Exam 3 Wound Care

Question 1

What are the burn categories and healing times by category?

Answer 1

⭐️Superficial Burns (1st degree) - usually heals 7 days
⭐️Superficial Partial Thickness (2nd degree) - usually heals 5-21 days
⭐️Deep Partial Thickness (2nd degree) - usually heals 3-5 weeks
⭐️Full Thickness (3rd degree) - 4-6 weeks (depends on depth)
Electrical Burns (4th degree) -

Question 2

What are the outcomes for the stages of wounds?

Answer 2

Stage 1 - Superficial Thickness (redness,sunburn like, heals in 7 days)
Stage 2 - Superficial Partial Thickness (dermal mild to moderate,most painfull, blistered, will heal independent in about about 3 weeks)
Stage 3 - Deep Partial Thickness (molted red or waxy white, wet, soft but elastic, epiderimis and most of epidermis destroyed, destruction of some hair follicle/sweat glands, closes in 3-6 weeks)
Stage 4 - Full Thickness (white/tan, waxy feel, thrombosed veins, dry/leathery texture, rigid, all dermis/epidermis is destroyed, may involve the fat layer, painless)

Question 3

What are the Iatrogenic factors in wound care?

Answer 3

⭐️Poor use of infection control practices
⭐️Excessive bandage changes
⭐️Not changing bandages often
⭐️Use of adherent dressings
⭐️Packing wounds too tight
⭐️Failure to relieve pressure
⭐️Failure to control incontinence
⭐️Failure to address intrinsic factors such as: diabetes, nutrition, circulatory problems
⭐️Excessive use of topical antimicrobials, cleaners and whirlpool additives
⭐️Excessive use of mechanical debridement and failure to consider use of autolytic debridement

Question 4

Which wounds are the most painful?

Answer 4

Arterial Ulcers and any Superficial Partial Thickness Injury (use thin duoderm on burns)

Question 5

What are the categories of wounds by sight (arterial, venous, pressure ulcers).

Answer 5

Toes, feet, and lower 1/3 of the legs - Arterial Ulcer (trophic nails, circular) (use hydrogel, foam, hydrocolloid) (nothing that dries it out)
Lower 1/2 (gator) of the leg - Venous Stasis Ulcer (calcium aginate
Bony prominences - Pressure Ulcer
Sole of foot - Neuropathic ulcer (Calus ring around it. Use foam)

Question 6

What are the management of wounds by category?

Answer 6

Pressure Ulcers - pressure relief
Arterial Ulcers - add moisture dressing (hydrocolloid), avoid leg raising,
Venous Ulcers - add absorbent (foam) dressing compression stocking. Leg elavation. Jobst pump.

Question 7

What are the wound solutions?

Answer 7

⭐️Dakin’s solutions - used to dissolve necrotic tissue and dry the wound🚨Not good for burns (bleach)
⭐️Acetic Acid .25 to .5 - bactericidal used for wet or wet-dry dressing in wounds with pseudonomas. (changes ph level, smells like vinegar, causes stinging)
⭐️Hydrogen Peroxide - used as a cleaning agent and to disolve dried up exudate or blood. (DO NOT use on closed wounds, the solution can cause gas build up and cause an embolism)
⭐️Betadine (Providone-Iodine) solution - Antimicrobial used on infected superficial wounds, dermatitis, eczema, safe for wounds with large cavities. ⭐️used before surgery (relatively few side effects)

Question 8

What are the differences between selective and non-selective debridement techniques?

Answer 8

Selective debridement (wet to dry dressings, topical anabiotics, surgical debridement,sharp debridement,forceful irrigations, and whirlpool) the removal of necrotic tissue only while non-selective debridement (enzymatic debridement, use of moist and/or occlusive dressing for autolytic debridement, and saline soaks or gentle saline rinse) is the removal of both healthy & necrotic tissue (viable tissue sacraficed for rapid results)

Question 9

What are the rules of Sterility?

Answer 9

• From waist up is steril
• 1 inch boarder steril field
• No talking over steril field
• Steril touches

Question 10

What mechanisms result in pressure ulcers?

Answer 10

• Nutrition
• Pressure
• Friction/wrinkled sheets

Question 11

What is the best way to pump venous blood back to the heart?

Answer 11

Calf muscle pump

Question 12

What is a the effect of Hemosideran?

Answer 12

It permanently discolors the skin

Question 13

What is the recommended time for hand washing?

Answer 13

30 seconds

Question 14

What is the pressure applied to a healed burn to prevent hypertrophic scarring?

Answer 14

25mmhg. Will respond if less than 6 months old. 23 hours 12-18 months (Through splinting or Jobts stockings -pressure garments)

Question 15

When should you was your hands?

Answer 15

Before and after every pt contact

Question 16

When the hospital requires strict isolation, what does it mean?

Answer 16

Strict isolation is used for diseases spread through the air and in some cases by contact. Patients must be placed in isolation to prevent the spread of infectious diseases. Patients are often kept in a special room at the facility designed for that purpose.

Gloves, gown , mask

Question 17

What does it mean when a hospital requires respiratory isolation?

Answer 17

Respiratory isolation is used for diseases that are spread through particles that are exhaled. Those having contact with or exposure to such a patient are required to wear a mask.

Question 18

What should you do when applying clothing for isolation?

Answer 18

Begin with handwashing and end with gloving.

Question 19

What is the difference between a first and second intention wound.

Answer 19

First is a surgical wound. All tissue is intact

Second has a piece of tissue missing. Pothole.

Question 20

What are the names of the enzymes used to treat wound?

Answer 20

Panafil

Santyl

Question 21

What is the basic premise of Standard Precautions?

Answer 21

Basic protection of everything. Treat everyone as infected

Question 22

Which dressing absorbs or supplies moisture?

Answer 22

Hydrocolloid
Hydrogel Dressing
Calcium Algenate (wet or dry like foam)

Question 23

What is the rule of nine?

Answer 23

The rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate the body surface area on an adult that has been burned by using multiples of 9.

Question 24

How long should patient with grafted body part be immobilized?

Answer 24

7-10 days

Question 25

What are different levels of burn and their associated healing times?

Answer 25

1st   degree (superficial burns) - 7 days
2nd degree (superficial partial thickness) - 5-21 days
2nd degree (deep partial thickness) - 3-5 weeks
3rd  degree (full thickness) (must graph)- 4-6 weeks (depends on wound size)
4th degree (electrical burns)

Question 26

How to manage a venous stasis ulcer and what lifestyle changes should be offered?

Answer 26

Mangenent:
Compression 30 min-1 hour
(20-30mmhg) Never put pressure higher than diastolic pressure
Apply ABSORBENT dressing
Apply unna boot if no infection
Encourage leg elevation until wound closes.

Lifestyle Changes:
Wear compression socks daily when moving or Jobst pump for 1 hour daily.
Encourage patient to walk 30 min a day
Remain smoke free 
No standing for long periods

Question 27

How to manage an arterial ulcer and what lifestyle changes should be offer?

Answer 27

Management:
Add moisture for healing (they are dry)
Ask pt to keep moving leg
Avoid leg elevation, keep in dependant position.
Inquire about diet. Eat low cholestrol. Diet high in vegetables. Low fatty meats and animal products.

Lifestyle Changes:
Good cardiac diet, regular aerobic exercise
Avoid a sedentary lifestyle
Quit Smoking, if appropriate.

Question 28

How to grade pressure ulcers?

Answer 28

Stage 1: Non blanchable redness
Stage 2: Partial thickness tissue; looks like a shallow open ulcer with the red or pink wound bed (pocket blister)
Stage 3: Full thickness tissue loss; subcutaneous fat may be visible but bone tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining or tunneling.
Stage 4: Full thickness tissue loss with exposed bone tendon or muscle that is visible or directly palpable. Slough or eschar maybe present on some parts of the wound bed. Undermining internally may be present

Question 29

How long should an Una boot be worn?

Answer 29

1 week (venus stasis ulcer, if not infected)

Question 30

What types of ulcers are pain free?

Answer 30

Ulcers under 1/16th of an inch

Question 31

What are the differences with keloids vs hypertrophic scarring?

Answer 31

️Keloids are raised well above and over the skin and Hypertrophic is usually over a joint and just raised above the skin

Question 32

What are was of assessing venous stasis?

Answer 32

🚨PRECUSSION TEST: may use if saphenous vein shows dilation. Tap up on one side and if wave is felt on distal side test is positive

🚨Trendelenburg Test: With the patient in the supine position, the leg is flexed at the hip and raised above heart level. The veins will empty due to gravity or with the assistance of the examiner’s hand squeezing blood towards the heart.

🚨Cuff Test: inflate cuff to 40mmhg if tolerated tes is negative

🚨Stasis Pigmentation (Hemosideran staining):

Question 33

How do we assess arterial wounds?

Answer 33

🚨Doppler Index: Also called the Ankle-Brachial Index =
systolic BP of LE
systolic BP of UE
.5 value means all are clogged with fat.
🚨Rubor of Dependancy
🚨Remember
* 80% of all led