Management of Wounds Flashcards
What are the 3 wound classes?
- 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
Why wouldn’t you close an infected wound?
it can trap the infection inside
How would you perform an initial assessment for a patient coming in with a wound?
- general assessment and history
- is it a trauma?
- vital signs
- analgesia
- first aid
- regular monitoring to stabilise the patient if necessary
What time and details are involved in the inflammatory phase?
- 0-5 days
- Haemorrhage, vasodilation, increase vascular permeability
What time and details are involved in the debridement phase?
- 0 onwards
- phagocytosis, migration of white blood cells, removal of cellular debris
What time and details are involved in the repair/proliferation phase?
- day 3- 4 weeks
- fibroblasts proliferate, collagen synthesis, epithelisation and contraction
What time and details are involved in the remodelling phase?
- day 20 ongoing
- wound contraction and remodelling of collagen fibres
How are the things to consider when lavaging a wound?
- volume of fluid
- type of fluid
- pressure
- 35/40ml syringe and 19G needle
- isotonic saline or chlorhexidine/iodine
- warmth of fluid
What is the aim for wound lavaging?
to remove loose foreign material and necrotic tissue, diluting the bacterial contamination of the wound
What pressure should you lavage a wound at?
8-12 pounds per square inch strong enough to overcome adhesive forces of bacteria
What pressure should you not exceed when debriding a wound?
15 psi
How much fluid do you need to debride a wound sufficiently?
around 500ml, dependent on wound
What type of fluid would you use for acute wounds?
isotonic crystalloid
What type of fluid would you use for heavility contaminated acute wounds e.g shearing injury?
large volume tap water
What type of fluid would you use for a chronic infected wound?
0.05% chlorhexidine solution
What are the considerations for secondary intention healing?
- topical agents?
- dressings
- types of bandage used
- client compliance
- cost
- expertise
Why would you do negative pressure wound therapy?
- 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
Why would you use honey to help with healing?
- broad spectrum antimicrobial activity
- anti-inflammatory properties
- shown to be effective against MRSA and pseudomonas
Who found that honey created an acidity level which has shown to be beneficial for cellular activity in chronic non-healing wounds?
willix et al (1992)
Why might you use medical frade honey over table honey?
- table honey was found to have less antibacterial activities and contained wide range of microbial species
- medical grade honey is sterile
What are the considerations for using honeyon a wound?
- 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
What is the primary benefit for using silver?
its antimicrobial effects and is indicated in the inflammatory stage
What are the disadvantages of using wet-to-dry bandages?
- 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
What are the advantages of using moisture-retentive dressings?
- 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
What is a hydrogel dressing?
- intrasite gel, GranuGel
- water based, amophous, cohesive application that is applied to the wound bed and covered with a secondary, non-aborbent dressing
What is a hydrocolloid dressing?
- aquacel, granuflex, hydrocoll
- carboxymethylated cellulose, pectin and gelatine that forms a non-adherent gel on contact with the wound
- uncommon in open wound management
What are vapour-permeable films and membranes?
- primapore, melolin
- sheet of absorbent material between two thin layers of film that contain small fores for movement of gas and fluid
What are foam dressings?
- 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
