final exam Flashcards

1
Q

if a wound is infected, what are the 2 objectives of the dressing?

A

antiseptic/antibiotics used

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2
Q

if a wound is undermined and/or tunneled you should…

A

lightly pack the wound

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3
Q

“clinical infection” is defined as

A

10^5 bacteria/gm of tissue

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4
Q

3 things that promote bacterial growth

A
  1. necrotic debris
  2. foreign body
  3. dessication of wound/eschar
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5
Q

the LOCAL factors impeding wound healing include .. (4)

A
  1. Pressure (ischemia within 2-6 hrs, necrosis > 6 hrs)
  2. Shear - responsible for wound undermining
  3. Friction (skin erosion)
  4. Moisture (issue friability)
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6
Q

what are 5 co-morbities that impede wound healing?

A
  1. DM - impaired inflammatory response, neuropathy, vasculature affected
  2. HIV - poor inflammatory response
  3. Cancer - chemo kills duplicating cells ie healing wound
  4. Arterial insufficiency (no circulation = no healing)
  5. venous insufficiency (congestion)
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7
Q

what whirlpool pressure is actually HARMFUL to granulating tissue?

A

> 8-15 psi

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8
Q

if compression therapy is overused during wound care, what can occur?

A

tissue ischemia

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9
Q

when should you use Bacteriostatic and Cytotoxic as topical agents?

A

ONLY for clinical infection

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10
Q

3 characteristics of COLONIZATION?

A
  1. on surface
  2. proliferating
  3. delayed healing
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11
Q

infection formula =

A

(# bacteria * virulence of bacteria) / host immune function

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12
Q

will an inflamed wound have edema and/or induration?

A

YES, slight swelling, firmness at wound edge

INFECTED: edema and induration are LOCALIZED with warmth

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13
Q

a NORMAL total lymphocyte count is..

A

2000-2500 lymphocytes/microL

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14
Q

if a pt has INCR PAIN , indicative of a — infection

A

local

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15
Q

if a pt has red streaks on their wound, it’s indicative of… what about erythema?

A

red streaks = systemic infection

erythema/skin discoloration = local

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16
Q

if a pt has an abscess, what can the PT do?

A

drain the abscess (CAN’T POP IT)

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17
Q

“severe depletion” of lymphocytes

A

<900 cell/microL

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18
Q

to determine ACUTE nutritional status, look at .. & should be —

A

ACUTE nutr status - serum PREalbumin >20 mg/dL

Long term = serum albumin >3.5 mg/dL

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19
Q

SURGICAL debridement is selective or non-selective?

A

NON selective – done if WIDE excision into viable tissue req

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20
Q

INDICATIONS for sharp debridement (5)

A
  1. extensive necrotic tissue
  2. advancing celulitis or sepsis
  3. thick adherent eschar
  4. adjunct to other therapies
  5. callous formation
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21
Q

if a pt has a sacral ulcer, what PT precautions should be taken?

A

limited spinal flexion, watch HAND PLACEMENT in xfers

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22
Q

IF a patient’s pain IMPROVES with elevation, you’re thinking it’s a … issue

A

venous (helps blood to flow back to heart so decreases venous insufficiency)

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23
Q

CONTRAINDICATIONS for sharp debridement:(5)

A
  1. ABI </= 0.5 (arterial insuff),
  2. gangrene
  3. stable heel ulcers
  4. unidentifiable structures
  5. palliative care (terminally ill)
24
Q

HOW DO YOU STOP BLEEDING

A
  1. pressure x10 min
  2. elevation
  3. Ca Alginate
  4. Xylocain jelly (vasoconstrictor)
  5. nitrate sticks (cauterize tissue)
25
Q

what injuries are classified by stages?

A

pressure injuries

26
Q

“stage 1” pressure injury

A
  1. nonblanchable erythema

2. warmth OR coolness, edema, induration and pain

27
Q

Stage 2 pressure injury:

A
  1. partial thickness skin loss (epi & dermis)
  2. “blister,” abrasion, or shallow crater
  3. red/pink and moist wound bed
28
Q

stage 3

A

FULL THICKNESS skin loss
does NOT go thru fascia
may have undermining and/or tunneling

29
Q

stage IV pressure injury

A
  1. FULL THICKNESS w extensive tissue destruction

2. dmg extended to MS, BONE ,TENDONS & JT CAPSULE

30
Q

“suspected deep tissue injury” recognized by..

A

purple/maroon localized area of discolored intact skin

-painful, firm, mushy, boggy, warmer/cooler v adjacent tissue

31
Q

considered “unstageable” if..

A

full thickness loss in which the base is covered by

  • SLOUGH (yellow, tan, gray, green OR brown)
  • ESCHAR (tan, brown or black)
32
Q

grade of 4+ for edma means..

A

> 1” pitting, indentation lasts >30 sec

33
Q

edema grade of 2+ means..

A

1/4” - 1/2” pitting, slight indentation visible, returns to normal

34
Q

if red granulation tissue ceases for a period of time to progress towards contraction and epithelialization, what should you do?

A

need to TRAUMATIZE the wound again to induce inflammation OR use topical antibiotics

35
Q

what ms are first to go in peripheral neuropathy?

A

instrinsics

36
Q

what can be used to assess the relative flow of blood?

A

arterial doppler (shoudl be triphasic/pulsatile)

37
Q

what can be used to assess the site of a blockage?

A

pulse volume recordings

38
Q

what test/measure detects and quantifies arterial disease?

A

ankle/brachial index
0.8 - 1.0 min symptoms, intermittent claudication
.5-.8 ischemic rest pain NO PRESSURE THERAPY
</= 0.5: Necrosis NO CUTTING

39
Q

NON-occlusive dressive used for..
ex :
NOT used for.. (2)

A
allowing wound drainage to evaporate
-acute surg wound
-primary dressing
-infected wound
-highly draining wounds
EX: hydrofiber, gauze, alginates
NOT USED FOR clearn, granulating, epithellializing wounds OR exposed bone, tendons, mesh, graft
40
Q

semi-occlusive/semi-permeable wound dressing purpose:
ex:
NOT used for..

A

allow gaseous and water exchange BUT moisture retentive
-autolytic debridement
-scant –> mod draining wounds
-secondary dressing for moderate–> highly draining wounds
-painful wounds as non-adherent dressing
NOT USED FOR : infected founds, highly draining wounds
ex: transparent films, foams, impregnated gauze

41
Q

when should the ‘healing ridge’ first appear?

A

5-9 days post op

42
Q

rule of 9s

A

for BURNS
head/each arm 9% each
each leg/trunk (front)/back = 18% each
perineum 1%

43
Q

if a burn is INSENSATE, with NO blistering, thick adherent eschar, and no blanching and is white and tan..

A

THIRD degree burn

44
Q

in a second degree DEEP burn, how long is healing time ?

-what sensation do they retain?

A

healin time > 3 weeks

(+) pressure sensation

45
Q

daily wound cleansing for a burn patient done via..

A

whirlpool

46
Q

according to the Wagner Ulcer Scale, a grade of 5 =

A

Full foot gangrene

47
Q

at what ulcer grade does a patient revert to NWB status?

A

non existent. clinical judgement

48
Q

6 Ps indicative of arterial insufficiency

A
  1. pain
  2. paresthesis
  3. paralysis
  4. pallor
  5. pulselessness
  6. poikilothermia (coolness)
49
Q

when does arterial insufficiency become a surgical emergency?

A

WET GANGRENE – infected, means infection IN THE BLOOD STREAM

50
Q

how should a pt be positioned if they have arterial insuffiency?

A

elevated HOB (dependent position alleviates their pain)

51
Q

3 burn zones:

A
  1. zone of COAGULATION (necrosis) – irreversible damage
  2. zone of INJURY (stasis)
    -originally, cells are viable
    • circulation progressively worsens to TOTAL OCCLUSION – can occur in as little as 2 hours
      =very susceptible to complications (ie infection)
  3. zone of HYPEREMIA
    • minimal cell injury BUT with vasodilation from inflammatory response
52
Q

burns must cover > — % of TBSA to obtain a referral (if age 10-50)

A

> 20% TBSA

>10% if 50 y.o.

53
Q

in a burn pt, the HOB should be ..

A

elevated 30-45 deg to prevent edema

54
Q

how should the neck of a burn victim be positioned?

A

in neutral with about 15 deg of ext
NO PILLOWS
towel roll/foam on upper back up to the scapulae

55
Q

how should the hips be positioned in a burn victim?

A

0 deg ext, 15-25 deg B abd

Ant hip spica for hip flexion contractures

56
Q

what burns will REQUIRE pressure therapy to be used?

A

> 21 days to heal a burn

14-21 days – monitor, pressure tx advised