Final: Wound Care

Question 1

Which type of wound demonstrates normal physiology?

Answer 1

Acute wounds

-lacteration, avulsion, skin tear

Question 2

Which type of wound has delayed healing?

Answer 2

Chronic wounds

-diabetic ulcers, or other types of ulcers

Question 3

What are the goals of acute wound treatment? (3)

Answer 3

Avoid infection
Assist hemostasis
Provide an esthetically pleasing scar

Question 4

What are some important history topics to obtain for acute wounds? (5)

Answer 4

Mechanism of injury
Location
Time/Age of injury
Risk factors for healing
Associated symptoms

Question 5

What immunization is important to check on for acute wounds

Answer 5

Tetanus

Question 6

What is the most important physical exam to perform on an acute wound?

Answer 6

Complete neurovascular exam distal to the injury

Question 7

What are the three options for closure of acute traumatic wounds?

Answer 7

Primary closure
Delayed primary
Secondary intent

Question 8

Describe primary closure of a wound

Answer 8

Wound is closed in the acute phase, on initial presentation to provider
-lowest risk for scar and infection

Question 9

Describe delayed primary closure of a wound

Answer 9

Wounds present for >24 hours
-wound that is irrigated, cleaned and debrided with repair scheduled in next 4-6 days

Better than secondary healing

Question 10

Describe healing by secondary intent

Answer 10

Wound is allowed to heal spontaneously, and heals form inside out
-healing is slower and often leads to significant scarring

Question 11

How do you prepare/clean the skin for wound repair?

Answer 11

Povidone/iodine, or chlorhexidine on wound margin

Question 12

Do you soak wounds in water?

Answer 12

Nope, increases risk for infection

Question 13

What should you document before giving anesthesia?

Answer 13

A complete neuro exam of the area

Question 14

Should you use lidocaine with epi on fingers, nose, penis, toes, or ears?

Answer 14

Nope, those organs have single blood supply

-causes necrosis

Question 15

When are adhesive/steri-strips indicated for wound closure? (4)

Answer 15

Low tension
Linear wounds
Superficial
Areas of thin skin

Question 16

When is adhesives/glue indicated for wound closure?

Answer 16

Low tension
linear
superficial
<4cm

Question 17

When are staples indicated for wound closure?

Answer 17

Scalp lacerations

Linear laceration on trunk/extremities where cosmetics are not priority

Question 18

What is the most common way to close a wound?

Answer 18

Suture

Question 19

Which sutures are smaller (thinner), 11 gauge or 0 gauge?

Answer 19

11

-higher is thinner

Question 20

What are some examples of nonabsorbable sutures?

Answer 20

Monofilamentous: ethilon or prolene

Multifilamentous: silk

Question 21

What are some examples of absorbable sutures?

Answer 21

Vicryl, polysorb

Question 22

How long is a non-adhesive dressing left on sutures?

Answer 22

at leas 24 hours
-after which, nonabsorbale sutures can be cleaned with soap and water

Can also put on antibiotic ointment

Question 23

When should you prescribe prophylactic antibiotics?

Answer 23

For pts with increase risk for infection

• animal bites
• intraoral
• open fractures
• Deep wounds
• immunocompromised

Question 24

What are the common types of chronic wounds and describe how they happen?

Answer 24

Decubitus Ulcers
-from people in a sustained position for a long time; bedridden; over bony prominences

Diabetic foot Ulcers
-due to vascular compromise and infection; tx w Abs

Ischemic Ulcers

• due to lack of vascular supply (PAD)
• try to optimize blood flow

Venous stasis ulcers

• Venous HTN or dysfunction of valves
• Tx: compression therapy

Question 25

What are the goals of chronic wound treatment? (5)

Answer 25

``` Reduce pain, itching, odor Minimize infection Deal w excessive exudate Address psychologic issues Cover it ```

Question 26

How do you treat chronic wounds?

Answer 26

Optimize wound bed Apply dressing and topical agents Delayed closure for grafts

Question 27

How do wound dressings facilitate chronic wound healing

Answer 27

Eliminate dead space Controll exudate Prevent bacteria Ensure proper fluid balance

Question 28

When do you use antibiotics in chronic wounds?

Answer 28

Only in clinically evident infections!

Question 29

When is glue/adhesives contraindicated?

Answer 29

Bites Contaminated wounds Need to let these types of wounds drain

Question 30

``` What suture sizes should you use for: Face Scalp Trunk Extremities Oral ```

Answer 30

``` Face: 5-0 to 6-0 Scalp: 4-0 to 5-0 Trunk: 4-0 Extremities: 3-0 to 4-0 Oral: 4-0 to 5-0 ```

Question 31

Why should you remove sutures as fast as possible?

Answer 31

Longer the suture stays in, more of a scar

Question 32

How long should you wait to remove sutures for: Face Scalp Trunk Extremities

Answer 32

Face: 5 days Scalp: 5 days Trunk: 7-10 days Extremities: 7-10 days

Question 33

What stage of decubitus ulcer: intact skin that's red?

Answer 33

Stage 1

Question 34

What stage of decubitus ulcer: partial thickness loss with exposed dermis

Answer 34

stage 2

Question 35

What stage of decubitus ulcer: full thickness loss of skin, adipose tissue is present

Answer 35

stage 3

Question 36

What stage of decubitus ulcer: full thickness loss of skin with fascia, muscle, tendon or ligament exposed

Answer 36

stage 4