquacel, Granuflex, Hydrocoll
Carboxymethylated cellulose, pectin, gelatine
Forms a non-adherent gel on contact with wound
Not commonly used in open wound management

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21
Q

Describe vapour-permeable films/membranes.

A

E.g. Primapore, Melolin
Sheet of absorbent material between two thin layers of film that contain small pores for movement of gas and fluid

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22
Q

Describe foam dressings.

A

E.g. Kendall Foam, Allevyn, ActivHeal Foam
Hydrophilic dressings made of polyurethane foam
Adhesive or non-adhesive
With or without breathable film backing

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23
Q

What considerations should we have when bandaging a wound?

A

Patient comfort
Patient interference
Secondary bandage concerns
How often to change
Position/area of wound

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24
Q

What kind of bandaging can we do for expansive, body wounds?

A

Tie-over dressings

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25
Q

Why might a wound not be healing?

A

Take pictures/measurements to record progression
Microbial presence? Culture for antibiotics
Patient/client factors

26
Q

What are some possible surgical reconstruction techniques?

A

Simple closure
Subdermal plexus flap
Axial pattern flap
Free skin graft

27
Q

When is simple suturing most appropriate?

A

Primary/delayed primary closure

28
Q

What wounds are most appropriate for simple suturing?

A

Fresh wound, clean/clean-contaminated
Shallow, not much skin loss
E.g. sharp incisional injury
Minimal surgical debridement

29
Q

What cons/complications can occur from simple suturing?

A

Relies on accurate wound assessment - can lead to breakdown
Infection, non-viable tissue left behind, excess tension, inappropriate suturing

30
Q

How can we carry out simple suturing?

A

GA / sedation and LA
Basic surgical kit only
Can consider using staples on skin only wounds
+/- bandage post-op

31
Q

What is the theory behind a subdermal plexus flap?

A

Generous plex of small arteries/veins in subdermal tissue under skin
Skin elevated and dissected away, vessels preserved, skin elasticity allows skin to be moved to a larger defect

32
Q

What are the two named subdermal skin flaps?

A

Flank fold flap - inguinal wounds
Elbow fold flap - axillary wounds

33
Q

When are subdermal flaps most appropriate?

A

Primary / delayed primary / secondary closure

34
Q

What are the pros of a subdermal plexus flap?

A

Simple yet versatile
Good for medium-sized wounds
Reduces tension

35
Q

What wounds are most appropriate for subdermal plexus flaps?

A

Fresh/bandaged for a while
Clean or contaminated/dirty
Any area, medium-sized, reduces tension
Significant surgical debridement

36
Q

What are the cons/complications of subdermal plexus flaps?

A

Relies on accurate wound assessment, size limitations, damage to plexus possible
Infection, non-viable tissue left behind
Too big a flap = blood supply inadequate = vascular necrosis
Poor technique = plexus damage = vascular necrosis

37
Q

What is the theory behind an axial pattern flap?

A

Incorporate direct cutaneous artery and vein in skin flap raised to cover large areas
Less chance of breakdown due to vascular necrosis

38
Q

When is an axial pattern flap most appropriate?

A

Secondary closure

39
Q

What are the pros of an axial pattern flap?

A

Come with good blood supply
Longer and wider flaps possible than subdermal
Can offer rapid healing of chronic wound

40
Q

What wounds are most appropriate for axial pattern flaps?

A

Wound bandaged for a while
Must be ‘clean’ at time of surgery
Specific sites on body, large defects

41
Q

What are the cons/complications of an axial pattern flap?

A

Steep learning curve, catastrophic flap necrosis, good post-op care vital, cosmetic result?

42
Q

What is the theory behind free skin grafts?

A

Need healthy bed of granulation tissue and skin to ‘grow’ into tissue
Sheet (creates a primary wound) / punch biopsy
Useful for distal limbs where other closures not an option

43
Q

When are free skin grafts most appropriate?

A

Only for secondary closure

44
Q

What are the pros of free skin grafts?

A

Punch grafts simple
Sheet grafts good for large extremity defects
Offer rapid healing of chronic wound

45
Q

What wounds are appropriate for free skin grafts?

A

Need healthy bed of granulation tissue
Useful for extremities where other closures not an option

46
Q

What are the cons/complications of free skin grafts?

A

Advanced procedure
Good post-op care vital
Partial/complete failure not uncommon

47
Q

Give some examples of open wounds.

A

Abrasion
Avulsion
Burn
Degloving
Incision
Laceration
Pressure sore
Puncture
Shearing

48
Q

Give some examples of closed wounds.

A

Contusion
Crush injury
Haematoma
Hygroma

49
Q

How can casts/bandages cause wounds?

A

Open/closed
Overly tight, inadequate padding, excess exercise, wet/dirty

50
Q

What initial considerations should we have before surgical reconstruction of a wound?

A

What wound have we got here?
What cause/trauma have we got?
What patient have we got here?
When is this likely to go to surgery?
Where is the wound?

51
Q

What are the three stages of skin healing?

A

Inflammation
Proliferation
Maturation

52
Q

What client factors affect surgical management of wounds?

A

Cost - bandaging may not be cheaper than surgery!
Compliance - revisits, bandage management, medications
Practicalities - more trips for bandaging than surgery? Distance to practice?

53
Q

What does TIME stand for?

A

Tissue
Infection/Inflammation
Moisture
Epithelialisation

54
Q

What considerations should we have for removing non-viable tissue?

A

Viability assessment
Timing of debridement
Method of debridement

55
Q

How do we describe wounds that are too wet?

A

Macerated
Excoriated

56
Q

How do we describe wounds that are too dry and how can we help these?

A

Desiccated - add moisture
Eschar (scab) present - debride

57
Q

How can we assess epithelialisation of wounds?

A

Wound edges - pink smooth vs dark red uneven
Measurements - length/width/depth
Photos, drawings
Tissue around wound - cellulitis, oedema, skin

58
Q

Why do we carry out wound lavage?

A

Rehydrate necrotic tissue
Remove foreign material
Reduce bacterial contamination
Remove toxins/cytokines

59
Q

How can we carry out surgical debridement?

A

Sharp dissection to remove all contaminated/necrotic tissue
Avoid damage to normal tissue

60
Q

How can we carry out non-surgical debridement?

A

Physical - using adherent dressings that remove tissue when dressing is removed
Chemical - using chemical substances to remove dead tissue

61
Q

Why do we bandage open wounds?

A

Protect - self-trauma, contamination/environment, desiccation
Provide - pain relief, immobilisation, pressure, topical medications
Debridement - chemical/physical
Moisture - keep moisture in/take excess moisture away

62
Q
A

Applied Clinical Veterinary Nursing (40 decks)

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