Module 2 Flashcards
Describe the stages of wound healing.
Haemostasis has 3 components: vasoconstriction, platelet response & biochemical response.
Inflammation stage:
Begins the moment injury occurs. Capillaries contract & thrombus to facilitate haemostasis. Vasodilation of surrounding tissue occurs in response to histamine release which increases blood flow & produces erythema, swelling, heat & pain.
Reconstruction phase: Cleaning & temporary replacement of tissue; polymorphs kill bacteria. Phagocytes & macrophages digest them. New blood capillaries are developed, granulation tissue laid down & epithelial cells migrate over granulation tissue. This thickens forming the epidermis.
Maturation phase: Remodelling. Collagen cells reorganised & strengthened. Process 24 days - 1 year.
Compare & contrast healing by primary intention and healing by secondary intention.
Primary (or first) intention:
When wound has minimal tissue loss & edges can be brought together by sutures or clips. In a surgical wound the granulation tissue is not obvious.
Secondary intention:
Wound cannot be brought together. Granulation tissue fills in the wound until re-epithilisation takes place.
Why are specific infection control procedures required when MRSA+ve patients are hospitalised.
Why are limited antibiotics available for MRSA+ve patients?
Identify the usual dose of Vancomycin, route of administration, precautions and side-effects.
To prevent transmission of MRSA to unaffected pts who may be at higher risk of opportunistic infection (eventually leading to death).
Due to bacteria being resistant to most antibiotics traditionally used to treat infections (penicillin, methicillin, flucoxacillin).
Vancomycin has limited oral absorption therefore unless used for eradicating pathogenic gut bacteria (such as Clostridium difficile) it is given IV.
Oral: 125mg - 500mg four times a day
May cause indigestion, N&V, diarrhoea or chills.
IV: Specific infections 15-20mg/kg
Endocarditis 500mg four times a day or 1g BD
Local pain (may be severe) Thrombophlebitis Interstitial nephritis Serious skin reactions Chemical peritonitis Nausea Hypersensitivity Stevens-Johnson syndrome Toxic epidermal necrolysis Rigor Eosinophilia Angiodedema
Rarely:
Anaphylaxis (may be confused with red man syndrome)
Thrombocytopenia (may be immune-mediated)
Neutropenia (more likely after at least 1 week & total dose >25g)
Leucopenia
Agranulocytosis
Ototoxicity
Multi-organ hypersensitivity syndrome
Precautions:
Allergy to teicoplanin - cross reactivity between teicoplanin and vancomycin has occurred.
Inflammatory GI conditions - significant oral absorption may occur increasing likelihood of ADRs, especially in renal.
Renal: Increase dose interval or reduce dose, or both in renal impairment.
Surgery: General anaesthetic increases risk of vancomycin infusion-related ADR effects; complete vancomycin infusion before anaesthesia.
Elderly: Increased risk of toxicity.
Pregnancy: Considered safe to use; Aus category B2.
Breastfeeding: Safe to use; may cause loose bowel motions in baby.
Identify 5 factors that affect wound healing.
Wound infection Wound dehydration Allowing maceration Inappropriate dressings Temperature variancies Not treating the underlying cause Keloid formation Foreign bodies Friction or shearing forces Age Underlying diseases such as diabetes Vascularity Obesity Disorders of sensation & movement Drugs Psychological state Nutritional state Radiation therapy
Describe the difference between a BCC, SCC and malignant melanoma.
BCC:
Most common of the skin cancers but the least dangerous. BCCs develop in the basal cells of the epidermis (slow growing).
SCC:
Less common than BCC but more dangerous.
Develop in the squamous cells, can spread via bloodstream & lymphatics.
Malignant melanoma:
Represent 4-11% of skin cancers and associated with 75% of all skin cancer-related deaths.
Develop in the melanocytes. Infiltrate skin, blood & lymph vessels.
What is the treatment for a basal cell carcinoma?
Surgical removal: Mohs micrographic surgery - removal of tumour layer-by-layer, most accurate method.
Electro-surgery: Destruction & removal of tumour via electrical energy. Current is converted to heat which passes to the tumour from a cold electrode.
Cryosurgery: Deep freezing, using liquid nitrogen, of cancerous tissue.
Radiation therapy.
What is the ‘rule of nines’?
Estimation of the total body surface area of the body.
Each area of the body is given a percentage.
The percentages are allocated to the burned areas are then calculated (using multiples of 9) to arrive at an estimation.
Estimation is essential as it guides treatment decisions including fluid resuscitation.
Name 3 types of dressings used to treat burns.
Silver impregnated (antimicrobial)
Alginate (mod-high exudate)
Hydrocolloids & foam (mod-low exudate)
Light dressings over joints (allow ROM)
Paraffin gauze (protect & promote skin graft adherence)
Antimicrobial impregnated applied to skin graft (remain in place 3-5 days)
Identify 4 methods of wound classification.
Acute/Chronic
Damage
Colour
Stage
