CI Flashcards
What are the three phases of healing?
inflammation, proliferation, maturation/remodeling
What is the hallmark of the inflammatory phase of healing?
controlling bleeding and fighting infection
What are the cardinal signs of inflammation?
pain, redness, warmth, edema, decreased function
Key cells in the inflammatory phase
PMN, platelets, macrophages, mast cells
What are the 3 keys of the proliferative phase?
angiogenesis, granulation tissue, wound contraction
What are the key cells of the proliferation phase?
angioblasts, fibroblasts, myofibroblasts, keratinocytes
How does tissue change in the remodeling phase?
Type 1 Collagen to Type 3 Collagen
When does greatest tissue change in the remodeling phase?
First 6-12 months
What are permanent tissue changes from a wound?
decreased sensation, 80% strength, loss of sweating ability
What is the best temperature for wound healing?
37-38 deg C
What co-morbidities can affect wound healing?
PVD, anemia, COPD, cardiac, HIV/AIDS, diabetes
What medications can delay healing
steroids, chemotherapy, NSAIDS
What behavioral factors decrease wound healing?
EtOH, smoking
T/F - it is good to use antiseptics for a prolonged time
F
What is primary intention?
Closure w/ stitches/staples
What is secondary intention?
Closure of the wound by itself
What is delayed primary intention?
Wait for a period of time, then close w/ stitches
What does DIME stand for?
Debridement, inflammation/infection control, moisture balance, edge effect
Name: viable tissue, 2 types of necrotic tissue
granulation tissue, slough, eschar
Sinus tract
a wound entrance w/ no exit
What is a wound tunnel
entrance + exit
fancy names for rolled or callused wound edges
epibole, hyperkeratosis
What does maceration mean
skin pruning - too much moisture
What are hallmarks of a chronic wound?
Low mitotic activity, increased inflammatory cytokines, high levels of proteases, persistence in time
General tips for venous, pressure, neuropathic, and arterial wounds
compress, offload, offload, protect and re-perfuse /restore blood flow
Characteristics of adequate perfusion (6)
- 80 mmHg in foot (feel pulse)
- ABI 0.6<x<1.2 (don’t believe above 1.2)
- audible triphasic or biphasic sounds with doppler
- venous filling time assessment 5-15 seconds
- Rubor of dependency (pallor >25 sec, refill less than 30 seconds)
What are the 4 types of precautions
contact, bloodborne, airborne, droplet - take a minute and mentally think of an example
(MRSA, HIV, COVID, a cold)
Clean technique v. sterile technique
clean technique is the standard in wound care
Contraindications for debridement (5)
Diabetic feet, dry gangrene, skin grafts, surgical incisions, actively bleeding wounds.
What is the safe PSI range for wound irrigation?
4-15 PSI
What are some cons of pulse lavage w/ suction (2)
expense, aerosolization risk
What are the options for irrigation methods? (4)
Low pressure, whirlpool, PLWS, ultrasonic mist
Contraindications to debridement
dry stable eschar, deeper wounds, electrical burns, viable/granular tissue
General rules w/ debriding blisters
clear = keep it
bloody/cloudy = remove
frostbite = keep
What is a caution with gauze?
It is drying
what is a caution with impregnated gauze?
maceration
What does a film dressing promote?
autolytic debridement
When should we not use a film dressing?
skin tears
What is the primary function of a hydrogel
promotion of moisture
When should we not use a hydrogel sheet?
over an infection
What form of debridement does foam promote?
autolytic
What types of wounds should we avoid using a hydrocolloid?
Deeper wounds
3 reasons for using antimicrobials
high infection risk, critical colonization, active infection
3 types of antimicrobials
honey, silver, codexamer iodine
what should codemader iodine never be combined with
collaginase
what can high BUN do?
impair healing, increase edema, yellow skin
what is an elevated INR value?
greater than 3.6
what is normal capillary refill time
less than 3 seconds
What are the possible results, normal and abnormal, for the rubor of dependency tests?
normal (no pallor)
mild/mod (45-60; 30 sec)
severe (less than 25 sec)
what is normal venous filling time in the test?
5-15 seconds; greater than 20 seconds indicates arterial disease
Examples of poor candidates for ABI:
non compressible vessels, diabetes, obesity, renal insufficiency, poor cardiac output,
Key characteristics of arterial wounds
dry, below ankle on met heads/tips of toes, punched out appearance
What do we do with gangrene?
Refer for wet, wait for dry
T/F we should debride with arterial insufficiency
F
guidance with ace wrapping
start low, go slow
Characteristics of VI wounds
distal 1/3 of lower leg, more common medially, lots of drainage, staining, champagne bottle leg, uneven edges
T/F VI wounds are painful
F - usually VI wounds are not painful
State LaPlace’s Law
compression = tension x # layers x 4630 / (limb girth circumference x bandage width)
What are the risks for getting a neuropathic foot ulcer? (8)
- DM
- Impaired healing
- Vascular disease
- Tri-neuropathy
5.Mechanical stress - Impaired ROM
- Foot deformities
- Previous ulcer or amputation
If more than 1 monofilament test is gone, what does it mean
a loss of protective sensation
Characteristics of a neuropathic foot ulcer (7)
bottom of foot, punched out, pain free, deep, callus, not much drainage (usually no eschar), red granulation, tracts&tunnels
State the wagner neuropathic grading scale!
Wagner Grading Scale
0‐ No open lesions, may have deformity or cellulitis
1‐ Superficial Ulcer
2‐ Deep Ulcer to tendon, capsule, or bone
3‐ Deep Ulcer with abscess, osteomyelitis, or joint sepsis
4‐ Localized gangrene
5‐ Gangrene of entire foot
Who is at risk for a pressure injury (3)?
SCI, long term care patients, hospitalized patients
supine: locations of pressure injuries
occiput, scapula, medial humeral epicondyle, spinous processes, sacrum, lower heel
Prone: locations of pressure injuries
anterior tibia, anterior knee, iliac crest
side lying locations of pressure injuries
ear, lateral humeral epicondyle, greater trochanter, medial and lateral femoral condyles, malleolus
seated locations of pressure injuries
sacrum, coccyx, ischial tuberosities, greater trochanter
Characteristics of a stage 1 pressure injury
non blanchable erythema (localized, over bone, hard to see on pigmented skin)
Characteristics of a stage 2 pressure injury
partial thickness skin loss with exposed epidermis (red/pink, no slough or granulation tissue, moist, NOT a skin tear, dermatitis, or maceration)
Characteristics of a stage 3 pressure injury
Full thickness skin loss (adipose, slough, and eschar are present, undermining, tracts, tunnels, and epiboly are possible)
Characteristics of a stage 4 pressure injury:
full thickness skin and tissue loss, exposed named structures, slough and eschar, epibole, undermining, tracts, and tunnels are common)
Characteristics of an unstageable pressure injury
covered by slough/eschar and depth cannot be determined (mucosal membrane pressure injuries also cannot be staged)
When are stitches/staples usually removed?
Days 10-14
T/F absence of a healing ridge is bad
T
What type of dressing can be used for scar management?
silicon
What is the main risk of complications with a bite wound?
infection
What are keys to diabetic foot care?
offload, total contact cast, footwear (larger and wider toe box, rocker sole, custom insole, runner’s tie)
At what angle is hallux valgus significant?
greater than 20 degrees
What is the technical name for dry skin?
xerosis
How does ESTIM for wound healing work?
- Attracts cells to area (- = neutrophils, macrophages, mast cells, + = fibroblasts, epidermal cells, some neutrophils)
- It works well
- Cleanse heavy metal dressings first!
Contraindications for ESTIM
near a natural heart pacemakers, over an artificial pacemaker, over malignancy
T/F further apart electrodes go deeper
T
What band of UV light is most used in wound care?
UV C
How does laser therapy work?
Influences the mitochondria to produce ATP
contraindications of pneumatic compression pumps
acute DVT, phlebitis, untreated cellulitis
Should you use a standard compression pump with a lymphedema patient?
No, the lymphatic system is very fragile.
When should we not use NPWT?
When the wound is more than 30% necrotic tissue.
At what pressure does optimal granulation tissue form in NPWT?
125 mm Hg
Say the pitting edema scale!
1+ (2mm or less and disappears immediately)
2+ (2-4 mm few second rebound)
3+ (4-6 mm 10-12 second rebound)
4+ (6-8mm greater than 20 second rebound)
What is phlebo-lymphedema?
Combined venous insufficiency and lymphedema
What can improve when lymphedema is solved?
5-10 degrees of motion, pain, gait, sleep, psychological status
what is the difference between edema and lymphedema?
edema = general swelling
lymphedema = swelling b/c of an impaired lymphatic system
What does glyco-calyx theory state?
the lymphatic system is responsible for returning all of the lymph fluid back to the vascular system
What is transport capacity?
the total amount of fluid that can be moved
what is dynamic overload?
when too much fluid is being transported by the lymphatic system (above transport capacity)
what is mechanical insufficiency?
a decreased transport volume in the lymphatic system
What kind of lymphedema patient am I able to treat?
- new VI based edema
- mild presentation
- no cancer history
- no swelling prior to surgery or injury
- distal to knee or elbow
- good pedal pulse
- duration less than 1 month
What are the properties of a good wrap?
Low resting pressure, high working pressure
How many hours should a lymphedema garment be worn?
23-24 hrs per day (especially with exercise)
