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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
what injuries are classified by stages?
pressure injuries
26
"stage 1" pressure injury
1. nonblanchable erythema | 2. warmth OR coolness, edema, induration and pain
27
Stage 2 pressure injury:
1. partial thickness skin loss (epi & dermis) 2. "blister," abrasion, or shallow crater 3. red/pink and moist wound bed
28
stage 3
FULL THICKNESS skin loss does NOT go thru fascia may have undermining and/or tunneling
29
stage IV pressure injury
1. FULL THICKNESS w extensive tissue destruction | 2. dmg extended to MS, BONE ,TENDONS & JT CAPSULE
30
"suspected deep tissue injury" recognized by..
purple/maroon localized area of discolored intact skin | -painful, firm, mushy, boggy, warmer/cooler v adjacent tissue
31
considered "unstageable" if..
full thickness loss in which the base is covered by - SLOUGH (yellow, tan, gray, green OR brown) - ESCHAR (tan, brown or black)
32
grade of 4+ for edma means..
>1" pitting, indentation lasts >30 sec
33
edema grade of 2+ means..
1/4" - 1/2" pitting, slight indentation visible, returns to normal
34
if red granulation tissue ceases for a period of time to progress towards contraction and epithelialization, what should you do?
need to TRAUMATIZE the wound again to induce inflammation OR use topical antibiotics
35
what ms are first to go in peripheral neuropathy?
instrinsics
36
what can be used to assess the relative flow of blood?
arterial doppler (shoudl be triphasic/pulsatile)
37
what can be used to assess the site of a blockage?
pulse volume recordings
38
what test/measure detects and quantifies arterial disease?
ankle/brachial index 0.8 - 1.0 min symptoms, intermittent claudication .5-.8 ischemic rest pain NO PRESSURE THERAPY
39
NON-occlusive dressive used for.. ex : NOT used for.. (2)
``` 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
semi-occlusive/semi-permeable wound dressing purpose: ex: NOT used for..
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
when should the 'healing ridge' first appear?
5-9 days post op
42
rule of 9s
for BURNS head/each arm 9% each each leg/trunk (front)/back = 18% each perineum 1%
43
if a burn is INSENSATE, with NO blistering, thick adherent eschar, and no blanching and is white and tan..
THIRD degree burn
44
in a second degree DEEP burn, how long is healing time ? | -what sensation do they retain?
healin time > 3 weeks | (+) pressure sensation
45
daily wound cleansing for a burn patient done via..
whirlpool
46
according to the Wagner Ulcer Scale, a grade of 5 =
Full foot gangrene
47
at what ulcer grade does a patient revert to NWB status?
non existent. clinical judgement
48
6 Ps indicative of arterial insufficiency
1. pain 2. paresthesis 3. paralysis 4. pallor 5. pulselessness 6. poikilothermia (coolness)
49
when does arterial insufficiency become a surgical emergency?
WET GANGRENE -- infected, means infection IN THE BLOOD STREAM
50
how should a pt be positioned if they have arterial insuffiency?
elevated HOB (dependent position alleviates their pain)
51
3 burn zones:
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
burns must cover > --- % of TBSA to obtain a referral (if age 10-50)
>20% TBSA | >10% if 50 y.o.
53
in a burn pt, the HOB should be ..
elevated 30-45 deg to prevent edema
54
how should the neck of a burn victim be positioned?
in neutral with about 15 deg of ext NO PILLOWS towel roll/foam on upper back up to the scapulae
55
how should the hips be positioned in a burn victim?
0 deg ext, 15-25 deg B abd | Ant hip spica for hip flexion contractures
56
what burns will REQUIRE pressure therapy to be used?
>21 days to heal a burn | 14-21 days -- monitor, pressure tx advised

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