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7333 Bringman > Exam 1- Wounds 1 > Flashcards

Exam 1- Wounds 1 Flashcards

1
Q

When did PT start (2 main reasons)

A

1- Back between WWI and WWI, people started to live after wars. They would come back with injuries (lots of amputations). *start of wound care
2- Polio also hit big at this time

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2
Q

What do we call the amputated limb? not stump

A

residual limb

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3
Q

What are the four areas of wound care?

A

~General
~Amputee
~Burn
~Edema

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4
Q

What do we do for an amputee? (10)

A 
~Promote healing
~Edema management 
~Education
~Strengthening
~Stretching
~Gait training
~Exercise
~Transfer training
~Wheel chair training
~Bed mobility training
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5
Q

Why is edema management important in an amputee?

A

~edema can from the inflammation

~you will need to keep the edema down in order to shape the limb (to be able to fit it into a prosthetics)

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6
Q

Why is stretching so important?

A

the muscles have been cut. you need to stretch so that the limb does not get stuck in a flexed position.

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7
Q

Ways to classify a general wound

A

~traumatic/ atraumatic
~open/closed
~cause of the wound
~type of the wound

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8
Q

What are the different types of wounds? (6ish)

A 
~Pressure ulcer/ Decubiti
~Surgical (acute)
~Diabetic 
~Arterial
~Venous
~Chronic* almost any of these could be  chronic wound
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9
Q

What will you want to do with a burn wound?

A

~Clean it until there is no dead/ injured tissue
~Stretch (position) since the scar will shink
~Wolff’s law applies
~Can use garments
~Scar management is very important here!
~Mobility
~Grafts in come burns

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10
Q

What are the general layers (outer to bone)

A 
~epidermis
~dermis
~subcutaneous fat
~fascia
~muscle/ tendon/ ligament
~bone
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11
Q

What happens if you lose layers in a wound?

A

It doesn’t come back the same! If you loose a muscle, you DONT have muscle anymore! You muscle be careful when cleaning out a wound so that you do not take out anything important because it will not be able to be replaced.
*at a high risk over boney prominences

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12
Q

What is the only system that the health care system will be at fault for if it fails?

A

integumentary system
~always is the health care’s fault when this systems fails if the pt comes in with no problems as gets a problem in our care
~very black and white even if there should be some gray

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13
Q

Why might the integumentary system fail, even when the health care system does every thing correctly?

A

If the pt does not get enough protein, then the pt does not have enough amino acids to heal the skin
*(pt’s skin also needs air and water)

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14
Q

What is the integumentary system so important?

A

~Protect!
~Dry up/ shiver up; we would loss all of our moisture (we are 70% water)
~temperature regulation
~increase blood pressure/ heart rate

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15
Q

What does the integumentary system protect us from?

A

from infection, worm, mild, virus, magnets, etc (keeps things out)

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16
Q

Why is temperature regulation important regarding wounds?

A

A wound can drop your temperature. It doesn’t take that big of a wound to drop your body temperature (especially if it is a wet/weepy wound)

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17
Q

Why does heart rate and blood pressure increase?

A

There is a decrease in fluid in the blood. This leads to a thickening of the blood. This leads to a higher blood pressure

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18
Q

What are the 3 phases of healing?

A

~inflammation
~proliferation
~maturation

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19
Q

What are 5 cardinal signs of inflammation?

A 
~swelling
~redness
~warmth
~pain
~loss of function

**redness and swelling are usually uniform; if they aren’t, it can be a sign of infection. the redness and swelling will follow the venous system proximally.

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20
Q

What can you do to assess for the 5 cardinal signs of inflammation?

A 
~S- edema; measure it
~R- look at the wound; has the redness changed
~W- take their temperature
~P-ask their pain levels
~LoF- any change in function
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21
Q

What should be do at the very beginning when you get a wound/ very beginning of inflammation phase?

A

~Stop the bleeding!
~apply pressure, add bandgaes
~NEVER take off the bandage during this phase; keep adding gauze
~elevate the limb if possible
~apply pressure higher up the limb to slow the bleeding (you don’t have to go all the way to the aorta :p)

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22
Q

Do you always have to look at a surgical wound at eval?

A 
YES
*make sure to look at the wound when you first see them (at initial eval) so that if you look at the wound at a different time, you will have documentation to compare it to
~how is the inflammation
~where are the wounds
~what are the size of the wounds, etc
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23
Q

What can be found in the wound (from our body)

A

~platelets and fibrin

~Macrophages and neutrophils clean up the wound

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24
Q

Should you use H2O2?

A

Not all the time!
~this is cytotoxic and will eat away you cells *restart the inflammation process
~once may be fine, but if you leave it on too long or use it too many time, it will eat away your skin

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25
Q

What’s the normal time frame for the inflammation phase?

A

1-10 days

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26
Q

What will dictate how long the inflammation phase will last?

A

~size of the wound
~health of the patient
~the environment of the wound
~ location of the wound

27
Q

When do you normally have a chronic wound?

A

a chronic wound can get stuck in any one of the healing stages

28
Q

What are the three things that a wound needs?

A

~environment
~blood flow
~available nutrients

29
Q

What is introduced to the wound to help get us to the proliferation phase?

A

growth factors will come during the inflammation phase to help get us to the proliferation phase

30
Q

What happens during the proliferation phase?

A

~will fill in the wound with new tissue; make granulation tissue
~need angiogenesis (new blood vessels)
~fibroblasts- make new collage
~reepithialization

31
Q

why are we at a higher risk of reinjury over a healed wound?

A

~the tissue is not the same over the healed wound

~the tensile strength is much less over the new skin

32
Q

How long does the proliferation phase last?

A

3- 20/21 days

33
Q

Wound like to be …..

A

MOIST!!!

not wert, not dry,… MOIST

34
Q

reepithialization is

A

epithelial migration
~skin formation; stops growing when skin means skin
*hopefully we don’t close in infection

35
Q

What is the name for rolled edges?

A

epibole
~when the skin wraps back onto itself bc it took too long to heal
~have to start back over/ cut the skin or else the skin will think that it is done healing

36
Q

How long does the maturation phase last?

A

can last weeks, months, years

37
Q

What is the range for tensile strengthen once the skin has healed?

A

15-80%

*don’t do cross friction massage when the tensile strength is too low; can break back open; but if the scar starts to get too tight, it can affect your ROM

38
Q

How do scars change color?

A

red to pink to natural skin color

39
Q

What can you loss the wound is deep enough?

A

~muscle/ strength/ movement
~nerves (no feeling)
~no hair
~Salivous glands (no oil); will need to add moisture to the skin

40
Q

what is granulation tissue?

A

~what you want growing in the wound! PROTECT THIS!

~looks like red, little domes

41
Q

What is eschar?

A

~looks black, leathery, tough, dry
~this will form because we cannot heal out wound
~looks like a deep scar
~we usually want to get rid of eschar (we only don’t on the heel)

42
Q

What is slough?

A

~white, yellow (maybe greenish if it is infected), stringy, thick mucous-like
~healing will not happen underneath this, so we want to get rid of slough so that we can heal the wound

43
Q

What is the tissue called when there is too much water around the edges of the wound?

A

Macerated

44
Q

What is the tissue called when it is dried out

A

Desiccated

~eschar is desiccated; when skin is desiccated, it can crack and infection is more likely to get in

45
Q

Why do wounds like to be moist? (10)

A

TO HEAL :)
~get nutrients
~aids in blood flow/ oxygen diffusion (allows gaseous exchange)
~prevents/ softens eschar
~lowers the risk of infection
~decreases contraction
~temperature regulation is better
~less painful (easier to take off the bandage, less contractions)
~scar will have better cosmesis
~epithialization will happen twice as fast
~moist will not desiccate or macerate the wound

46
Q

what is cosmesis?

A

presentation, restoring, or enhancing bodily beauty

47
Q

What are the different types to clean up/ get rid of necrotic tissue? (5 categories)

A 
~biological
~sharp
~mechanical
~enzymatic
~autolysis
48
Q

What is the main thing used in biological debridement?

A

Maggots!

~maggots are only going to eat dead tissue

49
Q

Is biological selective or non selective?

A

selective

it will only take out the bad stuff (not any of the good tissue)

50
Q

What is used in sharp debridement?

A

Scalpels

~scalpels will be used by physicians most of the time; don’t just start cutting away at the wound because once it gets cut away, it will not grow back

51
Q

Is sharp debridement selective or nonselective?

A

depends

If a physician is cutting, it will more likely be non selective bc they will just start cutting and will probably cut some good tissue too
If we do, it will be more selective because we can control what we cut.

52
Q

What is normally used during mechanical debridement?

A

~whirl pool
~pulse lavage
~forceps and wet gauze

53
Q

Details about whirl pool

A

~ the force of water will get rid of the dead tissue
~make sure not to leave in water too long- will macerate the tissue
~don’t leave a venous wound in for too long- want to have legs elevated; will have problems when the legs are in the dependent position for too long
~for an arterial wound, can affect the body temperature
~can cause infections on steroids bc the whirl pool will never really get completely clean; also can get the infection air borne

54
Q

Details about pulse lavage

A

~ will only hit the wound
~risk of making the infection air borne lower
~this is much faster and cleaner than a whirl pool

55
Q

Is whirl pool specific or non specific?

A

non specific

56
Q

Is pulse lavage specific or non specific?

A

More specific

57
Q

Details about forceps and wet gauze

A

~can wipe up with the wet gauze
~if the gauze wont get it off, cause use forceps to pull it off
~can do a cross hatch on the eschar and put wet gauze on top; next day you will be able to take off a little more

58
Q

Are forceps and wet gauze specific or nonspecific?

A

specific

~we decide what to take off
don’t take off too much!

59
Q

Is enzymatic selective or nonselective?

A

depends on the med

60
Q

Describes about enzymatic debridement

A

~enzyme debrider- help to stimulate granulation tissue growth, can break down eschar, can break down slough, or can do all three (which enhances healing)
~have to be careful how much you use because it is VERY expensive
~have to put it onto a wet qtip to put it onto the wound (use a new qtip each time)

61
Q

Is autolysis debridement selective or non selective?

A

selective

62
Q

Details on autolysis debridement

A

~the body does this- autoimmune
~our body/ macrophages are eating the bad stuff
~occlusive bandage

63
Q

Occlusive bandages

A

~a thin, clear film over the wound
~allows gas exchange
~adheres to the wound
~the fluid will go from a thin, clear fluid to a thick brown fluid
~should create beautiful graduated tissue after the fluid is removed
~will sometimes leave on from 5-7 days

7333 Bringman (23 decks)

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