FINAL REVIEW Flashcards
Arterial ulcers are usually present where?
Pulse is usually _____
Lateral malleolus
Absent
Venous ulcers are usually present where?
Pulse is usually ______
Medial malleolus
Present
What is used if ankle brachial index (ABI) is unreliable due to plaque build up
TBI Toe Brachial Index
How is ABI calculated?
Ankle systolic / arm systolic
ABI under 0.5 means…
Impaired healing
ABI of less than ____ is contraindicated for compression
0.7
What kind of bandages are preferred for compression?
Short Stretch Bandages
Compression garmets are used mainly for…
Maintenance
What is considered strong compression?
Medium?
Strong = 30-40mmHG
Medium = 15-30mmHG
How can diuretics affect lymphedema
Make it worse due to excess protein
What is stemmer sign
Pinch dorsum of toe to test for lymphedema
What kind of bite is most common?
What kind of bite is most infectious?
Dog
Human
What kind of spider bite requires wound care?
Brown recluse
Myofibrogen does what?
Fibrogen does what?
Closed wound edges
Makes granulation tissue
How are lymphatic channels divided into the body (2 major ones)
The R arm and head, and then everything else
If you debride a wound and it becomes larger w/ more necrotic tissue by the next day, what are you suspecting
Pyoderma gangrenosum
Most pressure injuries occur where
Sacrum and Heels
How fast can a pressure injury occur??
Under 2 hours
Where are pressure injuries most common in children?
Occiput
It can take ______ days for a pressure injury to become apparent
2-7
What is a HAPI?
Hospital Acquired Pressure injury
Hospitals have 48 hours to document existing pressure injuries, anything new they have to pay for
What’s the 1# cause of pressure injuries in pediatrics
Medical Device Pressure Injury MDRPI
Incontinence increases pressure injury risk ______
X5
Pressure injury is most likely to occur ______ into hospitalization
First 3 weeks
What is the number 1 and number 2 risk factor for pressure injuries
1# decreased mobility
2# nutrition
Braden scale does what?
Predicts PI risk, under 13 = high risk
Norton Scale does what??
Predicts PI risk, under 16= risk
Under 13= high risk
Inter professional education reduces PI by ____%
What 3 aspects?
90%
Skin Checks
Mobility
Incontinence management
What blood test indicates PI risk?
Serum Albumin,
1 gram under normal increases PI risk by x4
Can you downstage pressure injuries?
No
A stage 4 Is always a stage 4 until its healed
Nonblanchable erythema of intact skin
Stage 1 pressure injury
Partial thickness w/ exposed dermis
Stage 2 pressure injury
Full thickness skin loss ( may have undermining or tunneling)
Stage 3 pressure injury
Exposed bone muscle or tendon
Stage 4 pressure injury
Slough or Eschar obscures depth
Unstagable pressure injury
(Either a stage 3 or stage 4 underneath)
Maroon or deep purple color on a pressure injury means what?
Deep tissue PI
What is the Pressure Ulcer Scale for Healing (PUSH)
Higher score = worse wound
Can composite score for multiple PIs
Pressure relieving devices vs pressure reducing
Pressure relieving: reduces pressure below 23psi (The pressure of capillaries)
Pressure reducing ( 32- 23 psi)
T or F, pressure injuries heal faster than other wounds
F they heal slower
Half of all burn victims are _____
Most burns occur where
Children
Kitchen and bathroom
What’s the most common kind of burn
Thermal
Asphalt can cause a ________ burn
What kind of this burn is most severe?
Chemical
Alkaline (stronger burn than acidic)
What kind of electrical burn is worse, AC or DC
AC
Burn of only the epidermis
Superficial burn
Burn of some of the dermis (with blisters)
Superficial partial thickness
Burn with mottled white and red appearance, epidermis and dermis affected
Deep partial thickness burn
Burn with subcutaneous tissue exposed
Usually little pain
Mottled white gray black appearance
Full thickness burn AKA 3rd degree
Burn with charred or mummified appearance
Subdermal burn (4th degree)
What method of estimating TBSA in a burn is fastest and effective?
Rule of 9s
Note: don’t use palmar method
What are the 3 zones for a burn
Zone of coagulation - center
Zone of stasis- compromised perfusion
Zone of hyperemia- erythema.around the burn
What happens to cardiac output after a burn
Decreases by 50%
_______ accounts for 50% of deaths in first 12 hours after a burn
Smoke inhalation
Up to 75% of all burn deaths are related to _____
Infection
What happens to basal metabolic rate after a burn?
Doubles or triples
What stage of healing do scars occur
Remodeling phase
Compression wraps can prevent scar from forming
______ skin is x15 more likely to have hypertrophic scaring
Darker
Keloid scar vs hypertrophic
Keloid scar extends outside of the wound bed , hypertrophic does not
____ days for burn scar contracture
_____ days for tendon sheath contractures
_____ for adaptive muscle shortening
______ for ligamentous/joint capsule restriction
1-4 days
5-21 days
2-3 weeks
1-3 months
Most joints must be put in _____to prevent contracture
Extension
MCP position to prevent contracture
Flexion
Thumb and finger position to prevent contracture
Abduction
Arm position to prevent contracture?
Flexion abd and ER
What is an escharotomy
They cut incisions into burn tissue to prevent constriction, improves distal circulation
Xenograft is from ____
Allograft is from ____
Autograft is from ___
Biosynthic?
Animal
Cadaver
Self
Man-Made
Mesh vs full thickness skin graft?
Full thickness is more aesthetic and better for face and hands
Skin receives how much of resting cardiac output?
1/3
How many layers is the dermis
How many layers is the epidermis?
2
5
Main cell of re-epitheliazaiton is what?
Keratinocyte
What cell makes up 90% of the epidermis
Keratinocyte
Is the epidermis vascular or avascular?
What about the dermis?
Epidermis- avascular
Dermis - vascular
What are the 4 phases of wound healing?
Hemostasis -> inflammation -> proliferation -> maturation/remodeling
What is the first cell to an injury site?
What does it do
PMN (Polymorphic nuclear neutrophils)
Secrete inflammatory mediators
What cells produce histamine
Mast cells
What are the 4 stages of proliferation
Angiogenesis -> granulation tissue formation -> wound contraction -> epithelialization
New collagen is type ____ old collagen is type ____
How strong is new collagen?
New collage : type 1
Old collagen: type 3
Only 80% as strong, if injured twice only 64% as strong, keeps on being only 80% as strong as before
Primary vs secondary wound closure?
Primary.- w/ stitches
Secondary- wound closes on its own
Wound w/ no progress in 2-6 weeks or not healed in a month according to Medicare
Chronic wound
Skin is normally between what PH?
4-6.5
Note: this is called the acid mantle
Chronic wounds have higher levels of what cells?
MMP
Why don’t you want to change dressing too many times on a wound
Too many temperature changes delay wound healing
Should you let wounds air out?
No
What are the 5 indicators of infection? Which one is best?
Rubor, Calor, Dolor, Tumor, Functio Laesa
Dolor is best indicator
Instead of the word compliance, use the word _____ when describing patient participation
Adherence
What vitamin helps with collagen synthesis and helps w/ corticosteroid use?
Vitamin A
What vitamin is essential for blood clotting?
K
What are the 3 fat soluble vitamins
A E K
What are the 3 fat soluble vitamins
A E K
Why is prealbumin a better lab than albumin for indicating wound healing
Isolates more recent nutrition history
Debridement converts a chronic wound into what?
Back to the acute stage
What are the 4 selective debridement types?
What is the gold standard
Sharp, automatic, enzymatic, biological
Sharp
What are the 4 selective debridement types?
What is the gold standard
Sharp, automatic, enzymatic, biological
Sharp
What should you not debride?
Dry stable heel ulcer without edema
Granulation tissue
Anything you can’t identify
Cross hatching helps w/ what kind of debridement?
Autolytic
What is the only FDA approved enzymatic debridement
Is it appropriate for infection?
What can deactivate it?
How thick do you apply it?
Collagenase (santyl)
No
Silver and heavy metals
2mm (nickel thickness)
Contamination vs colonization vs critical colonization vs infection
Contamination - normal bacteria
Colonization- bacteria are dividing, but no risk to host
Critical colonization- detrimental to host, but not enough for an immune response
Infection- host response
A biofilm forms during what?
Can you test for it with a tissue biopsy?
What do you need to do?
Critical colonization
No
Debride
What are the ONLY wounds that you stage
Pressure injuries
