Final Exam content Flashcards
Describe moist wound healing
Allows epidermal cells to travel freely through exudate
Protects granulation tissue and promotes epithelialization
Barrier to microorganisms
What are some properties of an ideal dressing
Removes excess exudate without causing wound to dehydrate
Allows gaseous exchange
Thermally insulating
What are some practical considerations to dressings
Available
Cost effective
Ease of application and removal
Describe Film dressings
Skin protection for low exudate wounds
Wound visualization
Minor burns, simple injuries, post-op dressing
Describe foam dressings
Protects bony areas
wearable up to 7 days
Transmit vapor out of dressing
Exudate wounds
Describe hydrogels
Amorphous - free flowing
Sheet - thin and flexible as they absorb fluid
Moisture to dry wounds
Over tendons and tissues to prevent dehydration
Infected and necrotic wounds
Describe hydrocolloids
change every 2-3 days Provide moist environment Form gel in wound Burns, pressure injuries Contraindicated for infections
Describe an alginate
Calcium salts from seaweed
Exudate wounds
Infected wounds
Describe hydroactive dressings
Mod to heavy exudating wounds
Moist environment
Similar to hydrocolloids but do not form gel in wound
What is silver good for in wounds care
Possesses strong antimicrobial properties
What is the type of honey used in wound care
Manuka honey
What are some factors that predict death with burns
Severity of the burn
Age
Etiology of the burn
Inhalation injury
What are some common burn etiologies
Thermal
Radiation
Chemical
Describe skin conductivity
Skin is relatively poor heat conductor
tolerates 111F up to 6 hours before permeant damage
Describe burns and mortality
Immediate death is associated with airway issues
What may chemical burns cause
Cardiac arrhythmias 24-48 hours after injury
What are some burn management strategies
Nutrition
Respiratory support
Early debridement
Akin substitutes
What are some burn extent measures
Palmar - palm = 1%
Rule of 9s
Describe superficial burns
Epidermis damage only
No skin blistering
Sunburn
Describe superficial partial thickness burns, how long until they heal
Epidermis and dermis damaged
blisters
heals in 2-3 weeks
Describe superficial full thickness burns
Eschar
Zone of coagulation
Describe deep partial thickness burns
Extend into reticular dermis
Mottling - white eschar coagulation
greater potential for hypertrophic scar
Describe deep full thickness burns
may involve subcutaneous tissue, muscle and bone
if more than 1cm grafting is required
What is an autograft
Skin graft from patients own tssues
What is a allograft
Skin graft from cadaver
What is the procedure for a burn less < 30%
split-thickness auto or allograft
What is the procedure for a burn > 40%
Allograft, xenograft or synthetic coverings
What is the procedure for a burn > 90%
Up to 10 grafting cycles may be needed
Describe some skin graft characteristics
breakdown quickly
Must be immobilized to limit post op shear forces
Describe some musculoskeletal graft characteristics
Manage osteomyelitis
How long do grafts take to heal
about 1 month after graft
How do you treat hypertrophic scarring
Pressure garments 25 mmHG
takes 6 months - 2 years to mature
Describe the physiologic effects of Estim for wound healing
Attracts reparative cells
Modifies cell membrane permeability
Restoration of cell structures
Jump starts wound healing
What polarities are indicated for the different phases of healing
Inflammatory: + for macrophage activity, - for inflammation reduction
Proliferative: - for increased fibroblast activity
Maturation / remodeling: + for decreased scar thickness and decreased mast cells
What polarity is used ti treat edema
negative
For cataphoresis
What are some contraindications for estim usage
Malignancy Osteomyelitis Metal Electrical implants Severe cardiac arrhythmias
What does low frequency tens do for wound healing
increase blood perfusion
What is the most used electrode placement for estim wound management
Monopolar
Describe diathermy
increase tissue temperature
Autolytic debridement
C short wave - not for ischemia
Pulsed short wave - increased blood flow
What is Diathermy dosage
1 - lowest level - non thermal
2 - low level - <40c
3 - medium - moderate heat
4 -heavy - vigorous heat
How long is short wave diathermy used for
20-30 mins
What are the parameters for US wound healing
1-2w
5-10 mins
Describe pulsatile lavage
Cleans and debrides with high pressure solution
4-15 psi
What are some benefits of Pulsatile levage
decreased infection
Promotes granulation
What is the frequency of Pulsatile levage
1x per day
2-3 times per week
stop after wound closure
Describe NPWT
uses negative pressure to accelerate wound healing
Decreased Edema
Increased blood flow, granulation, epithelial migration
What are some NWPT contraindications
Active osteomyelitis Nondebrided necrotic tissue Unrestricted malignancy Unexplored fistula infection
What is the etiology of primary lymphedema
Congenital defects
aplasia
hypoplasia
hyperplasia
What is the etiology of secondary lymphedema
From a disease process or injury
Surgical lymph node removal
Venous insufficiency
DVT
Describe Stage 0 lymphedema
Latency
No swelling, normal skin
Describe Stage 1 lymphedema
Reversible
Soft pitting edema
No secondary tissue changes
Elevation reduces swelling
Describe Stage 2 lymphedema
Spontaneously irreversible
Fibrosclerotic changes
Hardening of tissues
Frequent infections
Describe lymphostatic elephantiasis
Extreme increase in volume and texture
skin changes, papilloma’s, deep skin folds
Describe the treatment phases for lymphedema
1 - intensive phase - mobilize accumulated fluid, reduce fibrosclerotic tissue
2 - maintenance - preserve and improve success in phase 1
What are some absolute contraindications for treating lymphedema
Unstable cardiac disease Severe arterial disease Acute renal failure Acute DVT or PR Acute infection / cellulitis
