Interventions in Wound Care

Question 1

Interventions

Answer 1

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

Question 2

How do you choose an intervention

Answer 2

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

Question 3

What will create an optimal environment

Answer 3

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

Question 4

Indications for whirlpool

Answer 4

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

Question 5

Risks related to whirlpool

Answer 5

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

Question 6

Temperature parameters for whirlpool

Answer 6

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

Question 7

Common additives for whirlpool

Answer 7

• Povidone iodine
• Sodium hypochlorite
• Hibiclens
• Chlorazene

Question 8

Contraindications for whirlpool

Answer 8

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

Question 9

Describe pulsatile lavage with suction

Answer 9

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

Question 10

Pulsatile lavage with suction advantages

Answer 10

• 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

Question 11

Pulsatile lavage with suction disadvantages

Answer 11

• 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

Question 12

Non-forceful irrigation

Answer 12

• pouring solution over wound bed

Question 13

Define debridement

Answer 13

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

Question 14

Non-selective debridement

Answer 14

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

Question 15

Wet to dry dressing

Answer 15

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

Question 16

Surgical debridement

Answer 16

• 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

Question 17

Selective debridement

Answer 17

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

Question 18

Sharp debridement

Answer 18

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

Question 19

Contraindications for sharp debridement

Answer 19

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

Question 20

Enzymatic debridement

Answer 20

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

Question 21

Disadvantages of enzymatic debridement

Answer 21

• 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

Question 22

Biosurgery/maggot & natural debridement

Answer 22

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

Question 23

Medical honey & natural debridement

Answer 23

• decreases wound odor
• softens necrotic tissue
• prevents bacteria

Question 24

Autolytic debridement

Answer 24

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

Question 25

Contraindications & disadvantages of autolytic debridement

Answer 25

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

Question 26

Common antiseptics

Answer 26

- 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

Question 27

Common antibacterials

Answer 27

- 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

Question 28

Ultrasound for wound healing

Answer 28

- stimulates cell activity - accelerates inflammation phase - speeds skin repair & contraction - stimulates collagen secretion - affects elastin properties to strengthen scar

Question 29

Estim for wound healing

Answer 29

- decreases bacterial load, edema, & inflammation - increases granulation - provides current support & promotes cellular activity

Question 30

Ultraviolet for wound healing

Answer 30

- increases granulation tissue, vitamin D, & blood flow - especially effective against MRSA & VRE

Question 31

Hyperbaric oxygen therapy (HBO) for wound healing

Answer 31

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

Question 32

Cold laser for wound healing

Answer 32

- increases wound healing & decreases peripheral neuropathy - increases circulation & decreases pain by release of citric oxide into microcirculation

Question 33

Negative pressure wound therapy (NWPT)

Answer 33

- 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

Question 34

Exercise for pressure reduction

Answer 34

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