Final Exam Flashcards
Describe the common features of each: primary intention, secondary intention, and third intention.
Primary intention (primary union) - A clean, approximated incision that is closed with a suture or other appropriate product. No discharge from wound or tissue loss. Nominal scar formation.
Secondary intention - The wound heals by granulation, leading to wound contracture. Repeated debridement may be necessary. Infection and tissue loss are present. Scar formation and contracture may result in scar revisions.
Third intention (delayed primary closure) - Delayed wound closure due to considerable tissue loss and/or gross infection. Wound is not devascularized. Deep sutures are not used to avoid granuloma formation. Wound is cleaned, debrided, and packed. Eventual approximation of clean granulation surfaces is achieved.
How can the patient’s health influence wound closure and healing?
A patient’s health can influence wound closure and healing based on their nutrition and the presence of co-morbidities. If a patient has diabetes and experiences malnutrition, it negatively impacts wound healing due to the effects of the processes on the body, which creates a poor state for the body to adjust. This makes the body more susceptible to SSIs.
Does your facility provide NPWT devices? Where are the devices stored? Are all of the supplies needed for the application of this dressing stored together? If not, where else would you need to go in order to have everything for the surgeon? How do you enter the patient charge for the use of this device? Is there additional paperwork that must follow the patient to the subsequent nursing units?
Yes, the facility does provide NPWT devices.
They are stored within the normal storage room.
All of the supplies needed are stored together.
Wound Designation Chart
Intentional
-Surgical: an incision made into intact tissue
Unintentional
-Traumatic: can be life-threatening or non-life threatenting injuries
-Incidental: pressure-related injury that is caused by compromised circulation from inadequate, inappropriate surgical positioning
-Chronic: chronic pressure injury, can be caused by tissue loss from either arterial insufficiency or venous
Suture Material Classifications
Natural or synthetic material
Absorbable or non-absorbable suture strand
Monofilament or multifilament
Suture Material Characteristics
Physical configuration
-Mono or multifilament
-Coating
-Capilarity: capability of fluid that is absorbed by suture to be transferred along length of suture
-Diameter: suture size defcreases as the zeros expressing the size increase (3-0 is smaller than 2-0)
-Tensile strength: measurement of the suture strand’s ability to resist breakage
-Knot strength: force required to allow a knot to slip on itself
-Elasticity: measurement of the suture’s ability to recover its primary form and length after stretching or other deformation
-Plasticity: measure of the suture’s capability to be stretched, tied, or misshapen without breaking and maintaining the new form
-Memory: inherent capability of suture to keep/return its original shape
-Knot tensile strength: breaking point of a knotted suture
Handling: suture’s bending ability and how easily a suture can move through tissue and be tied down
-Pliability: how easy suture bends
-Tissue drag: how easy suture slips through tissue (lower drag = more easy)
-Knot tying: how easy suture can be tied (more friction = more difficult)
-Knot slippage: ability of knots to be slid down suture (bad ability = no wound approximation)
Tissue Reaction
-Inflammation
-Absorption
-Infection potential
-Allergic reaction
Stich Types
Interrupted: single sutures that are tied independently
Continuous/running stitch: uninterruped suture line
Retention suture: a heavy suture that reinforces the primary suture line
Subcuticular stich: a suture line under the epidermis
Purse-string: a suture placed around a circular wound
Skin Closure Options
Staples
-Advantages: easy to use, proiders uniform incisional tension, faster wound closure
-Disadvantages: requires extraction unless staples are absorbable
Adhesives
-Advantages: reduced risk of infection, less scarring, eliminates skin closure device removal
-Disadvantages: limited to use for superficial wounds, higher allergic reaction rate, not optimal for slow-healing conditions
Adhesive strips
-Advantage: less expensive than other closure methods
-Disadvantage: can loosen with moisture, causing wound compromies
Zippers
-Advantage: skin stretching forces are distributed over a wide surface area; away from the wound edges, may replace the need for a tissue expander, faster application than suture, may provide a more cosmetic outcome
-Disadvantage: cost, may not be an optimal option in the obese population
SSI Categories
Superficial incisional
-Epidermis, dermis, subcutaneus layers
-Within 30 days after surgery
Deep incisional
-Fascial, muscle layers
-Beyween 30 and 90 days after surgery
Organ/space
-Organ/space
-Between 30 and 90 days after surgery
Negative Pressure
Wound therapy used for difficult wounds that ahve not esponseded to other care methods
A specialized device applies constant, controlled, negative pressure to a wound into which a drianage spone has been placed
Mechanical tension on tissue
-Reduces edema
-Decreases bacterial load
Macro deformation
-Wound contracture
Micro deformation
-Microscopic interaction between the wound tissue and the dressing
Drains
Used to provide an exit for blood, serum, bile, air, intestinal secretions, and pus
Create a portal of entry for pathogenic microorganisms
Aseptic technique is necessary when emptying closed systems and changing a wound drain dressing
Simple
-Penrose drain
Closed suction
-Hemovac
-Jackson-pratt
-Chest tube
What are the goals of hemostasis?
There are 7
Decresae and control bleeding
Minimize the need for blood replacement
Optimize the surgical field view
Avoid major organ damage
Shorten the length of surgery and length of facility stay
Decrease the risk of infection
Decrease health care costs for patietns and facilities
Risks of Impaired Hemostasis
Impaired visualization of the surgical field
Increased surgical time
Necessity of blood transfusion
Risks
-SSI
-Systemic inflammatory response syndrome
-Transfusion related acute lung injury
-Multiple organ failure
-Increased mortality
What promotes a Culture of Safety?
The healthcare organization’s commitment to patient safety above all goals
A commitment to safety at all levels of the organization
A focus on systems, process improvement, and individual accountability
Sufficient resources
The ability of providers to discuss near-miss events and errors without reprisal
Patient Safety Movement
As a result of landmark reports, there has been a shift from a culture of placing blame on an individual when errors occur to creating safer health care systems and standardizing processes (e.g. use of checklists, communication tools)
Patient Safety Efforts
The parts of Universal Protocol in order for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery consists of three key steps:
-Conducting a pre-procedure verification process
-Making the procedure site
-Performing a time out
What is a skill-based behavior error?
The provider has the knowledge for the action but there is little or no attention, or attention is diverted
What is a knowledge-based performance error?
Errors in perception, judgment, inference, or interpretation
What is a situational factor error?
Lack of attention and situational factors play a significant role in this type of error
What processes demonstrate that a healthcare organization is committed to a culture of patient safety?
Accountability, creating a learning environment, and forming reliable teams for patient action
What is an example of a situational factor error?
The RN is distracted by music, conversation, equipment noise, or alarms going off
