Exam 1- Wounds 3 and Wounds part of 4

Question 1

Quiz question: three things that need to be present for a wound to heal

Answer 1

~blood flow
~environment (moist)
~nutrition

Question 2

Quiz question: compare and contrast arterial and venous wound

Answer 2

~Arterial- deep, pale, dry, lateral, more likely to be painful, less common
~Venous- shallow, reddish, weepy, medial, less likely to be painful, more common (by 4x)

Question 3

Quiz question: three types of debridement that are selective (vs nonselective)

Answer 3

(Selective- This is only going to get rid of the stuff that we want it to get rid of and Non selective- this will get rid of everything)
~Maggots (get only the dead tissue)
~Pulse lavage- only if the stuff under the pulse lavage is dead tissue; if the stuff under is also good tissue, it could also take away good tissue (Whirl pool- Non selective)
~Enzymatic- some would be selective and some non-selective
~Forceps/ wet gauze/ scalpel (mechanical)- can be selective depending on how you apply them (If a physician does it, it is more likely to be non-selective)
~Autolytic- your body should be completely selective unless something is going wrong

Question 4

Quiz question: three points of education that you would want to give to a patient with a diabetic ulcer

Answer 4

~Wound positioning
~What’s your sugars; how often do you check it (80-120); when’s the last time you went to the doctor? Etc.
~Don’t go to nail salon; soak feet
~Don’t remove calluses
~Foot check
~Don’t wear compressions garments/ tight shoes/ shoes
~Proper shoes

Question 5

What do you do before examining the wound?

Answer 5

Take vitals!

~you will have a baseline and comparison

Question 6

What else will you do beside look at the wound?

Answer 6

~look at the whole person
~if they can walk, have them walk/ get them up
~do a gross motor screen
~sensory screen
~you have the same subj and obj
~see if they are active, if they smoke, etc

Question 7

Wound: what are ways to record the size of a wound?

Answer 7

~Can draw it/ sketch a picture of it
~Take a picture of a wound
~trace the wound

Question 8

Wound: what details of the size of the wound will you record?

Answer 8

~width, depth, length
~shape (is applicable)
~if there is undermining/ tunneling

Question 9

Wound: what are details that you want to record about the wound? (8)

Answer 9

~size
~direction of where the wound is located
~color
~temperature
~anthropometric
~smell
~wound bed (wet/dry/ moist)
~is there neurotic tissue?

Question 10

Periwound: what are details that you would want to record about the periwound? (3)

Answer 10

~turgor (firm, squishy, bogey, etc)
~regular/ irregular
~macerated/ desiccated

Question 11

What do you look at during an examination of the wound? (5)

Answer 11

~the wound (wound bed)
~the periwound
~drainage
~pain
~removal of dressing

Question 12

Details about the exam of drainage

Answer 12

~exude?
~transudate?
~the amount of the drainage

Question 13

Exude

Answer 13

~thick
~opaque
~infection

Question 14

Transudate

Answer 14

~thin

~transparent

Question 15

Details about the exam of pain

Answer 15

~before and after the dressing and after the cleaning of the wound
~you want to asses when it is the most painful and are you causing pain

Question 16

Detail about the exam of removal of dressing

Answer 16

~How well did the dressing come off
~Did any not come off
~Was the dressing Wet/dry when it came off; (will you have to apply moisture if it is dry)
~Need to record everything so that the next person will know what to expect when they come in next time

Question 17

What do you do with a black, dry heel?

Answer 17

~Don’t do anything
~the heel is there for protection
~if you open it up, you can let in an infection

Question 18

Are all wounds infected?

Answer 18

No

Question 19

Are all wounds contaminated?

Answer 19

Yes

~it takes until 10^5 MRSE/VRE to became infected

Question 20

what are signs of an infected wound? (6)

Answer 20

~changes in the wound: amount of drainage, color, odor
~periwound- irregular (can hit a vein)
~painful
~tender
~may not be able to walk easily 
~temperature changes/ fever

Question 21

Wound closure

Answer 21

~primary closure
~secondary closure
~tertiary closure

Question 22

What is a primary closure? (3)

Answer 22

~When a physician closes a wound
~Staples, stitches, skin flap/ grafts, glue
~Dehiscence- breaks open/ can pop open (too much movement, infection); need to heal secondary then (Happened a lot with total knees, amputations, etc)

Question 23

What is a secondary closure?

Answer 23

~mother nature/ when your body heals you on its own

~most happens this way

Question 24

What is a tertiary closure?

Answer 24

~you body heals it on its own for a while and then a physician closed it up
~can’t close up after too long bc of infection
~happens with burns- grafts

Question 25

What is a primary dressing?

Answer 25

inside the wound; fills the wound and makes it look like the anatomy (never dip)

Question 26

What is a secondary dressing?

Answer 26

on top of the primary dressing; will be dry

Question 27

Details on gauze

Answer 27

~A woven material that can fit into any shape ~Can fit in any shape, squared, round, etc ~Folded, unflold ~Can wounds are already contaminated: They are all infected so no worries about keeping things sterile ~Most wounds are filled with gauze- cheap ~Fluff up and fill wound- don’t shove them in- can create pressure

Question 28

Details on packing gauze

Answer 28

~Great for Tunnels ~Comes in packing stripes ~Leave a tail, have it moist ~Use the q-tip end (moisten) to help the packing gauze into the tunnel

Question 29

When you put gauze (or anything else in a wound,

Answer 29

KEEP COUNT!! record what you put into a wound so that the next person will know exactly how much to remove

Question 30

What do you call when the moisture gets through the primary dressing?

Answer 30

STRIKE THROUGH

Question 31

Why is strike through bad?

Answer 31

~when the fluid gets through the secondary dressing, the infection can get straight through to the wound

Question 32

What happens when moisture moves to the edges of the secondary dressing?

Answer 32

``` failed dressing (no longer a strike though because it is now macerated. need to redo) ```

Question 33

What happens if you add too much primary dressing?

Answer 33

~too much pressure | ~ischemia

Question 34

What does BID stand for?

Answer 34

twice a day

Question 35

What does TID stand for?

Answer 35

three times a day

Question 36

Details on impregnated gauze

Answer 36

~Take a gauze and add the meds to it; very difficult to but the meds straight to the wound so you add the gauze first ~You can impregnated the gauze with anything that the doctor has prescribed ~Used with venous wound ~NEVER DOUBLE DIP; never touch something that has touched the wound to anything else

Question 37

Types of things used for impregnated gauze

Answer 37

~Silvadene- take gauze and lather it with the silvadene; trying to put it on the wounds and it won’t come off; put it on the gauze!- Antibacterial ~can use honey- great for wounds; keeps it mosit and keeps the bad stuff out ~zinc- unna boot- is a ridge gauze that is an impregnated gauze with zinc; wrap with this around wound then use coban on top to keep the zinc from keep out; walk them then elevate them (compression and elevation with the zinc) ~can do anything that a doc prescribes

Question 38

Details on transparent films

Answer 38

~Expensive, comes in various shapes and sizes ~Very thin, hard to roll, outside is thinner so that it will not roll; going to stick to the periwound ~Best for autolytic debridement (need to tell the pt about what’s going to happen ahead of time) {Clear on the first day then will turn yellow to brownish} ~Not your primary dressing, usually your secondary ~For road rash- you will only have this (like your primary and secondary) ~Won’t let fluid/ moisture out, will let air in, won’t let bugs in

Question 39

Details on foam

Answer 39

~Going to stuck stuff up (fluid); comes in little shapes like pillows ~Good for really wet wounds

Question 40

Details on hyrdogel

Answer 40

~Good for desiccated/ dry wound | ~Like ultrasound gel; fills in the space with the gel

Question 41

Details for hydrocolloid

Answer 41

~your primary and your secondary are attached ~Will change opaqueness as the moisture changes ~Will soak up moisture in the primary ~Comes in all shapes and sizes ~Stage 2 pressure wounds- will take place of our epidermis and part of your dermis

Question 42

Details for Alginates

Answer 42

~primary dressing- will absorb a lot of moisture ~calcium alginate- comes in sheets (feels like cotton) ~do not pre-moisten this

Question 43

Details for hydrofibers

Answer 43

~comes in sheets ~can cut to the shape of the wound ~expensive ~absorb wet

Question 44

Details on Beladine-whirlpool

Answer 44

~Cytotoxic | ~Don’t have to put a lot in there, just a little bit in the whirlpool

Question 45

Details on Daikins

Answer 45

~A watered down bleach- .001%- .0025% (can be .005%) that will be with the gauze ~Kills stuff, good for a couple of days ~Have to talk to physician to stop using it because it slows healing because it is irritating the wound bed;; may have to use it in sacral area bc its so close to b/b

Question 46

What are the type of modality for wound care? (7)

Answer 46

``` ~wound vac ~ultrasound ~e0stim ~diathermy ~UV ~laser ~HBO ```

Question 47

Details on Wound Vac

Answer 47

~An accordion foam in the wound cut to the shape of the wound; big piece of plastic sheet over it; make a little hole in it; put the nipple in the whole and add the pump over it; creates a negative pressure ~Heals quickly, but not covered yet by insurance but hospitals use it like crazy because it works! ~Great for abdominal surgery, incontinence

Question 48

Details of Ultra sound

Answer 48

~Will bring a lot of blood and nutrients to the area ~Restart the inflammation stage ~Realign the collagen ~Gets rid of swelling/edema ~Put ultra sound gel in the wound- then use it ~More likely to be in the nursing home where we can get paid for it

Question 49

Details of E-stim

Answer 49

~Pain ~Swelling ~Infection ~Put it in the wound- gauze (wet) with AL foil, tongs, and a ground

Question 50

Details on HBO

Answer 50

*Hyperbaric oxygen therapy ~Can be rooms or a tank; but them in a camber to create more pressure- this will get more O2 into the tissue and will help to open up the little vessels to enhance healing ~More oxygen is diffused into the tissues with more negative pressure ~Allows wounds to get the oxygen it needs