exam 2 - wound interventions

Question 1

TIME

Answer 1

• Tissue (debride?)
• Infection/inflammation (goal is to reduce)
• Moisture (need balance, too much is bad)
• Edge (watch for undermining)

Question 2

What range of psi do you want with irrigation

Answer 2

4-15 psi

Question 3

antibacterial

Answer 3

• destroy or stop bacterial growth

- discontinue once infection is resolved

Question 4

antiseptic

Answer 4

• prevent infection by killing microorganisms
• broad spectrum antimicrobials
• cytotoxic

Question 5

antifungals

Answer 5

-inhibit or kill fungi

Question 6

Selective debridement strategies

Answer 6

• enzymatic/chemical
• autolytic
• sharp
• biological (maggots)

Question 7

non-selective debridement strategies

Answer 7

• surgical

- mechanical (wet to dry, pulse lavage, whirlpool etc)

Question 8

Mechanical Debridement (selective vs non, types, indications)

Answer 8

• non-selective
• irrigation, pulsed lavage, whirlpool, wet to dry, scrubbing
• indication: wounds with loose necrotic tissue

Question 9

Enzymatic or chemical debridement (selective vs non, indications, disadvantage, contraindication)

Answer 9

• selective
• **requires physician prescription
• indication: infected and uninfected with necrotic tissue, cannot tolerate sharp or mechanical
• disadvantage: slow
• contra: wounds with exposed deep tissues

Question 10

Sharp debridement (selective vs non, indications, contraindication)

Answer 10

• selective
• indication: large amount of necrotic tissue
• patient with dry gangrene, impaired arterial flow, clotting issues etc.

Question 11

surgical debridement (selective vs non, types, indications, contraindication)

Answer 11

• non-selective
• ***fastest most effective way to remove debris and necrotic tissue
• **always done by physician
• indicated: removal of necrotic bone, muscle, tendon. Wounds with extensive undermining etc.
• contra: medically unstable. Lack vascular supply for adequate healing

Question 12

Biological debridement (what is it?)

Answer 12

maggots = digest necrotic tissue

Question 13

Gauze (what, advantage, disadvantage)

Answer 13

• used on pretty much any wound
• can be impregnated with stuff
• low cost, easy to use
• disadvantage: freq changes, can dry wound, can shed

Question 14

Autolytic debridement (selective vs non, indication, contra)

Answer 14

• selective
• using bodies own enzymes in breakdown of necrotic tissue
• indication: dry or moist necrotic wounds and patient cannot tolerate more aggressive forms
• contra: infected wound.

Question 15

Calcium alginates (goods, bads)

Answer 15

• from seaweed
• highly absorptive (up to 20x)
• can be left 3-5 days
• good for moderate to heavy exudates (infected or not)

-not recommended for wounds with light exudates or dry eschar

Question 16

Transparent film dressings (goods, bads)

Answer 16

• thin membranes
• impermeable to bacteria and contaminates, yet permeable to o2, co2, and water
• can leave for 5-7 days
• not really absorptive

**not for infected, or wounds with moderate to heavy drainage.

Question 17

Foam dressings (goods, bads)

Answer 17

• from polyurethane
• for min, mod, or heavy drainage
• primary or secondary dressing
• not effective for wounds with dry eschar

Question 18

Hydrogels (goods, bads)

Answer 18

• water or glycerin based (80-99% water)
• permeable to gas and water
• min absorptive capacity

-not recommended with wounds with heavy exudates

Question 19

Hydrocolloids (goods, bads)

Answer 19

• occlusive or semi occlusive
• most occlusive - impermeable to water, o2, and bacteria
• light to moderate exudates

-not recommended for wounds with heavy exudates or sinus tracts. Not for infected wound

Question 20

Antimicrobial dressings

Answer 20

• silver

- intended for shot term use

Question 21

compression dressings

Answer 21

• manage edema and promote return of blood

- unna’s boot = gauze bandage blah becomes rigid compression dressing as it dries