Integ Exam Intro- Class 3 Flashcards
when did PT get involved with wounds
first and second world wars
were called reconstruction aides
primarily infected gun shot wounds
role of PT
sharp debridement
modalities
dressing selection
compression therapy
fxnal mobility
education
our role is
fxnal based
wound management
role –> fxnal based
biomechanics and fxnal mobility
strengthening and ROM
ADLs
discharge planning
pt education
biomechanics and fxnal mobility
WB considerations
mobility considerations
wound management –> role
wound assessments and interventions
pt eduacation
wound assessments and interventions
wound bed prep
dressing recommendations
wound care modalities
compression therapy
wound bed prep
debridement
layers of the skin
epidermis
dermis
subcutaneous tissue
fxn of the skin
protective
immunological
homeostasis
thermoregulation
neurosensory
social-interaction
metabolist
partial thickness would
includes the epidermis and part of the dermis
full thickness wound
through dermis
may extend into subcutaneous tissue, muscle and bone
wound
structural or physiological disruption of skin that incites normal or abnormal repair responses
acute wounds
heal in a timely manner
go through an expected course of tissue repair
chronic wounds
fail to heal in an expected time frame
arterial, venous, neuropathic nature
types of wound repair
primary intention
secondary intention
tertiary intension
primary intention
surgical intervention to heal a wound
secondary intension
our body heals on its own
the body granulates and create scar tissue on its own
epithelization to resurface the wound
tertiary intention
wound is left open for a reason
left open for 4-5 days
then cleaned out again and sewed back up
reasons to leave a wound open –> tertiary
allow infection, inflammation and moisture to leave the wound
avoid tension necrosis
all 3 types of healing…
go through the same 3 phases of healing
whats the difference b/w the 3 types of healing
scar tissue formation
phases of healing
inflammatory
proliferative
maturation
inflammatory phase –> signs
edema
erythema
warmth
pain
inflammatory phase characterized by
vascular and cellular response
inflammatory phase has a predominance of
leukocytes –> macrophages
proliferative phase
formation of granulation tissue and reepithelization
the proliferative phase includes
wound contraction
maturation phase
collagen fibers reorganize
scar strength 70-80% of normal skin
vascular response –> inflammatory phase
platelets activate
fibrinogen is converted
vasoconstriction
what is released during the vascular phase of the inflammatory phase
chemoattractant
_______ of leukocytes –> vascular response
margination
macrophages…. –> vascular response
predominate
the proliferative phase is predominated by
cellular activity to repair traumatized tissue
what cellular activity repairs tissue –> proloferative phase
neovascularization
fibroplasia
re-epithelization
neovascularization –> proliferative phase
growth factors, low O2 and lactic acid promote angiogenesis
fibroplasia –> proliferative phase
formation of granulation tissue
formation of granulation tissue –> fibroplasia
dense vascular network
fibroblasts and ground substance (extracellular matrix)
–> matrix contains collagen and elastin
proliferative phase includes
wound contraction
proliferative phase –> re-epithelialization
keratinocyte migration
form wound edge –> within wound
combination of granulation and epithelium tissue
biochemically correct wound environment
biochemically correct wound environment
the wound will close
keep it moist (do not let it dry out) and keep a dressing on it
how long does the remodeling phase last
up to a yr or more
in the remodeling phase –> fibers are
reoriented
what happens to the extracellular matrix in the remodeling phase
consistency changes
wound strength –> remodeling phase
reaches up to 80% of pre-injured state
factors impeding wound healing
local factors
clinician induced factors
systemic factors
local factors
bio-burden
tissue perfusion
wound desiccation
foreign bodies
pressure
shear
friction
bio-burden
bacterial loads: 10^5/gm of tissue = clinical infection
tissue perfusion
macro v. micro circulation
shear
undermining
systemic factors
stress situations
obesity
temp
comorbidities
nutrition
age
stress situations
psychological stress, pain or noise
obesity
increased complications –> increased infections and days on a vent –> decreased tissue perfusion and oxygenation
immobility and prolonged hospitalization
temp
hypothermic stress –> thermoregulatory vasoconstriction
comorbidities
DM
immunocompromised conditions
cancer
arterial/venous insufficiency
nutrition
essential for body’s response to infection and injury
serum albumin
< 3.5 g/dL
gives picture of the past three weeks on nutrition
decreases as we get older
affected by dehydration
prealbumin
< 18g/ dL
not eating enough, gives picture of last 2-3 days
little more accurate
elderly pts –> nutrition
@higher risk from decreased appetite
difficulties with eating and swallowing
age –> decreased
healing response
cohesion b/w epidermal and dermal layers
skin moisture
clinical consideration –> age
dressing frequency
selective v. non-selective
decreased cytotoxic agents
clinician induced factors
meds
topical agents
over utilization
dressing
poor infection control
meds
antibiotics
steroids
NSAIDS
immunosuppressing drugs
topical agents
bacteriostatic and cytotoxic (to fibroblasts)
over utilization
whirlpool
electrical stimulation
intermittent pneumatic compression therapy
dressings
wet –> dry dressings
synthetic dressings
dressings adhesives
wet–> dry dressings
for mechanical debridement only
when packed to firmly
pieces of gauze fibers left behind
when gauze allowed to dry out
synthetic dressings
when used improperly
dressing adhesives
may cause skin tears
poor infection control
clinicians who dont wash their hands
no gloves donned
poor sterile technique
wound infections will
delay healing
how do wound infections delay healing
affecting collagen metabolism
-decreases synthesis
-increases lysis of collagen
effects of wound infections are related to
toxins
enzymes
wastes from bacteria deposited into environment
infections decrease
amount of O2 for collagen synthesis and for oxidative killing by neutrophils
goal for health care team
to prevent bacterial contamination of wounds
to deal with present infections
to prevent contamination of themselves and of other pts when caring for other pts with infections
local infection
erythema or skin discoloration
edema
warmth
induration
increased pain
purulent wound exudate w/ or w/o foul odor
systemic infection
increased temp
increased WBCs
confusion or agitation
red streaks from wound
tachycardic
tachypneic
hypotension
inflamed v. infected –> erythema
inflamed –> well defined borders, not as intense
infected: intense discoloration, well demarcated and distinct borders, red stripes and streaking
inflamed v. infected –> temp
inflamed: elevated locally
infected: systemic fever
inflamed v. infected –> exudate character
inflamed: bleedings and serosanguinous –> serous
infected: serous and seropurulent –> purulent
inflamed v. infected –> exudate amount
inflamed: usually minimal, decreases in 3-5 days
infected: mod-heavy and remains high
inflamed v. infected –> exudate odor
inflamed: +/- due to necrotic tissue
infected: specific to pathogen
inflamed v. infected –> pain
inflamed: variable
infected: persistent
inflamed v. infected –> edema and induration
inflamed: slight swelling, firmness at wound edge
infected: edema and induration is localized and with warmth
