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Clinical Medicine I > Interventions in Wound Care > Flashcards

Interventions in Wound Care Flashcards

1
Q

Interventions

A
  • cleansing wound
  • debridement
  • topical agents
  • mechanical modalities
  • compression therapy
  • pressure relieving devices
  • dressings
  • education
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2
Q

How do you choose an intervention

A
  • least invasive and most specific
  • seek evidence based practice
  • avoid overused agents
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3
Q

What will create an optimal environment

A
  • moist
  • lacks necrotic tissue & exudate
  • warm
  • protected from trauma & infection
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4
Q

Indications for whirlpool

A
  • intensive cleaning
  • heavy necrosis or debris
  • moderate to heavy exudative wounds
  • benefit for increased circulatory perfusion
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5
Q

Risks related to whirlpool

A
  • contamination
  • dependent position
  • disruption granulation tissue
  • maceration & skin breakdown
  • prolonged inflammation
  • increased HR & RR
  • cytotoxic agents
  • time consuming
  • limited reimbursement
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6
Q

Temperature parameters for whirlpool

A

Tepid: 80-92 F
Neutral: 92-96 F
Thermal: 96-104 F

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7
Q

Common additives for whirlpool

A
  • Povidone iodine
  • Sodium hypochlorite
  • Hibiclens
  • Chlorazene
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8
Q

Contraindications for whirlpool

A
  • moderate to sever edema
  • lethargy
  • unresponsiveness
  • maceration
  • febrile conditions
  • acute phlebitis
  • dry gangrene
  • renal failure
  • urinary or fecal incontinence (if in full WP)
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9
Q

Describe pulsatile lavage with suction

A
  • forceful irrigation combined with suction
  • removes irrigated fluid, wound exudate, & loose debris
  • reduces bacteria & infection
  • promotes granulation & epithelialization
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10
Q

Pulsatile lavage with suction advantages

A
  • any time any place
  • less use of resources
  • easier to clean up
  • low cross contamination
  • removes contaminants
  • reaches tunneling & undermining
  • delivers antibiotics, antiseptics, & bacterial solutions
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11
Q

Pulsatile lavage with suction disadvantages

A
  • overuse on clean
  • risk of trauma from treatment
  • can be painful
  • must be skilled with technique
  • get aerosolization of microorganisms
  • equipment is one use & disposable
  • PPE for every use
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12
Q

Non-forceful irrigation

A
  • pouring solution over wound bed
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13
Q

Define debridement

A
  • removal of foreign material, dead, & damaged tissue (slough & eschar)
  • necessary to prevent & control bacterial growth to promote wound healing
  • non selective/selective
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14
Q

Non-selective debridement

A
  • removes both necrotic & living tissues
  • frequently cause damage to nearby healthy tissue
  • quick & painful
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15
Q

Wet to dry dressing

A
  • wet gauze to wound –> dry –> remove
  • removes good tissue, necrotic tissue, endogenous fluids, fibrin, & other critical cells
  • causes trauma & bleeding
  • uncomfortable
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16
Q

Surgical debridement

A
  • rapid results performed in or under anesthesia
  • life threatening necrosis or widespread infection
  • large wound or infected bone
  • wide excision of viable & non viable issue
17
Q

Selective debridement

A
  • removes necrotic tissue in controlled manner
  • generally more comfortable & gentle
  • remove tissue more slowly
  • avoid bleeding of tissue
18
Q

Sharp debridement

A
  • gold standard
  • bedside or treatment room
  • no bleeding should occur
  • selective removal of dead or necrotic tissue using sterile instruments
19
Q

Contraindications for sharp debridement

A
  • arterial insufficiency
  • vascular wounds with limited blood flow
  • if the wound has tunneling
  • patients who’s blood can’t clot well
20
Q

Enzymatic debridement

A
  • application of enzymes to dissolve necrotic tissue
  • not active on a dry environment
  • is effective with other types of debridement
21
Q

Disadvantages of enzymatic debridement

A
  • often used longer than necessary
  • may be slow to achieve success
  • may require frequent dressing changes
  • eschar must be cross hatched with a scapel
  • may cause dermatitis
22
Q

Biosurgery/maggot & natural debridement

A
  • removes devitalized tissue
  • decrease risk of infection
  • osteomyelitis & deep chronic wounds
23
Q

Medical honey & natural debridement

A
  • decreases wound odor
  • softens necrotic tissue
  • prevents bacteria
24
Q

Autolytic debridement

A
  • endogenous enzymes breakdown & digest devitalized tissue
  • promote granulation
  • occlusive dressing for 3-7 days
  • cross hatching
  • least invasive & most selective
25
Q

Contraindications & disadvantages of autolytic debridement

A

Contraindication: dry gangrene
Disadvantages: odor & exudate, caregiver requires education to prepare wound

26
Q

Common antiseptics

A
  • providone iodine
  • hypochlorite solutions: purulent exudate, cytotoxic at very dilute levels
  • acetic acid: more damaging to tissue than bacteria
  • oxidizing agents: non selective debridement of small debris
  • all are contraindicated for non-infected wounds
27
Q

Common antibacterials

A
  • Bacitracin: allergic reactions
  • Neosporin: increases allergic reactions
  • Silvadene: selectively toxic to bacteria & burns
  • Furacin: cytotoxic
  • Sulfamylon: diffuses thru eschar & burns
  • Bactraban/Mupirocin: staph infection
  • Gentamicin: staph & streptococcus
28
Q

Ultrasound for wound healing

A
  • stimulates cell activity
  • accelerates inflammation phase
  • speeds skin repair & contraction
  • stimulates collagen secretion
  • affects elastin properties to strengthen scar
29
Q

Estim for wound healing

A
  • decreases bacterial load, edema, & inflammation
  • increases granulation
  • provides current support & promotes cellular activity
30
Q

Ultraviolet for wound healing

A
  • increases granulation tissue, vitamin D, & blood flow
  • especially effective against MRSA & VRE
31
Q

Hyperbaric oxygen therapy (HBO) for wound healing

A
  • delivers 100% oxygen to pressure > than atmosphere
  • increases O2 available for cell metabolism, improving O2 delivery to hypoxic tissue
  • risk of oxygen toxicity
32
Q

Cold laser for wound healing

A
  • increases wound healing & decreases peripheral neuropathy
  • increases circulation & decreases pain by release of citric oxide into microcirculation
33
Q

Negative pressure wound therapy (NWPT)

A
  • applies localized negative pressure to draw the edges of the wound to the center
  • foam insert is placed in wound & covered to achieve an air tight seal
  • increases removal fluids from wound
  • increases granulation tissue & approximation
  • increases oxygen levels
  • allows for earlier grafting than conventional dressings
34
Q

Exercise for pressure reduction

A
  • increases strength & ROM
  • improve quality of movement
  • allow pressure relief
  • assist with muscle pump action for circulation
  • prevent pressure ulcers

Clinical Medicine I (26 decks)

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