Final: Wound Care Flashcards
Which type of wound demonstrates normal physiology?
Acute wounds
-lacteration, avulsion, skin tear
Which type of wound has delayed healing?
Chronic wounds
-diabetic ulcers, or other types of ulcers
What are the goals of acute wound treatment? (3)
Avoid infection
Assist hemostasis
Provide an esthetically pleasing scar
What are some important history topics to obtain for acute wounds? (5)
Mechanism of injury Location Time/Age of injury Risk factors for healing Associated symptoms
What immunization is important to check on for acute wounds
Tetanus
What is the most important physical exam to perform on an acute wound?
Complete neurovascular exam distal to the injury
What are the three options for closure of acute traumatic wounds?
Primary closure
Delayed primary
Secondary intent
Describe primary closure of a wound
Wound is closed in the acute phase, on initial presentation to provider
-lowest risk for scar and infection
Describe delayed primary closure of a wound
Wounds present for >24 hours
-wound that is irrigated, cleaned and debrided with repair scheduled in next 4-6 days
Better than secondary healing
Describe healing by secondary intent
Wound is allowed to heal spontaneously, and heals form inside out
-healing is slower and often leads to significant scarring
How do you prepare/clean the skin for wound repair?
Povidone/iodine, or chlorhexidine on wound margin
Do you soak wounds in water?
Nope, increases risk for infection
What should you document before giving anesthesia?
A complete neuro exam of the area
Should you use lidocaine with epi on fingers, nose, penis, toes, or ears?
Nope, those organs have single blood supply
-causes necrosis
When are adhesive/steri-strips indicated for wound closure? (4)
Low tension
Linear wounds
Superficial
Areas of thin skin
When is adhesives/glue indicated for wound closure?
Low tension
linear
superficial
<4cm
When are staples indicated for wound closure?
Scalp lacerations
Linear laceration on trunk/extremities where cosmetics are not priority
What is the most common way to close a wound?
Suture
Which sutures are smaller (thinner), 11 gauge or 0 gauge?
11
-higher is thinner
What are some examples of nonabsorbable sutures?
Monofilamentous: ethilon or prolene
Multifilamentous: silk
What are some examples of absorbable sutures?
Vicryl, polysorb
How long is a non-adhesive dressing left on sutures?
at leas 24 hours
-after which, nonabsorbale sutures can be cleaned with soap and water
Can also put on antibiotic ointment
When should you prescribe prophylactic antibiotics?
For pts with increase risk for infection
- animal bites
- intraoral
- open fractures
- Deep wounds
- immunocompromised
What are the common types of chronic wounds and describe how they happen?
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
What are the goals of chronic wound treatment? (5)
Reduce pain, itching, odor Minimize infection Deal w excessive exudate Address psychologic issues Cover it
How do you treat chronic wounds?
Optimize wound bed
Apply dressing and topical agents
Delayed closure for grafts
How do wound dressings facilitate chronic wound healing
Eliminate dead space
Controll exudate
Prevent bacteria
Ensure proper fluid balance
When do you use antibiotics in chronic wounds?
Only in clinically evident infections!
When is glue/adhesives contraindicated?
Bites
Contaminated wounds
Need to let these types of wounds drain
What suture sizes should you use for: Face Scalp Trunk Extremities Oral
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
Why should you remove sutures as fast as possible?
Longer the suture stays in, more of a scar
How long should you wait to remove sutures for:
Face
Scalp
Trunk
Extremities
Face: 5 days
Scalp: 5 days
Trunk: 7-10 days
Extremities: 7-10 days
What stage of decubitus ulcer: intact skin that’s red?
Stage 1
What stage of decubitus ulcer: partial thickness loss with exposed dermis
stage 2
What stage of decubitus ulcer: full thickness loss of skin, adipose tissue is present
stage 3
What stage of decubitus ulcer: full thickness loss of skin with fascia, muscle, tendon or ligament exposed
stage 4
