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Integumentary > Lecture 5 Interventions Part 1 > Flashcards

Lecture 5 Interventions Part 1 Flashcards

1
Q

What is Wound Management Long term goal?

A

Wound healing

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2
Q

What is wound management short term goal

A
  • maintain clean, moist, warm, granular wound bed
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3
Q

Treatment goal for red wound bed

A
  • Protect wound
  • Maintain warm, moist environment
  • Protect periwound
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4
Q

Treatment goal for yellow wound bed

A
  • Debride necrotic tissue
  • Absorb drainage
  • Protect periwound
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5
Q

Treatment goal for black wound bed

A
  • Debride necrotic tissue
  • Get rid of eschar
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6
Q
A
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7
Q

Wound treatment goals are achieved through a combination of?

A
  • Debridement
  • Microorganism control
  • Exudate management
  • Skin/wound protection
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8
Q

What is Debridement, and what is its general purpose?

A
  • Debridement is the removal of necrotic tissue from the wound bed
  • General purpose is to decrease infection risk and promote healing
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9
Q

What are the 2 types of Debridement?

A
  • Selective: removal of only non-viable tissue and may include sharp, enzymatic, or autolytic debridement
  • Nonselective: removal of nonspecific areas of devitalized tissue and may include mechanical and surgical debridement
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10
Q

Contraindications for Debridement

A
  • Granular tissue
  • Viable tissue
  • Stable, hard, dry eschar in ischemic limbs
  • Electrical burns
  • Deeper tissue muscle, tendon, ligament
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11
Q

General purpose of debridement

A
  • Decrease bacterial concentration
  • Increase the effectiveness of topical antimicrobials
  • Shorten the inflammatory phase of wound healing
  • Decrease wound odor
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12
Q

Prior to debridement, clinician must consider?

A
  • Patient current health, PMH, medications, nutritional status
  • Treatment goals
  • Personal skill level
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13
Q

What are the types of selective debridement?

A
  • Sharp
  • Autolytic
  • Enzymatic
  • Biologic (maggot)
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14
Q

What are sharp debridement used for?

A
  • wounds with large amounts of thick, adherent, necrotic tissue
  • Also indicated for callouses
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15
Q

Sharp Debridement is contraindicated for?

A

ABI < 0.5
Gangrene
Stable heel ulcers
unidentifiable structures
terminally ill

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16
Q

Sharp Debridement often requires?

A
  • pain management
  • one to a few treatment sessions to complete
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17
Q

Qualified providers for Sharp Debridement

A
  • physician, podiatrist, PT
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18
Q

Why is it important to remove calluses on the plantar foot?

A
  • Pressure points increase the risk of ulceration in people with diabetes (neuropathic ulcers)
  • eliminate localized areas of increased pressure
  • reduce infection
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19
Q

Autolytic Debridement

A
  • body’s own mechanisms to remove nonviable tissue
  • Most conservative treatment, pain free but takes a long time
  • a moist wound environment that rehydrates necrotic tissue and eschar, facilitating enzymatic digestion of the nonviable tissue
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20
Q

what are common methods used with autolytic debridement?

A
  • use of transparent films, hydrocolloids, hydrogels & alginates
  • Eschar should be cross-hatched prior to application of dressing
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21
Q

Enzymatic Debridement

A
  • can be used on infected and non-infected wounds with necrotic tissue
  • Eschar should be crosshatched prior to application of the enzyme
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22
Q

What is the purpose of Cross-hatching?

A
  • open up more surface area so that enzymes or other debriding agents can work
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23
Q

How can Maggot/BIologic debridement help?

A
  • debridement
  • disinfection
  • promoting cellular activity
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24
Q

Types of non-selective debridement

A
  • Surgical
  • Wet to dry dressings
  • Scrubbing
  • Wound Cleansing
  • Wound irrigation: palsatile lavage
  • Hyrotherapy: Whirlpool
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25
Surgical Debridement
- Fastest and most aggressive method of debridement
26
Wet to Dry dressings are only indicated for what type of wounds?
- contain 100% devitalized tissue
27
Importance of Wet to Dry Dressings
- allow the later to dry for 8-24 hours before being torn away from wound bed -Removal of dry dressings from granulation tissue may cause bleeding and pain - Also promotes wound bed desiccation (drying out) and delay dealing of granulating wounds
28
Scrubbing are used for what type of wounds?
- superficial wounds that are highly contaminated and/or wounds with 100% devitalized tissue
29
Wound Cleansing
- delivery of a wound cleanser to the wound surface - Cytotoxic, delay wound healing, rarely appropriate
30
Purpose of Wound irrigation: Basic Technique
- removal of loosely adhered cellular debris - improves clinician's visual wound inspection ability and provides wound hydration
31
Wound irrigation: Basic technique is indicated for?
- all wound types, including granulating wounds
32
Required pressure for Wound irrigation: Basic technique
4-15 psi; 35 mL
33
What is Pulsatile Lavage
- Delivery of a wound irrigant under pressure by an electrically powered device - Indicated for wounds requiring thorough irrigation or debridement - Can be used on infected wounds
34
Purposes and effects of Whirlpool
- Softens necrotic tissue and eschar, facilitating their removal - Hydrates the wound bed and promotes moist wound healing - Promotes circulation - Decreased patient pain - improves range of motion for patients with burn injuries
35
Whirlpool indications
- Burns - Infected wounds - Dry wounds - Wounds with eschar
36
Whirlpool Contraindications
- Clean/granulating wounds - draining or macerated wounds - Actively bleeding wounds - venous insufficiency
37
Considerations for Whirlpool
- Infection control - Patient PMH - Behaviors - Safety
38
Treatment for infected wounds
- Debridement - Antimicrobial Therapy: Topical vs Systemic
39
Antimicrobial agent
- substance able to destroy unicellular microorganisms
40
Antibacterial agent
- Type of antimicrobials that are effective against bacteria
41
Bactericidal
cause bacterial death
42
Bacteriostatic
Inhibit bacterial growth
43
Antifungal agent
- type of antimicrobials that act on yeast / molds
44
Antiseptic
- Antimicrobial that reduces bacterial contamination on intact skin
45
Goal of Topical Antimicrobial Therapy
- Destroy organisms while minimizing adverse reactions - Shown to penetrate the wound bed to the site of infection
46
What are Systemic Antimicrobial Therapy?
- Antibiotics
47
Systemic Antimicrobial Therapy typically used for?
Patients with sepsis, signs of advancing infection, deep space infections
48
Decision considerations for Systemic Antimicrobial Therapy
- type of microorganisms causing the infection - sensitivity of the microorganisms to different antimicrobial agents
49
Wound Healing Principles
- A moist wound heals 3 to 5 times faster than a dry wound
50
Why does Moist wound heal faster?
- Decreases the intensity and length of the inflammatory phase - Increases fibroblast proliferation and collagen synthesis - Promotes angiogenesis - Reduces Patient pain complaints
51
if a wound is too dry
- crust formation occurs - lack the enzymes and growth factors that facilitate wound healing
52
If a wound is too wet
- Fluid can pool and cause tissue maceration
53
Goals of Wound dressings
- Creating moist environment - Provide thermal insulation - reduce infection risk - reduce pain - edema control - eliminate dead space - allow adequate gas exchange
54
What is Occlusion defined as?
- ability of a dressing to transmit moisture, vapor, or gases between the wound bed and atmosphere
55
Full occlusive substance are?
- Cmpletely impermeable
56
Non-occlusive substance is?
Permeable
57
Least to Most Absorption
Semipeameable films > Hydrogels > Hydrocolloids > Semipermeable foam > alginates
58
What is Moisture Retention
- Ability to maintain moist wound environment
59
Gauze Dressings
- Highly permeable & nonocclusive - for wounds that require packing & frequent dressing changes
60
Petrolatum-impregnated gauzes
- used for burns
61
Zinc-impregnated gauze
- unna boot - used for venous insufficiency ulcers - used as the contact layer, and requires a secondary dressing
62
what dressings support Autolytic Debridement?
- transparent films - Hyrocolloids - Hydrogels - Alginates
63
Transparent films are permeable & impermeable to?
- Permeable to water vapor, oxygen, and carbon dioxide - Impermeable to bacteria and water
64
Semipermeable films are used for what type of wounds?
- minimal to no drainage - useful to superficial or partical-thickness wounds
65
Hydrogels
- not for fluid absorption - donate moisture to dry wounds - can decrease pain, and often require secondary dressing
66
Benefits of Semipermeable Foams
- moisture retentive - encourage autolytic debridement & provide therma insulation - provide thermal insulation - many provide cushioning
67
Hydrocolloids are used for?
- provide moderate absorption to wet wounds
68
Alginates
- Highly permeable and noocclusive - Require secondary dressing
69
Three composite dressings layers
- inner contact layer: nonadherent, preventing trauma - middle layer: absorbs moisture - outer layer: becaterial barrier (usually composed of a semipermeable film)
70
Silver Antimicrobial Dressings are used to?
- reduce wound bioburden
71
Charcoal Antimicrobirla Dressings
- control wound odor - infection management
72
Honey Antimicrobial Dressings
- decrease wound-related pain - reduce wound healing time - improve scar tissue formation
73
Skin Sealants
- Alcohol based wipes used on intact periwound skin
74
Moisture Barriers
- Prevent rashes and skin breakdown in areas of incontinence
75
pH value for Vulnerable skin
pH> 7.5
76
Pressure Redistribution can be achieved through?
- seating - positioning - support surfaces

Integumentary (9 decks)

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