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Complex Pt Management > Integumentary > Flashcards

Integumentary Flashcards

1
Q

What is the goal of inflammation? (vascular response)

A

Control bleeding, fight infectious agents

  • transudate leaks out of vessels: local edema
  • local blood vessesl contrict
  • 30 minutes of vasocontriction, vasodilation occurs: localized redness, warmth, edema
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2
Q

Cardinal Signs of inflammation

A

Edema, redness, warmth, pain, decreased function

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3
Q

What are the key cells in inflammation?

A
  • Polymorphonuclearnutrophils (PMNs) to sides of vessel walls

First to site of injury 12-24 hours, kill bacteria, clean wound, secrete matrix

  • Macrophages: kill pathogens, direct repair process
  • Mast cells: produce histamine and secrete enzymes to accelerate riddance of damage cells

(PPMM)

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4
Q

Key cells in proliferation

A
  • Angiogenesis: formation of new blood cells (angioblasts)
  • Granulation tissue - FIBROBLASTS lay down extracellular matrix (eventually replaced by scar tissue)
  • Wound contraction - myofibroblasts pull wound margins together
  • Epithelization - karatinocytes and epidermal appendages multiply and migrate across wound bed
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5
Q

Maturation Phase

A
  • Granulation tissue strengthened and reorgainzed
  • Rapid collagen synthesis

2 year following would closure 6-12 months greatest change

  • 80% of full strength tissue
  • Unable to sweat, less sensetive to touch and temp
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6
Q

What is an example of a systemic factor?

A

Age

  • slowed immune response
  • decreased collagen synthesis

Epidermal and dermal atrophy

less sweat

Decrease pain perception

Nutrition

Comorbidities

Affect O2 perfusion - PVD, anemia, COPD

Medications

Behavioral risks

Smoking

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7
Q

Primary (Primary intention) Would closure

A

Wound edges are approximated without/little formation of granulationtissue

Not seen by PT typically

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8
Q

Secondary (secondary intention) wound closure

A
  • Wound edges unable to be approximated

Granulation tissue fills wound bed (scar tissue)

PT more likely to be involved

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9
Q

What can lead to eschar formation and necrosis?

A

Low moisture levels

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10
Q

D I M E

A

Debridement

Inflammation/infection - stage of healing, infection, phase of healing

Moisture Balance - tissue type, immunocompromised, activity infection, out of proportion for phase of healing

Edge effect - progressing/stage rolled, callus clean

Local wound care and assessment

HEALABLE - Address underlying cause

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11
Q

Granulation tissue

A

Temporary scaffolding of vascularized conenctive tissue, healthing granulation is bright beefy red; if pale or dusky, blood supply may be poor or may be infected

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12
Q

Necrotic/Non-Viable tissue

A

Slough - yellow or tan, stringy or mucinous

Eschar - black and nectroic tissue,

Fascia, adimpose, muscle, tendon, joint, bone, new epithelium

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13
Q

Undermining

A

Tissue under wound edge is gone, similar to cave under skin

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14
Q

Serous Drainage

A

Protien rich fluid WBC

Clear-Pale yellow, watery

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15
Q

Sanguinous

A

Blood/Drying blood

Red/dark brown

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16
Q

Purulent

A

Indicator of Infection

White pale yellow creamy

17
Q

Odor in a wound

A

Assessed after irrigation or after cleanse

Caused by:

wound infection

non viable tissue

Old dressing

hot weather

18
Q

Irrigation

A

Use of fluid to remove loosely adherent cellualr debris, surface bacteria, would exudate, dressing residue, and residual topical agents

  • Facilitate debridement
  • Maintain moist wound environment
  • Enhave wound healing
19
Q

Irrigation CONTRAINDICATIONS

A
  • Do not immerse/soak
  • RECENT skin grafts
  • RECENT surgical insicion sites
  • Diabetic Feet
  • Active profuse bleeding wounds
  • Dry Gangrene
20
Q

Irrigation solutions and when to use them

A

Normal Saline (.9% Na Cl)

  • need to be warm

Sterile water

  • use with silver dressings

Tap

  • caution for immunocompromised

Would cleaners

  • Shur clens - sufactant oil
  • Vashe - antimicrobial
  • Wound wash
21
Q

Low Pressure Lavage

A

Irrigation without suction

Jetox:

  • 4-12 PSI
  • Wall O2 as pressure
  • Jet stream
22
Q

Whirlpool Contraindications

A
  • clean and granulating

Edematous, draining, macerated

Active bleedings

VI

Multi-wounds same area

Uncontrolled Seizures

B&B issues

23
Q

Pulse Lavage W/ Suction (PLWS)

A
  • Irrigation with suction

Pulse jets of irrigation with suction

creates NEGATIVE pressure

Positives:

-Cleaning disposable tips, site specific, sterile, no additives, temp range, portable, few contraindications

Negatives:

  • Expense, aerosolization risk, confined space, cover horizontal surfaces
24
Q

PLWS Contraindications

A

Exposed NAMED tissues (muscle, tendon, nerve, etc)

Body cavities (cannot visualize)

Facial wounds

Recent grafts or surgical procedures

Active bleeding

25
Q

Goals of Debridement

A
  • Decrease risk of infection
  • Increase effectiveness of topicals
  • Improve bacterial activity of leukocytes
  • Shorten inflammatory phase or conver from chronic to acute
  • Decrease energy required for body to heal
  • Eliminate physical barriers for closure
  • Tissue protection or Exam
  • Decrease wound odor
26
Q

What can PT’s debride?

A

Non-viable tissue, callus, blister

27
Q

Debridement contraindications

A
  • Arterial compromise
    • Stable, dry, hard eschar
28
Q

Sharp Debridement Precautions and contraindications

A

Precautions

  • Anticoagulant/clotting issues, pain
  • Immunosuppression
  • Unable to be still (contra)

Contraindications

  • PT comfort/skill level
  • Cannot see or ID tissue
  • Consent, not consistent with POC
  • Ischemic ulcers (AI)
  • Hypergranulation - live tissue
  • Pyoderma gangrenosum
29
Q

How to control bleeding from sharp debridement

A

Elevate, pressure x 10 min, silver nitrate

Pain control: meds 30 min prior, topicals, deep breathing

Contact MD: bleeding has pulse, wont stop heart it, fever/chills

30
Q

Debriding Blisters

A

Remove:

  • Larger than a nickel
  • area likely to rupture or tear
  • worried about possible tissue injury, burns
  • great medium for bacterial growth
31
Q

Enzymatic Debridement

A
  • Pain free, easy to apply

Can be used on infected wounds - polymyxin B powder

  • DO NOT USE WITH SILVER or IODINE products, HYDROGEN PEROXIDE, ACETIC ACID
  • Discontinue when clean (2 wks then use something else)
32
Q

Contraindications for Enzymes

A

Time frame - too long

  • not for deeper wounds (tracts/body cavities)
  • Named tissues)
  • Facial burns
33
Q

Autolytic Debridement

A
  • Selective
  • Conservative
  • Least painful
  • Maintains favorable wound environment (warm, moist) “cook”
34
Q

Autolytic Debridement Contraindications

A

Infection, dry gangrene, deep cavity wounds, other methods more appropriate

35
Q

Biosurgical Debridement

A

Maggot Therapy

Antimicrobial - MRSA, Strep, psudomonas, biofilm

Change in pH

  • Killing and ingestion of bacteria
  • Osteomylitis around hardare
  • cannot tolerate any other form

Complex Pt Management (12 decks)

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