Chapter 35 Flashcards

Wound Care

1
Q

constrict

A

to narrow

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2
Q

dilate

A

to expand

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3
Q

skin tear

A
  • break / rip of outer skin layer
  • tearing top layer skin from lower tissue
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4
Q

ulcer

A

shallow / deep crater sore of skin / mucous membrane

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5
Q

wound

A

break in skin / mucous membrane; portal of entry

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6
Q

wounds are commonly from ?

A
  • surgery
  • trauma
  • constant pressure / friction
  • shearing
  • nerve damage
  • decreased blood flow
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7
Q

circulatory ulcers include ?

A
  • venous ulcers
  • arterial ulcers
  • diabetic foot ulcers
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8
Q

ischemic

A

reduced blood flow to body part

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9
Q

stasis

A

stopped / slowed fluid flow

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10
Q

venous ulcers

A

open stasis sores of lower legs / feet due to poor venous blood flow
- usually heels, inner ankles
- dull-aching pain

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11
Q

arterial ulcers

A

open ischemic wounds of lower leg / feet due to poor arterial blood flow
- usually between / top of toes, outside ankles
- extreme pain

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12
Q

diabetic foot ulcers

A

open wounds on foot due to diabetes complications
- lose sensation in feet

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13
Q

common foot problems of diabetic person ?

A
  • corns
  • blisters
  • ingrown / fungal toenail
  • bunions
  • plantar warts
  • hammer toe
  • dry / cracked skin
  • athletes foot
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14
Q

elastic stockings

A

put pressure on veins to promote venous blood flow; help prevent thrombi
- compression stockings
- anti - embolism stockings

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15
Q

thrombus

A

blood clots in leg veins

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16
Q

embolus

A

blood clot that travels

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17
Q

pulmonary embolism

A

embolus that is lodged in the lungs

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18
Q

persons at risk for thrombi ?

A
  • heart / circulatory / lymphatic disorders
  • bed rest
  • older
  • pregnant
  • had surgery
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19
Q

anti embolism / thrombo embolic deterrent (AE stockings / TED hose)

A
  • prevent blood clot formation
  • common after surgery
  • not long term use
20
Q

compression socks

A
  • improve blood flow
  • prevent leg swelling
  • long term use
21
Q

how to wash elastic stockings

A

wash 1 pair while other is being worn
- hand wash w/ mild soap
- hang to dry

22
Q

how should elastic stockings be worn ?

A
  • toe opening is either on top / bottom of toe
  • no twists / creases / wrinkles
23
Q

when should elastic stockings be worn / taken off ?

A
  • applied before getting out of bed (dry legs)
  • taken off when in bed
24
Q

how should stockings be applied

A

turned inside out then rolled back / pulled back properly up the leg

25
elastic bandages
same purpose as elastic stockings; provide support / reduce swelling of injuries
26
applying elastic bandages ?
apply firmly / evenly starting from distal to proximal end of extremity (furthest to closest) - loose end of bandage is the bottom - expose toes / fingers if possible - wrap around twice for first / last spiral - spirals should cover 1/2 - 3/4 of previous spiral - each spiral is equal
27
when should elastic bandages be changed ?
if moist / soiled; only reapplied if loose
28
wound dressing functions ?
- protect wound - absorb drainage - remove dead tissue - provide comfort / pressure - cover unsightly wounds - moist environment for healing
29
common types of materials to secure dressing ?
- paper - plastic - cloth - elastic tape - adhesive; less common due to more complications (irritation, skin tears, etc.)
30
three methods of securing dressings ?
depends on dressing / wound - tape top, middle, bottom - tape edges - tape entire dressing
31
how should taping never be secured ?
fully circling body part w/ tape; can lead to impaired circulation
32
montgomery straps
used for large wounds / persons w/ frequent dressing changes - one end tape other has cloth ties
33
how are montgomery straps applied ?
1) clean away from wound each side; starting with one side going to the next 2) clean top to bottom of wound; starting from center of wound outward each side 3) apply to each side of dressing 3) tie cloth straps together over dressing
34
binders
wide bands of elastic fabric; support wounds / hold dressing in place
35
abdominal binders
provide abdominal support / hold dressing in place - top part at waist - lower part over hips - secured w/ velcro / hook and loop
36
breast binder
provide breast support after surgery - secured w/ velcro / padded zippers
37
compression garments
garments of tight stretchy fabric common after plastic surgery - reduce swelling - keep skin against body - prevent fluid buildup - achieve desired shape
38
heat applications help what problems ?
musculoskeletal injuries / problems - relieve pain / swelling - relax muscle - promote healing - decrease stiffness dilates area; constricts after too long
39
heat is never applied to what ?
- implant areas (peacemakers, joint replacements) - pregnant women's abdomen (can affect fetal growth)
40
cold applications help what problems ?
treat sprains / fractures - reduce pain - prevent swelling - decrease circulation / bleeding (constricts arteries / veins) constricts; after too long dilates
41
moist application
water contact w/ skin - moist heat = lower temps. - dry heat = higher temps.
42
dry application
no water contact w/ skin
43
hot temp
99°-106°F
44
warm temp
93°-98°F
45
tepid temp
80°-92°F
46
cool temp
65°-79°F
47
cold temp
50°-64°F