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WOUND CARE > Intro to Wound Care > Flashcards

Intro to Wound Care Flashcards

1
Q

What are the phases of wound healing?

A

Hemostasis –> inflammation –> proliferation –> remodeling

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2
Q

Characteristics of hemostasis

A

Platelets are primary players; involves activation of the clotting cascade and PLT aggregation (minutes)

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3
Q

Characteristics of inflammation

A

Involves increased presence of WBCs & cytokines to invade tissue space, clear debris - usually lasts 1-3 days

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4
Q

Characteristics of proliferation

A

Involves process of laying down granulation tissue and epithelization; fibroblasts are the key player (usually around 10 days)

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5
Q

Characteristics of remodeling

A

Involves increasing tissue tensile strength and formation of collagen (100 days or more)

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6
Q

Factors that limit healing of chronic wounds

A

Infection, malnutrition, edema, ischemia, pressure necrosis

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7
Q

What percentage of surgical wounds subsequently develop complications?

A

~5%

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8
Q

ISTAP type 1

A

skin tear without tissue loss

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9
Q

ISTAP type 2

A

skin tear with partial tissue loss

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10
Q

ISTAP type 3

A

skin tear with deep tissue loss

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11
Q

What is the MC reason why DFUs do not heal?

A

Inadequate offloading techniques

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12
Q

What percentage of DFUs Wagner Score 3+ do not heal?

A

~70%

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13
Q

Marjolin’s ulcer

A

malignancy that occurs @ the site of a long-standing wound

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14
Q

Signs/symptoms of wound infection

A

SIRS criteria, purulence, pain, necrosis, odor, fever, lymphangitis, PW rubor

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15
Q

How many cm beyond PW is considered clinically-significant cellulitis?

A

> 2cm

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16
Q

At what ABI level can full compression techniques be used?

A

ABI >0.70

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17
Q

General protein intake guidelines for wound healing

A

Protein: 1.75-2g/kg/day

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18
Q

General protein intake guidelines for patients with ESRD

A

0.75 g/kg/day

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19
Q

Absolute contraindications to NPWT

A

active untreated osteomyelitis/infection, malignancy, unexplored fistulas, necrotic tissue

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20
Q

When are skin substitutes indicated?

A

Wounds that have not healed by >50% in a 30 day span despite use of conventional therapy

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21
Q

BRADEN score characteristics

A

mobility, sensory perception, moisture, activity, nutrition, friction & shear

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22
Q

Uses of hyperbaric O2

A

ANEMIA, burns, CO poisoning, crush injuries, gas gangrene, hearing loss, osteomyelitis, Wagner 3+ DFUs, radiation skin necrosis, skin grafts at risk of necrosis

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23
Q

Hyperbaric O2 MOA

A

delivers 3x the normal [O2] in blood plasma to affected areas, resulting in higher [O2] at end-organ areas

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24
Q

Hyperbaric O2 ADRs

A

ocular toxicity, transient myopia, cataract growth, barotrauma, CNS toxicity, oxygen toxicity, flash pulmonary edema, confinement anxiety, paresthesias

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25
Q

Absolute CI to hyperbaric O2

A

untreated pneumothorax

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26
Q

Relative CIs to hyperbaric O2

A

patients previously treated with bleomycin & doxorubicin & cisplatin; disulfiram, amiodarone, sulfamylin, chronic sinusitis, seizure disorders, emphysema with CO2 retention, active malignancies, pregnancy

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27
Q

Characteristics of wound bed in chronic wounds (>4 weeks)

A

Exudate of chronic wounds contains higher levels of MPP; suggests slower tissue regeneration & delayed wound closure
-prolonged inflammatory phase –> impaired angiogenesis & neovascularization

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28
Q

What phase of wound healing do chronic wounds stay in?

A

Inflammatory phase

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29
Q

Transcutaneous oximetry (TCOM)

A

estimates the partial pressure of oxygen on the skin surface using non-invasive electrodes

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30
Q

What can TCOM be used for?

A

screening tool for PAD

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31
Q

What TCOM is typically referenced as representative of tissue hypoxia sufficient to delay wound healing?

A

TCOM <40 mmHg

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32
Q

What TCOM value is referenced as suggestive/indicative of critical limb ischemia?

A

TCOM <30 mmHg

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33
Q

Emergent hyperbaric O2 indications

A

acute CO poisoning, arterial gas embolism, decompression sickness

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34
Q

Urgent hyperbaric O2 indications

A

acute PAD, compartment syndrome, crush injuries, Central retinal artery occlusion, gas gangrene, compromised skin grafts/flaps, pyogenic & invasive fungal intracranial abscesses, acute blood loss anemia

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35
Q

Elective hyperbaric O2 indications

A

DFUs, chronic refractory osteomyelitis, soft tissue radiation skin necrosis, osteonecrosis of the jaw

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36
Q

Indications for air breaks during hyperbaric O2 therapy

A

prevents cumulative effects of hyperbaric O2 toxicity

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37
Q

PUSH tool

A

Assesses wounds via 3 characteristics: (1) size, (2) exudate type & amount, (3) tissue characteristics

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38
Q

BWAT tool

A

Assesses wounds using 15 characteristics
-size, depth, edges, UM, necrosis, exudate, PW skin color, peripheral tissue edema, induration, granulation tissue, epithelization

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39
Q

After how long (when acquired) is a wound considered a hospital or system acquired PI?

A

24 hours

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40
Q

Approach to informed consent

A

(1) assess capacity
(2) if unable to consent, reach out to POA for consent

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41
Q

EBP grading - Category 1A

A

Well-supported & recommended for implementation

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42
Q

EBP grading - Category 1B

A

Has supporting evidence & is recommended for implementation

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43
Q

EBP grading - Category 1C

A

Industry standard

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44
Q

EBP grading - Category II

A

Has supportive clinical studies

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45
Q

EBP grading - Category III

A

Described in clinical studies

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46
Q

EBP grading - Category IV

A

Expert opinion

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47
Q

Goals of palliative wound care

A

Reduce pain, minimize risk of infection, control odor

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48
Q

Is palliative wound debridement allowed?

A

Yes - in terms of debridement to minimize risk of infection

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49
Q

Functions of the skin

A

acts as a protective barrier against outside pathogens; prevents moisture loss; reduces UV radiation effect; sensory organ; temperature regulation; vitamin D production

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50
Q

What are the primary cells of the dermis?

A

fibroblasts

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51
Q

Papillary dermis

A

superficial layer of the dermis composed of loose connective tissue that is highly vascularized

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52
Q

Functions of the hypodermis

A

connection, insulation, shock absorption for organs, energy storage

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53
Q

Reticular dermis

A

deeper layer of the dermis composed of thick connective tissue

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54
Q

Layers of the epidermis (deep to superficial)

A

stratum basale –> stratum spinosum –> stratum granulosum –> stratum lucidum –> stratum corneum

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55
Q

Primary healing

A

active healing via an additive mechanism (i.e. sutures or staples)

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56
Q

Secondary healing

A

healing that occurs via re-epithelization that cannot be closed via primary intention

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57
Q

Tertiary healing

A

healing via delayed primary closure

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58
Q

What (technically speaking) does an ulcer refer to?

A

A wound that has been present for >4 weeks; AKA a chronic wound

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59
Q

Causes of hypergranulation

A

topical skin infection, malnutrition, impaired inflammatory phase/state, microtrauma

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60
Q

Management of hypergranulation

A

chemical cautery(primary), topical steroids, debridement

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61
Q

1+ edema

A

2mm sized wheel and takes 10-15 seconds to return to baseline

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62
Q

2+ edema

A

4mm wheel and takes 10-15 seconds to return to baseline

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63
Q

3+ edema

A

6mm wheel and takes <1 minute to return to baseline

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64
Q

4+ edema

A

8mm wheel and takes 2-5 minutes to return to baseline

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65
Q

Signs/symptoms of infection

A

PW induration, rubor >2cm beyond margins, lymphangitic streaking, localized warmth & tenderness to palpation, purulence, odor, necrosis, hypergranulated tissue

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66
Q

MC sites for pressure injuries

A

MC site is the sacrum (heels: 2nd MC)

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67
Q

External mechanical forces that result in pressure wounds

A

pressure, shear & friction

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68
Q

Intrinsic factors that lead or precipitate pressure wounds

A

age, nutrition, moisturize, body temperature

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69
Q

Stage 1 pressure wound

A

characterized as non-blanchable tissue usually over a bony prominence

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70
Q

Treatment for S1 pressure wounds

A

offloading of the affected areas +/- skin prep

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71
Q

Stage 2 pressure wound

A

involves partial thickness skin loss (dermis)

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72
Q

Stage 3 pressure wound

A

Involves full thickness wound without exposed soft tissue or bone

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73
Q

Stage 4 pressure wounds

A

Involves soft tissue skin loss/exposure (exposed muscle, tendon, ligament, bone, capsule)

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74
Q

Unstageable pressure wound

A

wound base is completed covered by eschar or slough and therefore an appropriate stage cannot be determined

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75
Q

Deep tissue pressure injury

A

non-blanchable deep red/maroon-colored wound or epidermal separation revealing a dark wound bed due to extensive tissue necrosis; may resolve completely or unveil a S3 or S4 pressure wound

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76
Q

Kennedy terminal ulcer

A

the presence of a rapid-onset & rapidly-deteriorating wound (MC on the sacrum) due to end organ skin failure as a result of end of life skin changes

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77
Q

Why are lubricants essential in preventing pressure wounds?

A

lubrication allows for reduction friction & shear –> reduction of pressure wound occurrence

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78
Q

What are the criteria for using silicone sacrum dressings for pressure wound prevention?

A

BRADEN score <18 and ANY of the following:
-vasopressor use, trach’d or intubated, spinal cord injury, TBI, age >60 YO

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79
Q

Incontinence Associated Dermatitis (IAD)

A

presence of skin inflammation due to prolonged skin exposure to urine & stool

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80
Q

Does a normal ABI rule out presence of microvascular disease?

A

No - low sensitivity

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81
Q

Wagner scale 0

A

intact skin

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82
Q

Wagner Score 1

A

superficial skin loss (as deep as SQ)

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83
Q

Wagner Score 2

A

deep tissue loss (exposed tendon, bone, capsule)

84
Q

Wagner Score 3

A

abscess, osteomyelitis, or tendinitis/deep space infection

85
Q

Wagner Score 4

A

gangrene of toes and forefoot

86
Q

Wagner Score 5

A

gangrene of the entire foot

87
Q

Are Darco offloading shoes appropriate for open wounds?

A

No - only prevent formation of new ulcers
-existing ulcers require total contact casts or knee walkers

88
Q

What percentage of DFUs will become infected?

A

~60% or greater

89
Q

What is the gold standard technique/test for diagnosing acute osteomyelitis?

A

bone biopsy

90
Q

What is the gold standard test for diagnosing acute wound infection?

A

tissue biopsy

91
Q

Which sites are tested in the Semmes-Weistein Monofilament Test?

A

10 total sites
-9 plantar (distal great toe, 3rd toe, 5th toe, 1st/3rd/5th metatarsal heads, medial foot, lateral foot, heel)
-1 dorsal (1st-2nd toe web space)

92
Q

A positive Semmes-Weinstein monofilament test indicates:

A

polyneuropathy
-4 or more sites with lack of sensation is a positive result

93
Q

Contraindications for sharp debridement

A

ABI <0.60, INR >1.5, factor Xa inhibitor use

94
Q

How long does a factor Xa inhibitor need to be discontinued for prior to sharp debridement?

A

> 48 hours prior to debridement

95
Q

Risk factors for arterial ulcers

A

> 65 YO, hx PAD/DM/HTN/Dyslipidemia, known atherosclerosis in other vessels

96
Q

Pathophysiology of arterial ulcers

A

tissue ischemia with intermittent reperfusion leads to release of ROS –> oxidative damage to ulcer site

97
Q

What percentage of venous ulcers recur after closure?

A

~70%

98
Q

Risks of venous ulcer formation

A

CVD, obesity, prior leg injury, DVT, prolonged standing/sitting

99
Q

Risks for delayed venous ulcer healing

A

ulcer presence >6 months, >50 YO, male, family history, BMI >33, location on the posterior ankle/calf

100
Q

Population at risk for venous ulcer recurrence

A

DVT & thrombophilic disease

101
Q

What are the characteristics of a simple venous leg ulcer?

A

area <100 cm^2, onset <6 months, limited comorbidities

102
Q

What are the characteristics of complex venous leg ulcers?

A

area >100 cm^2, presence >6 months, <30% decrease in size after 4 weeks of therapy, lipedema, leg/ulcer infection, decompensated or severe heart failure, non-compliance, lymphovenous disease

103
Q

When is an Unna boot not appropriate for a patient in the absence of arterial disease?

A

If the patient is immobile - Unna boot requires intact calf pump for venous return

104
Q

Treatment of stasis dermatitis

A

moisturizers/creams, topical steroids, zinc/calamine rolled gauze

105
Q

Ways to prevent venous ulcer recurrence

A

compression, leg elevation, weight control, proper skin care, smoking cessation, calf muscle exercises
-complex VLUs may require vascular surgery consultation/intervention

106
Q

Characteristic specifically associated with pyoderma in terms of debridement

A

Pyoderma will worsen with debridement

107
Q

Diagnostic criteria for pyoderma

A

Biopsy demonstrative of neutrophilic culture PLUS at least 4 of the following: exclusion of infection, pathergy, history of autoimmune disease, tenderness with erythema at ulcer site, multiple ulcers with rapid progression)

108
Q

Management of pyoderma gangrenosum

A

steroids & treatment of the underlying disease

109
Q

3 Ps of vasculitis

A

palpable, painful, purpura

110
Q

Epidermolysis bullosa

A

group of rare skin diseases that cause fragile, blistering skin

111
Q

Cryoglobulinemia

A

systemic inflammatory process of kidneys/joints/skin caused by immune deposition of cryoglobulin resulting in extremely erythematous skin lesions

112
Q

Marjolin ulcer

A

type of squamous cell carcinoma (SCC) that arises in areas of chronic wounds or scars that features an everted wound margin & ulceration
-requires biopsy for diagnosis

113
Q

Kaposi sarcoma

A

AIDS-defining skin malignancy that manifests as multiple brown or black patches

114
Q

Melanoma ABCDE rule

A

A: asymmetry
B: borders
C: color
D: diameter
E: evolution

115
Q

Fungating/ulcerating mass

A

complication of carcinoma with skin disfigurement associated with extreme pain & foul odor; often suggestive of end of life/near mortality

116
Q

Calciphylaxis

A

life-threatening skin disorder characterized by microvessel occlusion in SQ adipose tissue & dermis; associated with ESRD

117
Q

Management of Calciphylaxis

A

sodium thiosulfate, infection control/debridement, Calcium & Phosphorous management/repletion, Vitamin K1 therapy

118
Q

LRINEC score

A

scoring criteria to help rule in/rule out presence of necrotizing fasciitis

119
Q

LRINEC score criteria

A

CRP, WBC count, hemoglobin, sodium, creatinine, glucose

120
Q

LRINEC score of 8+

A

highly specific for necrotizing fasciitis (~94%)

121
Q

MC type of skin cancer

A

Basal Cell Carcinoma

122
Q

Head (rule of nines)

A

9%

123
Q

Arms (rule of nines)

A

9% each arm

124
Q

Legs (rule of nines)

A

18% each leg

125
Q

Torso (rule of nines)

A

18%

126
Q

Back (rule of nines)

A

18%

127
Q

Perineum (rule of nines)

A

1%

128
Q

Goals of debridement

A

removal of biofilm/necrosis, mechanical barriers, initiates coordinated inflammatory response, removal of bioburden/MMPs, enhances GF stimulation

129
Q

What is biofilm?

A

An aggregate of microorganisms with a matrix of ECM/substances which adhere to each other & wound surface that are impervious to washing & mechanical pressure

130
Q

Sharp debridement & biofilm

A

sharp debridement of biofilm will make bacteria susceptible to antibiotic therapy within a therapeutic window (24-48 hours)

131
Q

Contraindications to sharp debridement

A

unstable medical condition; hemodynamic instability; pyoderma gangrenosum; dry eschar without evidence of infection; ABI <0.6; presence of significant coagulopathy (INR >3.5, PPT >45 seconds), PLTs <30K

132
Q

Why are wet to moist dressings preferred over wet to dry dressings?

A

Wet to moist dressings help prevent removal of healthy granulation tissue with subsequent wound dressing changes that would not occur with wet to dry dressings

133
Q

Why is autolytic debridement alone not indicated for infected wounds?

A

Autolytic debridement amplifies effect/use of the body’s natural enzymes to destroy bioburden; this effect may not be amplified greatly enough in the face of active infection to clear bioburden

134
Q

When using biologic debridement, the outer layer dressing must be __ in order to work effectively

A

semi-permeable

135
Q

MIST therapy MOA

A

MIST therapy utilizes water filtered infrared light to cause an increase in local temperature at the wound bed –> local vasodilation –> increased oxygenation at the wound bed

136
Q

ABI >1.4

A

Indicative of calcified arteries
**requires follow-up with TBI for a true read

137
Q

ABI 0.9-1.3

A

normal value

138
Q

ABI 0.7-0.9

A

mild PAD

139
Q

ABI 0.5-0.7

A

moderate PAD

140
Q

ABI <0.5

A

severe PAD; potential (or likely) critical limb ischemia

141
Q

TBI >0.70

A

normal value

142
Q

TBI 0.5-0.7

A

mild PAD

143
Q

TBI 0.35-0.5

A

Moderate PAD

144
Q

TBI <0.35

A

Severe PAD

145
Q

Why are TBIs indicated/more accurate for patients with DM?

A

ABIs are usually artificially elevated in patients with DM due to significant arterial stiffening, leading to artifically higher ABI values for these patients

146
Q

TCOM >40mm Hg

A

recognized as adequate oxygenation/sufficient for wound healing

147
Q

TCOM 20-40mmHg

A

Indeterminant oxygenation status for wound healing

148
Q

TCOM <20mmHg

A

Indicative of tissue ischemia/not sufficient for wound healing

149
Q

What is the gold standard scoring tool/test to diagnose malnutrition?

A

ASPEN criteria

150
Q

Adequate hydration necessary for wound healing

A

1600 mL/24 hours

151
Q

Clinical manifestations of PAD

A

dry/leathery skin, atrophic skin, cool extremity, absence of hair below the knee, “punched out” ulcer appearance

152
Q

What angle must the doppler be held when determining ABI?

A

45 degree angle

153
Q

What TCOM value is incompatible with wound healing?

A

<30mmHg

154
Q

What is the primary function of fibroblasts?

A

epidermal re-surfacing

155
Q

MC post-operative complication of flap placement

A

Hematoma

156
Q

What is the optimal PSI for wound cleaning?

A

10mmHg

157
Q

Function of keratinocytes

A

GF/MMP release, protection against infection, assists with thermoregulation

158
Q

What direct effect does glycemic control have on the body/immune system?

A

improves neutrophil function

159
Q

What is the most common organism found in DFUs?

A

S. aureus

160
Q

Braden score of 9 or less

A

very high risk for PI

161
Q

Braden score of 10-12

A

High risk for PI

162
Q

Braden score of 13-14

A

Moderate risk for PI

163
Q

Braden score of 15-18

A

Mild risk of PI

164
Q

Braden score of 19+

A

No risk for PI

165
Q

What does the Braden score measure/what is it used for

A

Screening tool used to evaluate the risk of developing a PI

166
Q

Criteria used for Braden score

A

Sensory perception; moisture; activity; mobility; nutrition; friction & shear

167
Q

Steps to the Levine Technique

A

Cleanse wound with sterile water; rotate cotton swab over clean area of tissue for 5 seconds; apply enough pressure to express exudate from the wound bed; break off tip into a sterile medium

168
Q

6 criteria to diagnose malnutrition (ASPEN guidelines)

A

energy intake, weight loss, loss of SQ fat, muscle loss, fluid accumulation, grip strength

169
Q

How many of the ASPEN criteria must be satisfied to make a diagnosis of malnutrition?

A

2

170
Q

3 etiologies of malnutrition (per ASPEN criteria)

A

Acute injury/illness; Chronic disease; Social & environmental factors

171
Q

Examples of acute injury/illness (ASPEN)

A

infection, burns, trauma

172
Q

Examples of chronic disease (ASPEN)

A

ESRD/COPD/HIV, advanced liver disease

173
Q

Examples of environmental/social causes of malnutrition (ASPEN)

A

food insecurity, drug/alcohol abuse, eating disorders

174
Q

What is the Parkland formula used for?

A

an estimate of the volume of fluid resuscitation required for a burn victim within the first 24 hours of injury

175
Q

The Parkland formula

A

4mL * %BSA * weight(kg) = volume in 24 hours

176
Q

Fluid distribution with the Parkland formula

A

1/2 given within the first 8 hours; the remainder given over the next 16 hours

177
Q

How quickly can a pressure injury develop?

A

Within 2 hours

178
Q

Stage 0 Lymphedema

A

No visible edema nor pitting evident

179
Q

Stage 1 Lymphedema

A

considered mild disease; pitting is present, however stage is reversible and improves with elevation

180
Q

Stage 2 Lymphedema

A

considered moderate disease; pitting edema that does not resolve with elevation

181
Q

Stage 3 Lymphedema

A

considered severe disease; characterized by fibroadipose deposition & skin changes present

182
Q

Percentage of volume increase in Stage 3 Lymphedema

A

> 40%

183
Q

Percentage of volume increase in Stage 2 Lymphedema

A

20-40%

184
Q

Percentage of volume increase in Stage 1 Lymphedema

A

<20%

185
Q

Stemmer’s sign

A

involves pinching the dorsum of the 2nd toe with thumb & index finger; if unable to do so, the test is positive for lymphedema

186
Q

The most abundant form of collagen in the body

A

Type 1 Collagen

187
Q

Gold standard diagnostic tool for lymphedema

A

Lymphoscintigraphy

188
Q

Stratum basale

A

composed of a single layer of keratinocytes; rapidly dividing

189
Q

Stratum spinosum

A

composed of several layers of cells with web-like filaments & desmosomes; also contact dendritic cells

190
Q

Stratum granulosum

A

4-6 cell layers thick; keratinization begins here

191
Q

Stratum lucidum

A

2-3 cell layers thick; composed of dead & clear keratinocytes (found primarily in palms of hands & soles of feet)

192
Q

Stratum corneum

A

20-30 cell layers thick; composed of dead & anucleated cells

193
Q

Papillary dermis

A

superficial dermis; composed of areolar connective tissue with a network of collagen and elastic fibers
-allows for easy maneuverability of defensive cells to identify & neutralize bacteria

194
Q

Reticular dermis

A

~80% of the dermis (deeper dermis) composed of dense, fibrous connective tissue

195
Q

WiFi components

A

Wound, Ischemia, Foot infection

196
Q

Etiologies of malnutrition (per ASPEN criteria)

A

acute injury/illness; chronic disease; social/environmental factors

197
Q

Acute injury/illness (ASPEN criteria)

A

burns, infection, trauma

198
Q

Chronic disease (ASPEN criteria)

A

CKD, advanced liver disease, HIV

199
Q

Social/Environmental factors (ASPEN criteria)

A

eating disorders, religion, etc

200
Q

What are the 6 markers of malnutrition (ASPEN criteria)?

A

weight loss, energy intake, body fat, muscle mass, fluid accumulation, grip strength

201
Q

Albumin half-life

A

14-20 days

202
Q

Pre-albumin half life

A

2 days

203
Q

What leads to decrease in albumin & prealbumin

A

stress, trauma, infection, malnutrition

204
Q

Normal TBI value

A

> 0.7

205
Q

Low (mild PAD) TBI value

A

0.5-0.7

206
Q

Moderate (moderate PAD) TBI value

A

0.35-0.5

207
Q

Severe (severe PAD) TBI value

A

<0.35

WOUND CARE (1 decks)

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