Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Wound Care 467 > Module 3 - Surgical wounds, trauma wounds and debridement > Flashcards

Module 3 - Surgical wounds, trauma wounds and debridement Flashcards

1
Q

Classification of wounds

A

CLEAN
Wounds made under aseptic surgical conditions.
Wounds that do not enter genitourinary, respiratory or alimentary tracts
or oropharyngeal cavity.

CLEAN/CONTAMINATED
Wounds are contaminated by the resident flora or the cavities
but there is no host reaction.

CONTAMINATED
Contaminated by bacteria with no host reaction.

INFECTED
Clinical signs of infection present, with increased leukocyte and macrophage levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of surgical wound healing?

A

-Primary Intention
Sutures, staples, surgical tape
tissue glue (Histacryl)

-Delayed Primary Intention
Suture after 3-10 days

  • Skin grafts
  • Tissue flaps
  • Bioengineered Tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2 types of Natural Suture’s

A

-Absorbable
Catgut -Plain (lasts 7-10days) or chromic (lasts 10-14 days)

-Non-Absorbable
Silk
Linen
Stainless Steel Wire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

types of synthetic sutures

A
  • Absorbable
  • Non-absorbable
  • Vieryl
  • Polydioxone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the different types of skin sutures?

A 
Simple square interrupted
Continuous subcuticular
Vertical mattress
Horizontal mattress
Wound closure strips e.g. Steri-Strips
Tension sutures –deep support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Principles for surgical wound healing?

A
  • Protect the wound from
  • physical or pathogenic assault
  • Absorb exudate
  • Maintain wound temperature
  • Maintain body temperature
  • Oxygenation
  • Avoid stress –pain relief
  • Observe the suture line for complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dressing the suture line

A 
24-48 hours unless drains in situ
Dry low-adherent dressings
Island dressings
Semi-permeable film
Hydrocolloid
Foam
Other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of Drains?

A

Capillary-Penrose, corrugated, Portex

Attached negative pressure suction devices
-Redivac
-Jackson Pratt (similar to Redivac but
larger bore)
-Sump (double lumen)
-Axiom (triple lumen)

Percutaneous –biliary, nephrostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Principles of drain management?

A

-Client/carer support & education
-Secure drain
-Maintain patency of drain
-Maintain skin integrity
-Contain exudate
-Observe type & amount of exudate
-Prevent infection
-Observe for complications
discomfort, infection, dislodgement, blockage,
if on negative pressure -loss of suction, loss of skin integrity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Surgical wound complications?

A

-Haemorrhage –primary or secondary
-Haematoma
-Seroma
-Oedema
I-nfection
-Occlusion blood supply -necrosis
-Dehiscence / evisceration
-Adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define Dehiscence?

A

Separation of a sutured wound resulting in an cavity that requires either a second attempt at primary closure or will be allowed to heal by secondary intention

Aetiology:
Haematoma
Seroma
Infection
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define Sinus?

A

A track or opening into the tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define Fistula?

A

A fistula is an abnormal track connecting one viscus to another viscus or to the skin surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aetiology of a fistula?

A 
Leaking surgical anastomosis
Spontaneous rupture due to obstruction, disease, trauma,
radiotherapy damage
Mesenteric ischaemia
Sepsis –diverticulitis & appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Principles for management of a fistula?

A 
Patient comfort & support
Fluid & electrolyte replacement
Nutritional assessment & supplementation
Prevention & management of infection
Maintenance of skin integrity
Containment of effluent & odour
Cost-effective care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define abberant healing and the different types?

A

any deviation from the normal wound healing and remodeling process

Hypergranulation
Contracture
Hypertrophic scar
Keloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Explain hyper-granulation?

A

Raised granulation tissue above the level of the surrounding skin commonly occurs as a result of:

Friction
Increased bacterial burden in the wound
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Explain Contracture

A

Abnormal scar formation that can inhibit movement or function due to excessive myofibroblast activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Explain Hypertrophic scar?

A

Excessive scar that remains within the perimeter of the original wound

20
Q

Explain keloid

A

Excessive scar that extends outside the

perimeter of the original wound

21
Q

Principles for packing wounds

A
  1. Determine goal of care
  2. Ascertain extent of sinus or dehiscence
  3. Do not pack fistulae
  4. Select appropriate packing dressing
  5. Avoid probes in favour of safer instruments
  6. Pack lightly & gently (unless haemorrhage)
  7. Protect the surrounding skin
  8. Select appropriate secondary dressing
  9. Support peri-wound tissue
  10. Ensure all packing is removed
22
Q

When not to pack?

A 
The 6 ‘Fs”...
Fistula
Fascial plane separation
Facilitate exudate drainage
Foreign bodies
Formed track -lined with epithelium
Fear of the unknown
23
Q

Explain negative pressure therapy?

A

The use of controlled negative pressure wound therapy to assist and accelerate wound healing
Also known as vacuum assisted wound healing

24
Q

Define a skin graft

A

A skin graft is a segment of dermis and epidermis which has been completely separated from its blood supply and donor site
attachment before being transplanted to another area of the body

25
Q

What are the different types of skin grafts?

A

-Autografts
Transfer of tissue from one site to another on the same person

-Allografts / Homografts
Transfer of tissue from one person to another

-Xenografts / Heterografts
Transfer of tissue from one species to another (e.g. pig skin)

-Tissue Culture
Epidermal cells cultured in the laboratory

-Bio-engineered Skin -Dermagraft, Apligraf

26
Q

The difference between split thickness grafts?

A

Thin:
Contracts within the first few months
No hair
Higher survival rate as vascularisation occurs easily

Thick:
Less contraction
Usually contains some hair follicles.

27
Q

Vascularisation of skin grafts?

A

Plasmatic imbibition: Almost immediately a skin graft comes in contact with the recipient bed, it begins to absorb a plasma like fluid from it (first 48 hours). A fibrin network is also being formed between the graft and the recipient bed to hold the graft in place.

Inosculation of blood vessels: In the first 48 hours, vascular buds grow into the fibrin network that binds the skin graft to the recipient site.

True Circulation: New capillary activity establishes in the graft within 4-7 days. The lymphatic system establishes concurrently with these stages.

28
Q

Factors that inhibit graft take?

A

-Poorly vascularised recipient bed
-Shearing movement
Fluid collection beneath the graft (e.g. haematoma, seroma, pus,
debris)
-Infection
-Inadequate graft support when dependent
-Patient intrinsic or extrinsic factors

29
Q

Define shearing movement?

A

Movement between the graft and the recipient bed causes

damage to the capillaries growing into the graft and prevents revascularisation

30
Q

Whats involved in the care of a graft?

A
  • Palpate for fluid collection
  • Nick with fine point scissors and dab excess fluid
  • protect with silicone or tulle gras dressing
  • fill with fluffed gauze
31
Q

Complication of grafts?

A
  • shearing

- incomplete take due to fluid collection or infection

32
Q

Flap Definition?

A 
A flap is a surgical
relocation of tissue from
one part of the body to
another part in order to
reconstruct a primary
defect.
Flaps are described as skin
or cutaneous flaps and
composite flaps.
33
Q

Types of flaps?

A
  • skin or cutaneous
  • composite tissue
  • free flap
  • pedicle flap
  • rotational flap / z plasty
34
Q

Skin Flap observations?

A

•Vital signs
•Fluid intake -IV and oral
•Monitor urinary output -0.5ml per Kg/ hr.
•Oxygen therapy and continuous saturations
•Drains for sudden increased drainage
•Type of exudate
•Pain management
•Warmth
•Change in tissue turgor
Prune-like or hollow if arterial occlusion
Tense, swollen and distended if venous occlusion
•Skin colour changes
•Bleeding
•Change in capillary refill time
•Doppler -arterial, venous, force, regularity

35
Q

Goals of care burns?

A

Alleviate pain
Control microbial colonisation & prevent infection
Prevent wound conversion to a deeper burn
Achieve wound coverage as early as possible
Promote function of healing skin
Preserve function of the body part

36
Q

Whats involved in the rehabilitation of burns?

A

-Bio-psychosocial adjustment
-Scar management
-Multidisciplinary input
Surgeon, GP, Nurse, OT, Physio, Dietician, Clinical Psychologist, Social Worker, Family

37
Q

The effects of ageing skin?

A
  • Thinning & flattening of the epidermis
  • Decreased epidermal proliferation
  • Cells in the horny layer lose elastin
  • Atrophy of the dermis -  contraction
  • Changes to & loss of collagen
  • Decreased vascularity of dermis
  • Decreased number of oil & sweat glands
  • Vascular response is compromised
  • Altered or reduced sensation
  • Fragility
38
Q

Define skin tear?

A

A skin tear is a traumatic wound occurring
principally on the extremities of older adults, as a
result of friction alone or shearing and friction
forces which separate the epidermis from the
dermis (partial thickness wound) or which separates
both the epidermis and the dermis from underlying
structures (full thickness wound)

39
Q

Explain Star 1A

A 
A skin tear where
the edges can be
aligned to the
normal anatomical
position without
undue stretching
and the skin or flap
is not pale, dusky
or darkened
40
Q

Explain star 1B

A 
A skin tear where
the edges can be
aligned to the
normal anatomical
position without
undue stretching
and the skin or flap
is pale, dusky or
darkened
41
Q

Explain Star 2A

A 
A skin tear where the
edges cannot be
realigned to the
normal anatomical
position and the skin
or flap colour is not
pale, dusky or
darkened
42
Q

Explain Star 2B

A 
A skin tear where the
edges cannot be
realigned to the
normal anatomical
position and the skin
or flap colour is pale,
dusky or darkened
43
Q

Explain Star 3

A

A skin tear where the skin flap is completely absent

44
Q

What dressing would you use for a skin tear?

A

silicone dressing for fragile skin

-draw an arrow to indicate dressing removal direction.

45
Q

Define debridement?

A 
The removal of all foreign
material and all contaminated
and devitalised tissue from or
adjacent to a traumatic or
infected lesion until healthy
tissue is exposed
46
Q

Debridement methods?

A 
Surgical
Conservative sharp
Mechanical
Autolytic
Enzymatic
Chemical
Biological or parasitic

Advanced Wound Care 467 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions