Chapter 13: Med Surg Flashcards
regeneration
replacement of lost cells and tissues with cells of the same type
repair
healing as a result of lost cells being replaced by connective tissue
epithelial regenerative ability
skin, blood vessels, mucous membrane; readily regenerate
connective tissue regenerative ability
bone active tissue regenerates, cartilage regeneration possible but slow, tendons and ligaments regeneration possible but slow, blood cells actively regenerate
muscle regenerative ability
smooth regeneration possible mostly in GI tract, cardiac muscle is replaced by connective tissue, skeletal muscle some regeneration in moderately damaged muscle, but mostly connective tissue replaces severely damaged
nerve regenerative ability
neuronal is nonmitotic aka irreversibly damaged, glial the cells regenerate and scar tissue replaces
what type of cells regenerate constantly?
labile cells (skin, lymphoid, bone marrow, and mucous membranes)
what type of cells only regenerate if damaged?
stable cells (liver, pancreas, kidney, bone cells)
what type of cells do not regenerate?
CNS and skeletal and cells muscle
primary intention
healing takes place where wound margins are neatly approximated (e.g. surgical incision or paper cut)
initial phase
lasts for 3-5 days, incision fills with blood to form clots and begin healing process, macrophages ingest and digest debris and fragments to begin capillary growth
granulation phase
5 days-4 weeks, fibroblasts migrate, secrete collagen, the wound is pink, vascular, and red granules are present, wound begins to resemble adjacent skin
maturation phase and scar contraction
7 days to several months, overlaps granulation phase, fibroblasts disappear as the wound becomes stronger, myofibroblasts help to cause contraction and close the wound, may be painful
secondary intention
wounds that occur from trauma, ulceration, and infection have large amounts of exudate and wide irregular wound margins, healing and granulation take place from the edges inward and from the bottom upward and there is more granulation tissue, so the scar is bigger
tertiary intention
delayed primary healing, wound may be left open and sutured closed after the infection is controlled, resulting in a larger and deeper scar
what classifies a wound as chronic?
does not heal within 3 months
red wound
superficial or deep, clean and pink, possible serosanguineous
examples of red wounds
skin tears, stage 2 pressure ulcers, partial thickness loss, second degree burns, wounds that heal by secondary intention
red wound dressings
transparent dressing, hydrocolloid, gauze, gentle atraumatic cleansing permeable to oxygen
yellow wound
prescence of slough or soft necrotic tissue, creamy ivory to yellow-green
examples of yellow wounds
wounds with nonviable necrotic tissue
yellow wound dressings
absorptive dressing, hydrocolloidal dressing, hydrogel, wound irrigations, moist gauze, wound cleansing to remove nonviable tissue and absorb excess drainage, left in place for up to 7 days
black wound
black, gray, or brown, eschar, risk of wound infection high
examples of black wounds
full thickness loss, third degree burns, stage 3 and 4 pressure ulcers, gangrenous ulcers
black wound dressings
topical debridement, hydrogel, absorptive dressing, debridement of eschar and nonviable tissue
lack of Vitamin C effects the wound by
delays collagen production for fiber and capillary development
lack of protein effects the wound by
decreases amino acids for tissue repair
lack of zinc effects the wound by
impairs epithelialization
inadequate blood supply effects the wound by
decreases supply of nutrients to the effected area, decreases removal of nonviable tissue, inhibits inflammatory response necessary in the initial stage
corticosteroid drugs effect the wound by
impair phagocytosis of WBCs, inhibit fibroblasts, depress granulation tissue, and inhibit wound contraction necessary for the last stage of healing
infection effects the wound by
increases the inflammatory response too much and tissue destruction
smoking effects the wound by
impedes blood flow to healing area
obesity effects the wound by
decreasing blood supply in fatty tissue
diabetes effects the wound by
decreasing collagen synthesis, retards capillary growth, impairs phagocytosis (resulting from hyperglycemia), reduces supply of O2
anemia effects the wound by
supplies less oxygen at tissue level
adhesion
bands of scar tissue that form between or around organs in the abdominal cavity or between the lungs and pleura
contractures
normal part of healing, but complications occur when it is excessive; shortening of muscle or scar tissue results from excessive fibrous tissue formation
evisceration
wound edges separate to the extent that intestines protrude through wound
dehiscence
separation of previously joined wound edges
excess granulation tissue
“proud flesh”, if it is cauterized or cut off, normal healing continues
fistula formation
abnormal passage between organs or a hollow organ and skin
hemorrhage
abnormal internal or external blood loss
hypertrophic scar
occur when an overabundance of collagen is produced at healing site, raised red and hard scar that is not life threatening
keloid formation
great protrusion of scar tissue that extends beyond wound edges and may form tumorlike masses
tunneling
when a cotton applicator is placed in wound there is movement
undermining
when a cotton applicator is placed in wound there is a “lip” around the wound
fibrin sealant
used independently to seal wound sites where sutures cannot control bleedings or would aggravate bleeding
when should antimicrobials and antibactericidals not be used?
on granulating tissue e.g. types of these solutions: iodine, Dakin’s solution, hydrogen peroxide, chlorhexide
wounds that are suitable for negative pressure:
acute or traumatic, surgical wounds that have dehisced, pressure ulcers, and chronic ulcers
why use negative pressure on wounds?
pulls fluid from wound, reduces bacterial load, encourages blood flow to wound
what to watch for with negative pressure?
monitor serum protein levels and f&e due to losses from the wound, watch coagulation as well (platelets, prothrombin time PT, partial thromboplastin time PTT)
gauze
provides absorption of exudates and supports debridement
nonadherent dressing
minimally absorbent, used on minor wounds or as a second dressing e.g. xeroform, Vaseline gauze
transparent film
semipermeable, permits gaseous exchange between wound and environment, used for dry noninfected wounds e.g. opsite, tegaderm, bioculsive
hydrocolloid
wafers, powders, or pastes composed of gelatin, pectin, or carboxymethylcellulose, does not allow oxygen, supports debridement and prevents secondary infections, used for superficial or partial thickness loss e,g, duoderm
foam
polymer solution, moderate to heavy amounts of exudate can be absorbed, nonadhesive, partial or full thickness loss e.g. polyderm, curafoam
absorptive dressings
large volumes of exudate absorbed, maintains a moist wound surface, partial or full thickness loss e.g. ABD pads
hydrogel
gives moisture, debrides, partial or full thickness loss, minimal drainage e.g. intrasite, woun’dres
alginates
nonwoven, nonadhesive, derived from seaweed, forms a moist gel when in contact with exudate, e.g. seasorb, algisite
antimicrobials
iodine, silver, bacteria are not able to develop resistance, partial or full thickness loss e.g. biopatch, acticoat
hyperbaric oxygen therapy
delivery of oxygen at increased atmospheric pressures, which allows oxygen to diffuse into the serum rather than RBCs and transported to tissues and move past narrowed arteries and capillaries that RBCs cannot go
autolytic debridement
semiocclusive or occlusive dressings that soften dry eschar
enzymatic debridement
drugs applied topically to dissolve necrotic tissue and then covered with moist dressing, process can be slow and dried eschar can be removed with scalpel
Regranex
platelet derived growth factor gel that accelerates healing and should only be used if wound is free of devitalized tissue and infection; do not use with cancer patients
adequate protein needed for
correcting the negative nitrogen balance resulting from the increased metabolic rate and synthesis of immune factors
adequate carbs needed for
increased metabolic energy needed for inflammation and healing
adequate vitamin C needed for
capillary synthesis and collagen production
adequate vitamin A needed for
epithelialization
Z-technique
rotating a culture swan over a cleansed wound bed surface in a 10-point Z track fashion
Levine’s technique
rotating a culture swab over a cleansed 1 cm area near the center of the wound using sufficient pressure to extract wound fluid from deep tissue layers
what to know about swabs
do not take the specimen from exudate of eschar and do not use cotton tipped swabs
what intention do pressure ulcers fall under?
second intention
shearing force
pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement
slough
yellow, tan, gray, green, brown
eschar
tan, brown, black
stable eschar
on the heels and serves as the bodys natural biologic cover and should not be removed
suspected deep tissue injury
purple or maroon localized area of discolored intact skin
stage 1 pressure ulcer
intact skin and nonblanchable redness
stage 2 pressure ulcer
partial thickness loss of dermis with a shallow open ulcer and red/pink wound bed, shiny; NO SLOUGH OR ESCHAR
stage 3 pressure ulcer
full thickness loss, subq may be visible, but no bone or muscle, slough may be present but does not obscure the depth of tissue loss; may have undermining and tunneling
stage 4 pressure ulcer
full thickness loss with exposed bone, tendon, or muscle and often include undermining and tunneling
unstageable ulcer
full thickness loss in which the base of the ulcer is covered by slough or eschar; REMOVE
how often do you reassess an acute care patient for risk of pressure ulcers?
every 24 hours
how often do you reassess a long term care patient for risk of pressure ulcers?
weekly for the first 4 weeks after admission and then at least monthly or quarterly
how often do you reassess a home care patient for risk of pressure ulcers?
every visit
how to assess a dark skin patient for pressure ulcers
look for changes of color such as purple or blue skin, use a natural or halogen light, feel the skin for heat and the consistency (boggy or edematous may indicate stage 1 pressure ulcer)
what irrigation pressure is used on pressure ulcers?
4-15 psi
what syringe and gauge are needed for correct irrigation pressure?
30 mL, 19 gauge
do you want to keep the pressure ulcer moist, wet, or dry?
moist to enhance re-epithelialization
