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PCM Final > Concepts in Wound Care > Flashcards

Concepts in Wound Care Flashcards

1
Q

What are the steps in wound healing?

A

1) Coagulation
2) Inflammatory process
3) Epithelialization occurs in epidermis
4) New blood vessel growth
5) Collagen formation
6) Wound contraction

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2
Q

Complete bridging of the wound occurs within how many hours after suturing?

A

48 hours

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3
Q

When does new blood vessel growth peak?

A

Four days after injury

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4
Q

What is necessary to restore tensile strength to a wound?

A

Collagen

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5
Q

When does collagen formation begin?

A

48 hours after injury

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6
Q

When does collagen formation peak?

A

Within the first week

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7
Q

When does wound contraction occur?

A

3-4 days after the injury

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8
Q

What are systemic disturbances that influence wound healing?

A 
Renal insufficiency
Diabetes mellitus
Nutritional status
Obesity
Chemotherapy
Corticosteroids
Anticoagulants
Disorders of collagen synthesis
Patients of African/Asian ethnicity can be prone to hypertrophic scar formation of keloids
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9
Q

What are examples of acute wounds?

A

Lacerations
Avulsions
Skin tears
Abrasions

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10
Q

What are examples of chronic wounds?

A 
Non-healing or infected surgical or traumatic wounds
Venous ulcers
Pressure ulcers
Diabetic foot ulcers
Ischemic ulcers
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11
Q

For acute wounds what does history and PE determine?

A

Timing of wound closure
Type of closure tape
Need for consultation

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12
Q

What are the goals of acute wound treatment?

A

Avoid infection
Assist in hemostasis
Prove an esthetically pleasing scar

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13
Q

What are important historical components for acute wounds?

A 
Mechanism of injury
Location of injury
Time/age of injury
Identification of risk factors that impact healing
Tetanus immunization status
Associated symptoms
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14
Q

What is the most important PE component for acute wounds?

A

Complete neurovascular exam distal to the injury

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15
Q

What are the three options for closure of acute traumatic wounds?

A

Primary closure
Delayed primary closure
Secondary intent

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16
Q

Most wounds are closed by what?

A

Primary closure

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17
Q

What is primary closure?

A

Closed in acute phase, on the initial presentation to the provider

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18
Q

When should delayed primary closure be used?

A

Wounds that present after 24 hours and have increased risk for infection

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19
Q

What happens with delayed primary closure?

A

Wound is irrigated, cleaned, debrided, and bandaged

Repair is scheduled for a later date (4-6 days)

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20
Q

What happens in healing by second intention?

A

Wound heals spontaneously from the inside out

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21
Q

What type of wounds are reserved for healing by secondary intention?

A

Dehisced surgical wounds
Grossly contaminated wounds
Wounds presenting very late after injury

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22
Q

Why shouldn’t you clean inside of an open wound with povidone/iodine or chlorhexidine?

A

They are cytotoxic

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23
Q

How should you clean a wound?

A

Start at wound margins and clean outward towards periphery

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24
Q

Should wounds be soaked in water or other solutions?

A

No

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25
Q

What is the benefit of irrigation?

A

Decreases the amount of bacterial contamination and removes debris

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26
Q

What solutions should be used for irrigation?

A

Sterile water
Saline
Tap water

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27
Q

What is the key factor in decreasing contamination when irrigating a wound?

A

Volume of irrigant

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28
Q

How much fluid should be used to irrigate the wound?

A

250cc

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29
Q

The more contaminated the wound the more or less solution should be used to irrigate it?

A

More

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30
Q

What should you document prior to anesthesia?

A

Complete neurologic exam

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31
Q

What are common local anesthetics?

A

Lidocaine
Lidocaine with epi
Bupivacaine

32
Q

Where should you not use lidocaine with epi?

A 
Fingers
Nose
Penis
Toes
Ears
33
Q

What are options for wound approximation/closure?

A

Adhesive tapes/steri-strips
Tissue adhesives
Staples
Sutures

34
Q

When should adhesive tapes/steri-strips be used?

A

Low tension
Linear
Superficial
Areas where sutures might not hold

35
Q

When are adhesive tapes/steri-strips contraindicated?

A

High tension wounds
Wounds requiring layered closure
Wounds in high moisture areas

36
Q

What are the indications for tissue adhesives/glues?

A

Low tension
Linear
Superficial
< 4cm length

37
Q

What are the contraindications for adhesives/glues?

A

High tension wounds
Bite wounds
Contaminated wounds

38
Q

Should you apply antibiotic ointment to a tissue adhesive?

A

No (it will dissolve the glue)

39
Q

What are indications for staple use?

A

Scalp lacerations

Linear laceration on trunk or extremities where cosmesis is not a priority

40
Q

What are contraindications for staple use?

A

Gaping wounds requiring layered closure

Wounds in areas where cosmesis is high priority

41
Q

Which suture number is the biggest?

A

Zero

42
Q

What are the nonabsorbable monofilamentous sutures?

A

Ethilon

Prolene

43
Q

What are the non-absorbable multifilamentous sutures?

A

Silk

44
Q

What are examples of the absorbable sutures?

A 
Vicryl
Polysorb
Cat gut
"Chromic"
Monocril
45
Q

What size suture should you use for face?

A

5-0

6-0

46
Q

What size suture should you use for scalp?

A

4-0

5-0

47
Q

What size suture should you use for trunk?

A

4-0

48
Q

What size suture should you use for extremities?

A

3-0

4-0

49
Q

What size suture should you use for oral?

A

4-0

5-0

50
Q

When should you remove stitches from face?

A

5 days

51
Q

When should you remove stitches from scalp?

A

5 days

52
Q

When should you remove stitches from trunk?

A

7-10 days

53
Q

When should you remove stitches from extremities?

A

7-10 days

54
Q

How long should the dressing be kept on after suturing?

A

24 hours

55
Q

What should wounds closed with nonabsorbable sutures but cleaned with?

A

Mild soap and water

Half-strength peroxide

56
Q

How often should antibiotic ointment be used after suturing a wound?

A

2 times per day until suture removal

57
Q

Do you prescribe prophylactic antibiotics for patients with low risk of infection?

A

No

58
Q

For what patients should you prescribe prophylactic antibiotics?

A 
Animal/human bites
Intraoral lacerations
Open fractures
Wounds that extend into cartilage, joints, or tendons
Patients with vascular insufficiency
Patients with immunocompromised state
59
Q

What are decubitus ulcers?

A

Pressure-induced skin and soft tissue injuries

60
Q

Where do decubitus ulcers typically occur?

A

Over bony prominence

61
Q

Where are decubitus ulcers found in people who are wheelchair bound?

A

Sacral
Ischial
Trochanter

62
Q

Treatment of pressure ulcers depends on what?

A

Stage of the ulcer

63
Q

What are the stages of decubitus ulcers?

A

1) Intact skin with localized area of nonblanchable erythema
2) Partial thickness loss of skin with exposed dermis
3) Full-thickness loss of skin, in which adipose is visible and granulation tissue often present
4) Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle tendon, ligament, cartilage, or bone in the ulcer

64
Q

How are diabetic foot ulcers initially treated?

A

Broad spectrum antibiotics

65
Q

What should be considered before surgery and in between surgical debridements in diabetic foot ulcers?

A

Negative pressure wound therapy

66
Q

What causes ischemic ulcers and gangrene?

A

Lack of vascular supply (PAD, microvascular disease)

67
Q

What is the treatment for ischemic ulcers and gangrene?

A

Optimization of blood supply and surgery

68
Q

What causes venous stasis ulcers?

A

Venous hypertension secondary to chronic venous insufficiency, dysfunction of venous valves, and/or obstruction of venous outflow

69
Q

What is the treatment for venous ulceration?

A

Local wound care and compression therapy

70
Q

When is skin grafting indicated in venous stasis ulcers?

A

Inappropriate wound healing after 12 months of medical care

71
Q

What are the goals for chronic wound treatment?

A 
Reduce pain, itching, odor
Minimize infection and bleeding from wound
Deal with excessive exudate
Address psychological issues
Tissue coverage over wound
72
Q

What is the treatment for chronic wounds?

A

1) Optimization of wound bed
2) Application of dressing to the wound
3) Topical agents such as antiseptics and antimicrobial agents
4) Sharp surgical debridement of devitalized tissue
5) Negative pressure therapy
6) Delayed closure or skin grafts

73
Q

What are the wound bed requirements for optimal healing of chronic wounds?

A

Well vascularized
Free of devitalized tissue
Clear of infection
Moist

74
Q

How do wound dressings facilitate chronic wound healing?

A

Eliminating dead space
Controlling exudate
Preventing bacterial overgrowth
Ensuring proper fluid balance

75
Q

Only what chronic wound infections should be addressed with culture and antibiotic treatment?

A

“Clinically evident infections”

PCM Final (11 decks)

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