Management of Wounds

Question 1

What are the 3 wound classes?

Answer 1

• class 1 = 0-6hours, minimal contamination and tissue trauma
• class 2 = 6-12hours, microbial burden has not reached critical level or contamination and tissue trauma
• class 3 - more than 12 hours, wound infection

Question 2

Why wouldn’t you close an infected wound?

Answer 2

it can trap the infection inside

Question 3

How would you perform an initial assessment for a patient coming in with a wound?

Answer 3

• general assessment and history
• is it a trauma?
• vital signs
• analgesia
• first aid
• regular monitoring to stabilise the patient if necessary

Question 4

What time and details are involved in the inflammatory phase?

Answer 4

• 0-5 days
• Haemorrhage, vasodilation, increase vascular permeability

Question 5

What time and details are involved in the debridement phase?

Answer 5

• 0 onwards
• phagocytosis, migration of white blood cells, removal of cellular debris

Question 6

What time and details are involved in the repair/proliferation phase?

Answer 6

• day 3- 4 weeks
• fibroblasts proliferate, collagen synthesis, epithelisation and contraction

Question 7

What time and details are involved in the remodelling phase?

Answer 7

• day 20 ongoing
• wound contraction and remodelling of collagen fibres

Question 8

How are the things to consider when lavaging a wound?

Answer 8

• volume of fluid
• type of fluid
• pressure
• 35/40ml syringe and 19G needle
• isotonic saline or chlorhexidine/iodine
• warmth of fluid

Question 9

What is the aim for wound lavaging?

Answer 9

to remove loose foreign material and necrotic tissue, diluting the bacterial contamination of the wound

Question 10

What pressure should you lavage a wound at?

Answer 10

8-12 pounds per square inch strong enough to overcome adhesive forces of bacteria

Question 11

What pressure should you not exceed when debriding a wound?

Answer 11

15 psi

Question 12

How much fluid do you need to debride a wound sufficiently?

Answer 12

around 500ml, dependent on wound

Question 13

What type of fluid would you use for acute wounds?

Answer 13

isotonic crystalloid

Question 14

What type of fluid would you use for heavility contaminated acute wounds e.g shearing injury?

Answer 14

large volume tap water

Question 15

What type of fluid would you use for a chronic infected wound?

Answer 15

0.05% chlorhexidine solution

Question 16

What are the considerations for secondary intention healing?

Answer 16

• topical agents?
• dressings
• types of bandage used
• client compliance
• cost
• expertise

Question 17

Why would you do negative pressure wound therapy?

Answer 17

• reuces oedema and exudate accumulation
• eliminates strikethrough of bandagesbecause wound fluid is evacuated into the collection canister
• increased central wound perfusion and vascularisation
• rapid contraction and wound healing
• reduction of dressing changes

Question 18

Why would you use honey to help with healing?

Answer 18

• broad spectrum antimicrobial activity
• anti-inflammatory properties
• shown to be effective against MRSA and pseudomonas

Question 19

Who found that honey created an acidity level which has shown to be beneficial for cellular activity in chronic non-healing wounds?

Answer 19

willix et al (1992)

Question 20

Why might you use medical frade honey over table honey?

Answer 20

• table honey was found to have less antibacterial activities and contained wide range of microbial species
• medical grade honey is sterile

Question 21

What are the considerations for using honeyon a wound?

Answer 21

• there is a higher levels of exudate so consider using dressings
• consider the cellular damage in healthy granulating wounds and epithelisation
• consider initial honey use to aid granulation then hydrogel

Question 22

What is the primary benefit for using silver?

Answer 22

its antimicrobial effects and is indicated in the inflammatory stage

Question 23

What are the disadvantages of using wet-to-dry bandages?

Answer 23

• macerate, then desiccate wound bed, compromises function of cells involved in wound healing
• cells, tissue, white blood cells and granulation tissue can be pulled off when bandages removed
  -white blood cells can migrate into open-weave dressing
• environmental bacteria can penetrate through gauze
• can cuase discomfort
• remnants of fibre can remain in the wound causing inflammation
• increase cost for total wound care

Question 24

What are the advantages of using moisture-retentive dressings?

Answer 24

• would healing progresses 24hours a day due to wound not drying out
• removes excess exudate
• maintain contact between wound fluid and wound, allows patient to benefit from normal balance of prohealing factors during each healing phase
• promotes optimal fucntion of cells and proteases
• stimulates faster healing with lower infection rates
  -requires less bandage changes
• decrease costs

Question 25

What is a hydrogel dressing?

Answer 25

• intrasite gel, GranuGel
• water based, amophous, cohesive application that is applied to the wound bed and covered with a secondary, non-aborbent dressing

Question 26

What is a hydrocolloid dressing?

Answer 26

• aquacel, granuflex, hydrocoll
• carboxymethylated cellulose, pectin and gelatine that forms a non-adherent gel on contact with the wound
• uncommon in open wound management

Question 27

What are vapour-permeable films and membranes?

Answer 27

• primapore, melolin
• sheet of absorbent material between two thin layers of film that contain small fores for movement of gas and fluid

Question 28

What are foam dressings?

Answer 28

• kendall foam, allevyn, activheal foam
• hydrophilic dressings made of polyurethane foam, which can be adhesive or non-adhesive and with or within a breathable film backing