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MultiSystem Management > Exam 2-the end of wound care (starting at bariatric solutions) > Flashcards

Exam 2-the end of wound care (starting at bariatric solutions) Flashcards

1
Q

What is something you can use for bariatric patients with skin infection?

A

interdry silver for an infection between skin folds

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2
Q

What are treatment options for stage 1 wounds?

A
  • hydrocolloids
  • transparent films
  • foams
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3
Q

What are treatment options for stage 2 wounds?

A
  • alginates
  • foams
  • hydrocolloids
  • hydrogels
  • transparent films
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4
Q

What are treatment options for stage 3 and 4 wounds?

A
  • alginates
  • foams
  • hydrocolloids
  • hydrogels
  • wound fillers
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5
Q

What are treatment options for necrotic tissue?

A
  • autolytic debridement
  • santyl
  • surgical debridement
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6
Q

What are dressings for deep vs. shallow wounds?

A
  • alginates, hydrogels, and foams are good for both
  • deep wounds: negative pressure wound therapy
  • shallow wounds: hydrocolloids, semi-permeable film
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7
Q

What are dressings for low, medium, and high exudate wounds?

A
  • low: semi-permeable foam, hydrogel
  • medium: foam, alginate, hydrocolloid
  • high: foam, alginate, negative pressure wound therapy
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8
Q

What is the TIME principle of pressure ulcers?

A

For wound bed prep

  • Tissue: viable or non-viable
  • Infected or inflamed
  • Moisture: balance between dry and heavy exudate
  • Edges: advancing, heals outside in
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9
Q

What test has the greatest sensitivity with fall prevention in diabetic pts?

A

TUG

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10
Q

How can you use skin equivalents with diabetic foot ulcers?

A

weekly allografts with moist, non adherent dressing and compression wraps, offloading

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11
Q

Class 1 compression

A

light support; fashion hose, nonambulatory- TED hose

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12
Q

Class 2 compression

A

patients w/ dependent edema; elastic wraps, paste bandage

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13
Q

Class 3 compression

A

low to moderate compression; edema w/ or w/out ulcer, poor healing ulcer, persistent edema; custom stocking, sequential pump, 4 layer bandage

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14
Q

Class 4 compression

A

high compression required secondary to severe edema; lymphedema; can add forma to inside

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15
Q

What ABI is the cutoff for compression?

A

.5

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16
Q

What kind of compression does profore give?

A

30-40mmHg: severe edema (venous insufficiency or lymphedema), initial tx for edema and exudate, appropriate for ambulatory and non-ambulatory

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17
Q

What kind of compression can circ-aid give?

A

20-30, 30-40, 40-50: moderate to severe edema, chronic venous insufficiency (20-30), when initial edema and drainage are reduced

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18
Q

What kind of compression does an Unna boot give?

A

none, but you can put coban for 30mmHg; just to inhibit more edema

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19
Q

How long do you wait before you start modalities?

A

30 days of a non-healing wound

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20
Q

High frequency US

A

1-3 Hz; elevate temp, enhance blood flow

-couples: water; hydrogel-partial thickness; sterile aqueous gel-full thickness

21
Q

low frequency US

A

20-40kHz; debridement, bactericidal, healing of acute and chronic, removing biofilms
-couple: sterile saline, Dakin’s for debridement

22
Q

Indications for high frequency US

A
  • chronic wounds
  • recalcitrant wounds
  • pressure ulcers, venous ulcers (.5W)
  • traumatic wounds
    precautions: wound inflammation, fractures
23
Q

Contraindications for high frequency US

A
  • pregnancy
  • CNS tissue
  • joint cement
  • pacemaker
  • thrombophlebitis
  • reproductive organs, eyes
24
Q

parameters for high US

A
  • 20% duty cycle, pulsed
  • 1 for deep, 3 for superficial
  • inflammatory: .3 W/cm2
  • proliferation: .5; daily
  • remodeling: .5-1; 3x/week
25
Q

What’s the only US for biofilms?

A

MIST

26
Q

So tell me what you want…NO MIST let’s talk about MIST baby

A
  • noncontact US
  • 40kHz
  • wound cleansing, pain reduction; removal of slough, fibrin, exudate, biofilms; burn healing, venous insufficiency healing, painless
27
Q

What electrical current is most supported by evidence?

A

HVPC

28
Q

What are indications for estim?

A
  • chronic or recalcitrant wound (pressure or venous)
  • clean or infected
  • granular or necrotic
  • acute
  • donor sites
29
Q

What are contraindications for estim?

A
  • osteomyelitis
  • cancer
  • pacemaker
  • pregnancy
  • precautions: silver dressing, bleeding, sensory neuropathy
30
Q

Estim mediums

A
  • saline soak

- dressing: gauze under electrode, dispersive

31
Q

negative vs positive polarity

A
  • negative: lyses necrotic tissue, stimulates granulation, increase blood flow, fibroblasts proliferation, enhance collagen synthesis, attract neutrophils
  • positive: greatest effect during proliferative phase, promote epithelial growth, attracts marophages, bactericidal
32
Q

parameters for HVPC

A
  • pulsed, 100pps, interval 20-100 microseconds
  • 75-200 volts
  • 45-60mins
  • 5-7 days a week
33
Q

What is cold laser for?

A
  • enhances wound healing
  • reverses symptoms of peripheral neuropathy
  • minimize or reduce fibrosis-stage 2 edema
34
Q

What is anodyne?

A
  • photo energy-releases NO from hemoglobin and other proteins->decreases inflammation and edema and increases granulation base, rate of healing, remodeled tissue
  • peripheral neuropathy
  • diode pad over wound for 20-30 mins, 1-2x/week
  • Kim no le gusta
35
Q

What is UV radiation for?

A
  • chronic wounds
  • initiates inflammatory response-stalled out wounds
  • kills MRSA and others
  • 15-30 secs, 2-3x/week until contamination is resolved
36
Q

What does negative pressure wound therapy do?

A
  • mitosis stimulated, new vessels formed, wound contraction

- evacuates fluids, stimulates granulation, reduces bacterial burden, maintains moist wound bed

37
Q

What do you do if a tendon is exposed and you want to use NPWT?

A

cover it with nonadherent wound contact layer!

38
Q

NPWT indications

A
  • acute, traumatic wounds
  • dehisced incisions
  • pressure ulcers
  • chronic open wounds
  • meshed grafts
  • flaps
39
Q

NPWT contraindications

A
  • untreated osteomyelitis
  • fistulas of unknown origin
  • necrotic tissue with eschar-debride first, slough OK
  • exposed organs, vasculature, and nerves
40
Q

What is hyperbaric O2?

A
  • O2 delivery for 60-90mins at >1 atmosphere
  • induces revascularization
  • may cause toxicity and destruction of new blood vessels
  • benefits diabetes grade 3, arterial insufficiency, burns, osteomyelitis, radiation burns
41
Q

Indications for HBOT

A
  • air/gas embolism
  • gas gangrene
  • crush injury
  • compartment syndrome
  • necrotizing infection
  • osteomyelitis
  • delayed radiation injury
  • compromised grafts and flaps
  • Wagner 3 or higher DFU
  • acute peripheral arterial insufficiency-last effort before amputation
42
Q

community acquired MRSA

A
  • spider bite looking
  • close injury contact, person to person contact
  • most common cause of soft tissue and skin infection
  • tx: drain lesion, topical antibiotics; education and protection of area until well healed
43
Q

Kennedy Terminal Ulcer

A
  • pear shaped
  • pass in next 72 hours
  • sudden onset, progresses rapidly
44
Q

Fungating wounds

A
  • cancerous lesion, primary cancer or metastasis
  • nodular fungus or cauliflower shaped lesion
  • odor, pain, exudate, bleeding
  • can remove it, but they probably aren’t going to live much longer
45
Q

scleroderma

A

-scar tissue and fibrosis

46
Q

impetigo

A
  • bacterial
  • peds
  • highly infective
47
Q

hand foot and mouth

A
  • viral

- highly infective with blisters

48
Q

sickle cell

A
  • looks like venous insufficiency
  • up to 2 year healing time
  • not well oxygenated, lots of slough
49
Q

calciphylaxis

A
  • calcification of small vessels
  • pts on dialysis; end stage renal disease
  • death due to infection-debride if it gets infected, but they usually can’t tolerate debridement
  • necrotic tissue

MultiSystem Management (6 decks)

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