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Clinical Pharmacy 1 - Term 1 > 12 - Wound Care > Flashcards

12 - Wound Care Flashcards

1
Q

What are acute wounds?

A

Heal quickly (typically w/in 4 weeks)

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2
Q

What are examples of acute wounds?

A
  • Bites
  • Scrapes
  • Minor lacerations
  • Punctures
  • Burns
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3
Q

What are chronic wounds?

A
  • Fail to progress through normal healing w/in 4 weeks

- Healing is delayed or impaired

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4
Q

What are examples of chronic wounds?

A
  • Pressure ulcers

- Diabetic ulcers

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5
Q

In which locations do chronic wounds tend to occur?

A

Hospital and home-care settings

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6
Q

What are the 4 phases of the healing process?

A

1) Hemostasis
2) Inflammatory phase
3) Proliferative phase
4) Maturation phase

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7
Q

What occurs in the first stage of healing?

A
  • Hemostasis
  • Begins w/in minutes of injury
  • Vasoconstriction occurs and platelets aggregate to form a clot
  • Appearance – temporary blanching of skin and blood clot forms
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8
Q

What occurs in the second stage of healing?

A
  • Inflammatory phase
  • Begins shortly after injury and can last up to 4 days
  • Vasodilation allows increased blood flow
  • Neutrophils cleanse wound and macrophages remove bacteria and debris
  • Appearance – redness, heat, swelling, pain and may have some drainage
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9
Q

What occurs in the third stage of healing?

A
  • Proliferative phase
  • Can last from 4-24 days
  • Granulation tissue formed, wound contraction, and new epithelium formed
  • Wound is considered closed, but not healed (scar formation)
  • Appearance – bright red tissue and raised; scar tissue beginning to form
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10
Q

What occurs in the fourth stage of healing?

A
  • Maturation phase
  • Also called remodeling phase as the dermal tissue strengthens
  • Collagen forms early scar tissue and continues to be deposited to increase strength of tissue
  • Starts about 3 weeks after injury and complete healing can take up to 2 years
  • Appearance – changes from pink to red to white
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11
Q

How can you determine if a wound is in the third phase of healing or if it is infected?

A
  • Third phase produces a raised, red wound

- Infection will also produce pus and expansion of red areas

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12
Q

Can the wound become infected in the fourth phase of healing?

A

No

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13
Q

What are some factors that affect wound healing?

A
  • DIDNT HEAL
  • Diabetes
  • Infection
  • Drugs (steroids, ASA, anticoagulants, cancer drugs)
  • Nutritional problems
  • Tissue necrosis
  • Hypoxia
  • Excessive tension on wound edges
  • Another wound
  • Low temp
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14
Q

Which locations will wounds have slower healing?

A

Bony areas and lower extremities because of decreased blood flow

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15
Q

What patient factors should be assessed when they present with a wound?

A
  • Tetanus immunization?
  • Medical conditions that affect healing (diabetes, immunocompromised)
  • Factors that delay healing?
  • Bleeding longer than 10 minutes?
  • Age?
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16
Q

What are red flags for a wound?

A
  • Wound larger than 2 cm
  • Lacerations on face or hand where edges don’t fall together
  • Deep wound
  • Px unable to move injured part
  • Dirt and debris cannot be removed w/o scrubbing
  • Infected wound
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17
Q

What are some non-pharms are basic wound care management?

A
  • Cleanse wound (wash w/ water and remove dirt/debris)
  • Stop bleeding (use clean dressing or gauze to apply pressure to wound for 10 minutes)
  • Protect wound (apply dressing to protect and improve healing)
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18
Q

What is debridement and who performs it?

A
  • Removal of dead or contaminated tissue

- Only done by a health care professional

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19
Q

What products are recommended for cleaning wounds?

A
  • Lukewarm drinkable water to remove dirt and debris

- Normal saline to remove dirt and debris

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20
Q

What products are not recommended for cleaning wounds?

A
  • Hydrogen peroxide 3% (may impair healing and cause tissue toxicity)
  • Isopropyl alcohol 70% (may dry and irritate skin)
  • Iodine (may irritate tissue and impair healing)
  • Povidone-iodine (may impair healing)
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21
Q

What are signs of a skin infection?

A
  • Area around wound is red
  • Localized pain
  • Warm to touch around affected area
  • Edema/swelling
  • Drainage/pus/yellow discharge
  • Fever
  • Redness extending from wound after 2 days
  • Abnormal smell
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22
Q

Can antibiotic ointments be used to prevent a skin infection?

A
  • No, only work after infection has occurred

- Can use soap and water for prevention

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23
Q

When are topical antibiotics used?

A

For superficial, mildly infected wounds only

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24
Q

When are topical antibiotics used prophylactically?

A
  • Wounds at high risk for infection
  • Chronic wounds
  • Wounds that haven’t been cleaned properly
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25
Q

What is the concern w/ prolonged use of topical antibiotics?

A

Resistance or secondary fungal infection

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26
Q

What is the spectrum of bacitracin?

A

GM+ and minimal GM-

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27
Q

What is the dosage of bacitracin?

A

1-3 times daily

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28
Q

What are adverse effects of bacitracin?

A
  • Common sensitizer/allergic contact dermatitis

- Itching, burning, redness

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29
Q

There is a cross-sensitivity potential w/ bacitracin and _____

A

Neomycin and polymyxin

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30
Q

What is the spectrum of gramicidin?

A

GM+

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31
Q

What is the dosage of gramicidin?

A

1-3 times daily

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32
Q

What are adverse effects of gramicidin?

A
  • Low risk of sensitivity

- Itching, burning

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33
Q

Where should gramicidin not be applied and why?

A
  • Nasal membranes

- Damages sensory epithelium of nose

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34
Q

What is the spectrum of polymyxin B?

A

GM-

35
Q

What is the dosage of polymyxin B?

A

1-3 times daily

36
Q

What are adverse effects of polymyxin B?

A
  • Low risk of sensitivity

- Itching, burning

37
Q

Is contact allergy from polymyxin B common?

A

No

38
Q

What is the spectrum of neomycin?

A

GM- and partially active against GM+

39
Q

What is the dosage of neomycin?

A

1-3 times daily

40
Q

What are adverse effects of neomycin?

A
  • Low risk of sensitivity

- Itching, burning

41
Q

What is the spectrum of fusidic acid?

A

GM+

42
Q

What is the dosage of fusidic acid?

A

2-3 times daily for 7-10 days

43
Q

What are adverse effects of fusidic acid?

A
  • Dryness
  • Itching, burning
  • Some local irritation
44
Q

What is the 1st line therapy for impetigo?

A

Fusidic acid

45
Q

What is the spectrum of mupirocin?

A

GM+ including some strains of MRSA

46
Q

What is the dosage of mupirocin?

A

2-3 times daily for 7-10 days **should not be used more than 10 days

47
Q

What are adverse effects of mupirocin?

A
  • Dryness
  • Itching, burning
  • Some local irritation possible
48
Q

What should be monitored for w/ wounds?

A
  • Bleeding should stop w/in 10 minutes (15 mins for px on anticoagulants)
  • Infection - monitor daily for 48 hours
  • Wound healing - monitor daily for 4-14 days; if not closing w/in 2-4 weeks, refer
49
Q

What is the purpose of dressings?

A
  • Protect wounds from further damage
  • Help stop bleeding
  • Help prevent infection
  • Some help promote healing
50
Q

What are primary dressings?

A

Placed directly on wound, absorbs fluids, prevents infection and adhesion of secondary dressing

51
Q

What are secondary dressings?

A

Placed over primary dressing for protection, absorption, compression, and occlusion

52
Q

What are the types of dressings?

A
  • Gauze
  • Transparent films
  • Hydrogels
  • Hydrocolloids
  • Alginates
  • Foams
  • Liquid tissue adhesives
53
Q

Purpose of gauze dressings

A
  • Absorbent and protectant

- May be used for wet or dry wounds

54
Q

What are the types of gauze dressings?

A
  • Non-adherent (doesn’t stick to wound)

- Self-adherent (clings to itself)

55
Q

What is the application for gauze?

A
  • Place directly on wound, used as a primary dressing

- Moisten w/ saline, wring out excess fluid, and apply secondary dressing

56
Q

Purpose of transparent films

A
  • Provide moist environment
  • Protective and waterproof
  • May be used for superficial clean wounds where it is required to frequently view the wound
57
Q

What is the application of transparent films?

A
  • Gently lay dressing over wound, avoid wrinkling and don’t stretch
  • Overlap wound by 2.5 cm and apply tape
58
Q

When should use of transparent films be avoided?

A

Moist wounds

59
Q

What is an example of a transparent film?

A

Tegaderm transparent

60
Q

Purpose of hydrogels

A
  • High moisture content, some absorption properties

- May be used for dry wounds, painful wounds, pressure ulcers, and burns

61
Q

What is the application of hydrogels?

A
  • Apply moderate amount to wound and cover w/ gauze
  • May require secondary dressing
  • If self-adherent, may be used as primary dressing
62
Q

When should use of hydrogels be avoided?

A

Gangrenous wounds and weeping wounds

63
Q

What are examples of hydrogels?

A
  • Dudoerm gel

- Intrasite

64
Q

Purpose of hydrocolloid dressings

A
  • Retains moisture

- May be used for burns or small abrasions

65
Q

What is the application for hydrocolloid dressings?

A
  • Apply adherent side to skin and hold in place

- Painless to remove

66
Q

When should hydrocolloid dressing use be avoided?

A
  • Dry wounds that are infected

- Weeping wounds

67
Q

What is an example of a hydrocolloid dressing?

A

Duoderm

68
Q

Purpose of alginates

A
  • Create moist environment, highly absorbent
  • May be used for packing cavities and wounds, wound drainage, and pressure ulcers
  • Can reduce pain
69
Q

What is the application for alginates?

A

Apply dressing to area, cover w/ secondary dressing and tape in place

70
Q

When should alginate use be avoided?

A

Dry wounds

71
Q

What are examples of alginates?

A
  • Algisite
  • Tegaderm
  • Kaltostat
72
Q

Purpose of foam dressings

A
  • Retains moisture, highly absorbent, protective

- May be used for wounds w/ mild to moderate exudate, partial to full thickness wounds

73
Q

What is the application for foam dressings?

A
  • Gently lay dressing over wound, cover w/ gauze, tape in place if necessary
  • May need a secondary dressing
74
Q

When should foam dressing use be avoided?

A
  • Dry wounds

- Wounds that need to be frequently checked

75
Q

What is an example of a foam dressing?

A

Allevyn

76
Q

When are liquid adhesives used?

A
  • Paper cuts
  • Minor cuts
  • Skin cracks
77
Q

How long do liquid adhesives last?

A

5-10 days

78
Q

What is the application for liquid adhesives?

A

Wash cut first, apply pressure to stop bleeding then apply adhesive

79
Q

What are the 3 types of adhesive tape?

A
  • Cloth tape
  • Silicone tape
  • Paper
80
Q

Cloth tape?

A
  • Breathable but not water resistant
  • Can adhere to dry or damp skin
  • Generally used if dressing needs to stay intact or area is damp/moist
81
Q

When is silicone tape used?

A

For sensitive or “at risk” skin or if dressings are to be replaced often

82
Q

Paper tape?

A
  • Breathable but does not adhere as well as others

- Generally used for sensitive areas or if dressings are to be replaced often

83
Q

What determines the choice of tape?

A
  • Size and type of wound
  • Potential skin sensitivities
  • Personal preference
84
Q

What are adhesive skin closures used for and what are the 2 types?

A
  • Generally used to hold wounds closed after suture removal
  • Steri-strips
  • Butterfly closures

Clinical Pharmacy 1 - Term 1 (18 decks)

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