Caring for an Individual with a Chronic Wound

Question 1

Causes of wounds

Answer 1

• Hypoxia / ischemia
• heat/cold
• mechanical trauma
  - Abrasion, laceration, contusion, puncture, avulsion, incision

Question 2

exudate (drainage) can be described in the following 4 ways

Answer 2

• serous
• purulent
• serosanguinous
• sanguinous

Question 3

serous drainage

Answer 3

clear, watery plasma

Question 4

purulent drainage

Answer 4

thick, yellow, green, tan, or brown drainage

Question 5

sero-sanguinous drainage

Answer 5

pale, red, more watery drainage

Question 6

sanguinous drainage

Answer 6

indicates fresh bleeding, bright red

Question 7

what are the 4 stages of wound healing

Answer 7

• hemostasis
• inflammatory
• proliferative
• remodeling

Question 8

hemostasis (stages of healing)

Answer 8

• blood vessels constrict; clotting factors activate to stop bleeding.
• platelets release growth factors to begin repair process

Question 9

inflammatory (stages of healing)

Answer 9

• vasodilation occurs; edema, erythema, and exudate can be noted in the wound
• leukocytes arrive
• result: clean wound bed in a patient with a noncomplicated wound

Question 10

Proliferative (stages of healing)

Answer 10

• epitheliazation (construction of the new epidermis
• new granulation tissue is formed
• new capillaries created (angiogenesis)
• collegen synthesized

Question 11

Maturation / remodelling (stages of healing)

Answer 11

• collegen is remodelled to become stronger and provide tensile strength to the wound.
• outer appearance of an uncomplicated wound is a well healed scar

Question 12

primary intention

Answer 12

• occurs when the edges of a clean surgical incision remain close together
• wound healing is quick
• tissue loss is minimal or absent

Question 13

secondary intention

Answer 13

• wounds that are left open )not approximated) and heal from scar formation
• heal by granulation tissue formation and contraction of wound edges

Question 14

tertiary intention

Answer 14

• occurs when surgical wound are not close immediately to allow edema or infection to diminish
• wound edge are stapled or sutured together

Question 15

what are the wound classification categories

Answer 15

• underlying cause (surgical/non surgical)
• duration of inflammation (acute / chronic)
• depth of tissue involvement (superficial, partial thickness, full thickness)
• pressure ulcers (stages I, II, II, IV, unstageable)
• color (red, yellow, black)

Question 16

superficial

Question 17

partial thickness heal by

Answer 17

process of regeneration

Question 18

full thickness heal by

Answer 18

scar formation

Question 19

complications during wound healing

Answer 19

• infection
• fistula formation
• dehiscence
• evisceration (emergency)
• adhesions
• contractures
• hyper-granulation
• hemmorage
• formation of hypertophic scars and keloids

Question 20

potential causes of delayed wound healing

Answer 20

• nutrition
• inadequate blood / oxygen supply
• smoking
• corticosteroid drugs
• infection
• anemia
• advanced age
• obesity
• diabetes mellitus
• poor general health
• mechanical friction on wound
• cold temperature
• excessive moisture

Question 21

Negative Pressure Wound Therapy

Answer 21

Pulls on cells so they divide faster
- absorbs drainage
- fills dead space
- keeps moist environment

Question 22

Psychological impact of Chronic Wounds

Answer 22

• anxiety
• depression
• pain
• sleep disturbances
• negative coping behaviours
• self concept
• hygiene
• mobility issues
• ADLs
• worry about odour and drainage

Question 23

dehiscence

Question 24

care strategies for supporting the psychological effects of a wound

Answer 24

• social support and emotional disclosure
• increased social interaction
• adequate sleep
• adequate nutrition
• support with ADL’s and hygiene needs
• use appropriate dressing to absorb drainage and odour

Question 25

tertiary intention is also called

Answer 25

delayed primary intention

Question 26

how is wound healing advanced

Answer 26

debridement

Question 27

types of debridement

Answer 27

- enzymatic, mechanical, autolytic, or sharp

Question 28

enzymatic debribment

Answer 28

- topical application of enzymes such as collagenase over the necrotic tissue

Question 29

When should patients be given analgestics before a dressing change

Answer 29

30 mins prior

Question 30

chronic wounds typically result form

Answer 30

burns, pressure injuries, or leg ulcers

Question 31

chronic wounds

Answer 31

wounds that fail to move past the inflammatory phase of wound healing