Interventions in Wound Care Flashcards
1
Q
Interventions
A
- cleansing wound
- debridement
- topical agents
- mechanical modalities
- compression therapy
- pressure relieving devices
- dressings
- education
2
Q
How do you choose an intervention
A
- least invasive and most specific
- seek evidence based practice
- avoid overused agents
3
Q
What will create an optimal environment
A
- moist
- lacks necrotic tissue & exudate
- warm
- protected from trauma & infection
4
Q
Indications for whirlpool
A
- intensive cleaning
- heavy necrosis or debris
- moderate to heavy exudative wounds
- benefit for increased circulatory perfusion
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
6
Q
Temperature parameters for whirlpool
A
Tepid: 80-92 F
Neutral: 92-96 F
Thermal: 96-104 F
7
Q
Common additives for whirlpool
A
- Povidone iodine
- Sodium hypochlorite
- Hibiclens
- Chlorazene
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)
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
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
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
12
Q
Non-forceful irrigation
A
- pouring solution over wound bed
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
14
Q
Non-selective debridement
A
- removes both necrotic & living tissues
- frequently cause damage to nearby healthy tissue
- quick & painful
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
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
