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FINAL REVIEW Flashcards

1
Q

Arterial ulcers are usually present where?

Pulse is usually _____

A

Lateral malleolus

Absent

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2
Q

Venous ulcers are usually present where?

Pulse is usually ______

A

Medial malleolus

Present

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3
Q

What is used if ankle brachial index (ABI) is unreliable due to plaque build up

A

TBI Toe Brachial Index

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4
Q

How is ABI calculated?

A

Ankle systolic / arm systolic

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5
Q

ABI under 0.5 means…

A

Impaired healing

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6
Q

ABI of less than ____ is contraindicated for compression

A

0.7

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7
Q

What kind of bandages are preferred for compression?

A

Short Stretch Bandages

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8
Q

Compression garmets are used mainly for…

A

Maintenance

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9
Q

What is considered strong compression?

Medium?

A

Strong = 30-40mmHG

Medium = 15-30mmHG

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10
Q

How can diuretics affect lymphedema

A

Make it worse due to excess protein

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11
Q

What is stemmer sign

A

Pinch dorsum of toe to test for lymphedema

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12
Q

What kind of bite is most common?

What kind of bite is most infectious?

A

Dog

Human

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13
Q

What kind of spider bite requires wound care?

A

Brown recluse

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14
Q

Myofibrogen does what?

Fibrogen does what?

A

Closed wound edges

Makes granulation tissue

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15
Q

How are lymphatic channels divided into the body (2 major ones)

A

The R arm and head, and then everything else

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16
Q

If you debride a wound and it becomes larger w/ more necrotic tissue by the next day, what are you suspecting

A

Pyoderma gangrenosum

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17
Q

Most pressure injuries occur where

A

Sacrum and Heels

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18
Q

How fast can a pressure injury occur??

A

Under 2 hours

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19
Q

Where are pressure injuries most common in children?

A

Occiput

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20
Q

It can take ______ days for a pressure injury to become apparent

A

2-7

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21
Q

What is a HAPI?

A

Hospital Acquired Pressure injury

Hospitals have 48 hours to document existing pressure injuries, anything new they have to pay for

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22
Q

What’s the 1# cause of pressure injuries in pediatrics

A

Medical Device Pressure Injury MDRPI

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23
Q

Incontinence increases pressure injury risk ______

A

X5

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24
Q

Pressure injury is most likely to occur ______ into hospitalization

A

First 3 weeks

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25
What is the number 1 and number 2 risk factor for pressure injuries
1# decreased mobility 2# nutrition
26
Braden scale does what?
Predicts PI risk, under 13 = high risk
27
Norton Scale does what??
Predicts PI risk, under 16= risk Under 13= high risk
28
Inter professional education reduces PI by ____% What 3 aspects?
90% Skin Checks Mobility Incontinence management
29
What blood test indicates PI risk?
Serum Albumin, 1 gram under normal increases PI risk by x4
30
Can you downstage pressure injuries?
No A stage 4 Is always a stage 4 until its healed
31
Nonblanchable erythema of intact skin
Stage 1 pressure injury
32
Partial thickness w/ exposed dermis
Stage 2 pressure injury
33
Full thickness skin loss ( may have undermining or tunneling)
Stage 3 pressure injury
34
Exposed bone muscle or tendon
Stage 4 pressure injury
35
Slough or Eschar obscures depth
Unstagable pressure injury (Either a stage 3 or stage 4 underneath)
36
Maroon or deep purple color on a pressure injury means what?
Deep tissue PI
37
What is the Pressure Ulcer Scale for Healing (PUSH)
Higher score = worse wound Can composite score for multiple PIs
38
Pressure relieving devices vs pressure reducing
Pressure relieving: reduces pressure below 23psi (The pressure of capillaries) Pressure reducing ( 32- 23 psi)
39
T or F, pressure injuries heal faster than other wounds
F they heal slower
40
Half of all burn victims are _____ Most burns occur where
Children Kitchen and bathroom
41
What’s the most common kind of burn
Thermal
42
Asphalt can cause a ________ burn What kind of this burn is most severe?
Chemical Alkaline (stronger burn than acidic)
43
What kind of electrical burn is worse, AC or DC
AC
44
Burn of only the epidermis
Superficial burn
45
Burn of some of the dermis (with blisters)
Superficial partial thickness
46
Burn with mottled white and red appearance, epidermis and dermis affected
Deep partial thickness burn
47
Burn with subcutaneous tissue exposed Usually little pain Mottled white gray black appearance
Full thickness burn AKA 3rd degree
48
Burn with charred or mummified appearance
Subdermal burn (4th degree)
49
What method of estimating TBSA in a burn is fastest and effective?
Rule of 9s Note: don’t use palmar method
50
What are the 3 zones for a burn
Zone of coagulation - center Zone of stasis- compromised perfusion Zone of hyperemia- erythema.around the burn
51
What happens to cardiac output after a burn
Decreases by 50%
52
_______ accounts for 50% of deaths in first 12 hours after a burn
Smoke inhalation
53
Up to 75% of all burn deaths are related to _____
Infection
54
What happens to basal metabolic rate after a burn?
Doubles or triples
55
What stage of healing do scars occur
Remodeling phase Compression wraps can prevent scar from forming
56
______ skin is x15 more likely to have hypertrophic scaring
Darker
57
Keloid scar vs hypertrophic
Keloid scar extends outside of the wound bed , hypertrophic does not
58
____ 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
59
Most joints must be put in _____to prevent contracture
Extension
60
MCP position to prevent contracture
Flexion
61
Thumb and finger position to prevent contracture
Abduction
62
Arm position to prevent contracture?
Flexion abd and ER
63
What is an escharotomy
They cut incisions into burn tissue to prevent constriction, improves distal circulation
64
Xenograft is from ____ Allograft is from ____ Autograft is from ___ Biosynthic?
Animal Cadaver Self Man-Made
65
Mesh vs full thickness skin graft?
Full thickness is more aesthetic and better for face and hands
66
Skin receives how much of resting cardiac output?
1/3
67
How many layers is the dermis How many layers is the epidermis?
2 5
68
Main cell of re-epitheliazaiton is what?
Keratinocyte
69
What cell makes up 90% of the epidermis
Keratinocyte
70
Is the epidermis vascular or avascular? What about the dermis?
Epidermis- avascular Dermis - vascular
71
What are the 4 phases of wound healing?
Hemostasis -> inflammation -> proliferation -> maturation/remodeling
72
What is the first cell to an injury site? What does it do
PMN (Polymorphic nuclear neutrophils) Secrete inflammatory mediators
73
What cells produce histamine
Mast cells
74
What are the 4 stages of proliferation
Angiogenesis -> granulation tissue formation -> wound contraction -> epithelialization
75
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
76
Primary vs secondary wound closure?
Primary.- w/ stitches Secondary- wound closes on its own
77
Wound w/ no progress in 2-6 weeks or not healed in a month according to Medicare
Chronic wound
78
Skin is normally between what PH?
4-6.5 Note: this is called the acid mantle
79
Chronic wounds have higher levels of what cells?
MMP
80
Why don’t you want to change dressing too many times on a wound
Too many temperature changes delay wound healing
81
Should you let wounds air out?
No
82
What are the 5 indicators of infection? Which one is best?
Rubor, Calor, Dolor, Tumor, Functio Laesa Dolor is best indicator
83
Instead of the word compliance, use the word _____ when describing patient participation
Adherence
84
What vitamin helps with collagen synthesis and helps w/ corticosteroid use?
Vitamin A
85
What vitamin is essential for blood clotting?
K
86
What are the 3 fat soluble vitamins
A E K
87
What are the 3 fat soluble vitamins
A E K
88
Why is prealbumin a better lab than albumin for indicating wound healing
Isolates more recent nutrition history
89
Debridement converts a chronic wound into what?
Back to the acute stage
90
What are the 4 selective debridement types? What is the gold standard
Sharp, automatic, enzymatic, biological Sharp
91
What are the 4 selective debridement types? What is the gold standard
Sharp, automatic, enzymatic, biological Sharp
92
What should you not debride?
Dry stable heel ulcer without edema Granulation tissue Anything you can’t identify
93
Cross hatching helps w/ what kind of debridement?
Autolytic
94
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)
95
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
96
A biofilm forms during what? Can you test for it with a tissue biopsy? What do you need to do?
Critical colonization No Debride
97
What are the ONLY wounds that you stage
Pressure injuries

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