Miscellaneous Wounds Flashcards
What can be defined as a wound caused by friction to the skin’s surface?
abrasion
Describe the general presentation of a skin abrasion
- May or may not be contaminated
- Mild, stinging sensation
- Light to moderate bleeding
- Rarely progress to be chronic wounds
Describe the general intervention strategy for abrasions
Irrigate thoroughly with water or saline. Whirlpool may be indicated in extensive abrasions. Debridement may be required.
Clean wounds can be covered with a moisture-retentive dressing. Contaminated wounds may be treated with a broad-spectrum topical antimicrobial and a gauze dressing
What can be defined as a traumatic wound that has resulted from shear or friction forces that separate the epidermis from dermis?
Skin Tear
A skin tear is classified as a ____-thickness wound
partial
Who as at an increased risk for a skin tear?
The elderly due to age-related skin changes such as decreased dermal thickness, decreased skin elasticity, decreased sweat gland production, and flatter rete pegs
Describe the general presentation of a skin tear
- Linear tear or flap
- Wound edges can readily be approximated or may have tissue defect
- Slight serous drainage
- Bleeding minimal to significant
- Minimal pain
Describe the general intervention strategy for skin tears
Irrigate with saline or water, then pat dry. The wound edges should be approximated if possible. Debride if necessary.
Apply a moisture-retentive dressing.
Skin tears that can be completely approximated may be best treated with what?
a skin sealant
What types of dressings are appropriate for a skin tear?
- amorphous/film hydrogels
- nonadherent gauze
All anchored with rolled gauze
What should be avoided in the management of a skin tear?
adhesives
What are the 3 types of surgical wounds?
- muscle flaps and skin grafts
- wound dehiscence
- wounds that have been surgically debrided and left to close via 2ndary intention
What are the keys to wound care for surgical wounds treated via primary closure?
- Keep clean and dry for 24 to 48 hours
- Observe for infection
- Protect from friction and tension
Wounds closed with staples are _ times more likely to become infected than wounds closed with sutures
4
Surgical wounds closed via primary intention are expected to epithelialize in __-__ days
7-10
What are 4 patient factors that increase the risk of dehiscence?
- Malnutrition
- Diabetes
- Steroids
- Smoking
Deficiencies of what 3 types of vitamins may decrease wound tensile strength?
A, C and B complex
Dehisced surgical wounds may result from what 2 things?
- Too much tension on wound edges
- Underlying infection and abscess
What can be defined as sinus tracts that connect 2 epithelial surfaces (such as the GI tract and the skin)?
fistula
What is the intervention strategy for surgically debrided wounds?
It should be directed towards formation of granulation tissue, wound contraction, and epithelialization
What is the wound dressing of choice for surgically debrided wounds, of course assuming infection is not an issue?
moisture-retentive dressing
Every year how many people in the US experience a bite wound?
4-5 million
What percentage of all bite wounds do dog bites account for? Cats? Humans?
80-90%
5-15%
2-3%
Patients who have been bite and have not had a tetanus shot in the last _ years should receive a booster shot
5
Bite wound victims are at an increased risk for infection if they have an associated what 10 things?
- age less than 2 or greater than 50
- history of corticosteroid use
- diabetes
- cancer
- HIV/AIDS
- SLE
- prosthetic joints or valves
- asplenic
- vascular disorder
- wrist or hand bite
What are a few other things to ask the patient with an animal bite wound?
- day and time of bite
- is the animal a pet?
- does the animal have a current rabies vaccine?
- was the animal provoked?
- was the animal exhibiting abnormal behavior prior to the bite?
What are a few other things to ask the patient with a human bite wound?
- day and time of bite
- does the biter have hepatitis, HIV/AIDS, or syphilis
Most bite wounds are polymicrobial, with an average of _ different microbes per bite
4
What percentage of dog bites will become infected?
2-20%
What percentage of cat bites will become infected?
5-50%
What percentage of human bites will become infected?
10-50%
Why do human bite wounds tend to be more serious?
- the human mouth has more varied microflora
- closed fist bite wound etiology in which the tendons glide proximally, bringing the bacteria under the intact proximal skin
In the United States, only __% of suspected spider bites were actually caused by spiders
45
In the United States, only two types of spider bites require medical intervention, what are they?
- Black widow
- Brown recluse
What is the most venomous spider in the US?
black widow
Describe patient symptoms following a black widow spider bite
They become acutely ill within 1-3 hours of the bite. Experiencing weakness, headache, nausea/vomiting, hyperreflexia, dyspnea, diaphoresis, HTN, and tachycardia.
Describe the presentation of a black widow spider bite
Small bite surrounded by erythema with urticarial rash, stinging sensation
How is a black widow spider bite treated?
With antivenom, tetanus booster, muscle relaxers, and NSAIDs
What regions of the country are brown recluse spiders endemic?
- Southeast
- Southwest
- Midwest
Brown recluse spiders will bite only defensively and the majority of these bites will heal without complications in - days
3-5
Describe the general presentation of a brown recluse spider bite within the first 24 hours
Red inflammation, blue thrombosis, and white ischemia present with a possibly necrotic center
Describe patient symptoms following a brown recluse spider bite
Fever, nausea, malaise, joint pain, seizures
The mean wound healing time for a brown recluse spider bite ranges from _ to __ weeks
5-17
Why should superficial heat be avoided following a brown recluse spider bite?
it may increase necrosis
Why is early surgical excision contraindicated following a spider bite?
It may spread the spider’s venom and prolong the inflammatory response
When is surgical intervention appropriate following a spider bite?
If the wound is stable but not healing after 6-8 weeks of appropriate wound care
What percentage of patients with spider bite wounds require skin grafting?
3
Describe the general presentation of a radiation burn
- Mild inflammation, slight erythema, and local edema
- Dry, scaling, itchy, hyperpigmented skin
Late tissue injury causes radiation _____
fibrosis
What causes radiation fibrosis?
The overproduction and decreased degradation of collagen as well as hypovascularity
What does radiation fibrosis look like?
Skin is dry, discolored, hairless, atrophied, fibrotic, and inelastic.
The skin appears translucent
How many grades are there in terms of skin reactions due to radiation therapy?
4
Describe grade 1 skin reaction due to radiation therapy
- faint erythema
- epilation
- dry dequamation
- decreased sweating response
Describe grade 2 skin reaction due to radiation therapy
- bright erythema
- tenderness to palpation
- moderate edema
- moist desquamation
Describe grade 3 skin reaction due to radiation therapy
Moist desquamation with pitting edema
Describe grade 4 skin reaction due to radiation therapy
ulceration or necrosis
What are the general treatment guidelines for radiation fibrosis/burns?
- protect from mechanical forces
- avoid adhesions
- decrease bathing frequency
- pat skin dry
- avoid superficial heat and ice
- avoid heavy detergents or perfumes
What can be used to soothe radiation burns?
- amorphous hydrogel
- moisturizing ointments
- oatmeal baths
- topical steroids
What is Pyoderma Gangrenosum?
A noninfectious, progressive necrotizing skin condition
Onset of Pyoderma Gangrenosum:
__% have a systemic inflammatory condition
__% insidious
__% after trauma or surgery
50
25
25
What are 5 differential diagnoses for Pyoderma Gangrenosum?
- cancer
- vasculitis
- adverse drug reaction
- spider bite
- chronic venous insufficiency
Describe the progression of Pyoderma Gangrenosum
- Begins as small, painful papule, vesicle, or pustule on lower extremities and trunk
- Progresses to full-thickness ulceration with irregular borders and undermining present
Describe the general presentation of Pyoderma Gangrenosum
- Indurated, boggy
- Purulent and hemorrhagic exudates
- Erythematous due to inflammation
- Wound bed covered with eschar or slough
What are a few patient complaints associated with Pyoderma Gangrenosum?
- fever
- malaise
- myalgia
Under what 2 circumstances should Pyoderma Gangrenosum be suspected?
- If wound cultures are positive and do not respond to antibiotics
- If the wound does not respond to standard care for presumed wound etiology
The mainstay of pyoderma gangrenosum treatment includes medication and local wound care. What type of medication is suggested?
- Immunosuppressive agents, such as cyclosporin
- Corticosteroids that can be administered either systemically or topically injected
Is debridement suggested in patients with pyoderma gangrenosum?
Gentle and limited debridement of slough and necrotic tissue, however sharp or surgical debridement is contraindicated because it increases the inflammatory response leading to severe exacerbations
Pyoderma gangrenosum healing is extremely ____ and recurrence is _____.
slow
recurrence
