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Respiratory Diseases & Dermatology > P14: Wounds & Dressings > Flashcards

P14: Wounds & Dressings Flashcards

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Dermatology Board Prep flashcards
1
Q

what is a wound

A

any defect or damage in the skin caused by physical, chemicl or thermal factors; damage caused by an infectious disease
result of disruption of normal anatomical structure and function

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2
Q

what is an incision

A

regular wound caused by a clean sharp-edged object

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3
Q

what are lacerations

A

rough irregular wounds, caused by crushing or ripping forces

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4
Q

what are abrasions

A

grazes

superficial wound caused by a sliding fall onto a rough surface

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5
Q

what are puncture wounds

A

caused by a sharp-pointed object punching the skin; high risk of anaerobic infection, injury of big vessels and nerves

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6
Q

what are penetration wounds

A

caused by a knife entering the body

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7
Q

what are avulsion wounds

A

when the integrity of any tissue is compromised

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8
Q

what is a contusion

A

bruise

caused by blunt force trauma, damaged tissues under the skin

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9
Q

what is a hematoma

A

caused by damage to a blood vessel, blood accumulation under the skin

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10
Q

what are crushing injuries

A

caused by blunt force, pressure injury over a long period of time

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11
Q

what does the wound healing process involve

A

dynamic interactive process involving; parenchymal cells, extracellular matrix, blood cell and soluble mediators

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12
Q

what is homeostasis (vasoconstriction) during the inflammatory phase

A

first bleeding occurs at the site to remove toxic waste; then activation of homeostasis begins

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13
Q

how does the clotting mechanism work during the inflammatory phase

A

elicited by platelets resulting in coagulation and the formation of fibrin network; the inflammation causes vasodilation and hagocytosis -> release of histamine and serotonin
phagocytes enter the wound, engulf dead cells, platelets are liberated and form aggregates as part of the clotting mechanism

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14
Q

what happens during granulation in the proliferation phase

A

migrating cells travel about 3cm from the point of origin in all directions; process occurs 2 days - 3 weeks following injury; results in granulation tissue at the wound space

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15
Q

what is granulation

A

the effect of fibroblasts and macrophages provising a continuing source of growth factors for stimulating angiotensins and fibroplasia (production of fibrous tissue)

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16
Q

what happens during contraction and angiotensins during proliferative phase of wound healing

A

fibroplasia results in formation of a bed of collagen to fill the defect, so wound edges pull together
(contraction) and new capillaries are produces (angiotensins)

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17
Q

what happens during the remodelling phase of wound healing

A

involves formation of collagen to increase tensile strength
begins 3 weeks post-injury up to months; principle cells involved are fibroblasts, collagen molecules formation, further modification to form in a characteristic helical structure; collagen is released in extracellular space to form stable cross links, collagen matures more at the wound its resulting in intra and intrer-molecular cross links forming
cross linking provides strength and stability to collagen
the tissue will never regain the properties of uninjured skin

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18
Q

what do myofibroblasts do in normal tissue

A

microvasculature is stable and covered by pericytes and inactivated fibroblasts occupy the surrounding connective tissue

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19
Q

what do myofibroblasts do during wound healing

A

activated fibroblasts or pericytes may differentiate into myofibroblasts and enter the wound bed
signals and matrix from the wound microenvironment may cause pericytes to assume a more contractile and matrix depositing phenotype

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20
Q

what dressings are used in primary wound dressing

A

hydrogel dressing, hydrocolloids, gauze impregnated, gauze non-impregnated, composite dressings, wound fillers, alginate dressings, foam dressings

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21
Q

what dressings are used in secondary dressing

A

tape, elastic bandage, transparent film dressings, gauze dressing, carbon dressing

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22
Q

when are petroleum impregnated dressings used

A

for clean, healthy wounds with minimal granulation bed; for wounds with no need for debridement/granulation/contraction, used at early stage wound repair for shallow wounds, increases wound contraction but delays epithelialisation

23
Q

what are non-adhering dressings used for

A

dry to highly exuding wounds where adherance of dressing and exudate is to be prevented, including first and second degree burns, abrasions, grafts, venuous ulcers, pressure ulcers, nail extractions, eczema, staples, surgical incisions, lacerations, reconstructive procedures and suture lines

24
Q

what are hydrogel sheets used for

A

shallow wounds

like burns, fungating, lesions, low exuding wounds

25
Q

what are some examples of hydrogel sheet dressings

A

cross-linked sterile hydrogel, solid polymer matrix with propylene glycol, dependent on wound conditions as it maintains moisture balance, no maceratino of the skin surrounding the wound

26
Q

what are hydrogel gels used for

A

cavaties, effective for dislodging and debriding

27
Q

what are hydrogel gels and sheets used for

A

rehydration of hard eschar and necrotic wounds;
donate moisture, permits autolytic debridement, increases collagenase activity in burns, promotes granulation and epithelialisation, promotes contraction

28
Q

when are hydrocolloid wound dressings used

A

early to mid-repair phase of healing; can reduce pain in wounds, encourages angiogenesis in acute wounds

29
Q

what are hydrocolloid wound dressings used for

A

wounds with the need for granulation, minimal to moderate exudates, advanced wound contraction, decupital ulcers, pressure ulcers, bed sores, burns, cavity wounds

30
Q

how do hypercolloid wound dressings work

A

occlusive to semi-occlusive, highly absorbent, promotes moist wound healing, promotes autolysis to debride wounds that are sloughy and necrotic, promotes granulation (may cause hypergranulation), adhesives may reduce contraction

31
Q

what is foam dressing

A

non-adherent dressing that can absorb large amounts of exudates several times their own weight and accumulate the exudate at the back of the dressing
can also be used as secondary dressing

32
Q

what are foam dressings used for

A

inflammatory or repair phase of healing, deep wounds with mild to moderate exudates, decubital ulcers, can be used at any stage of healing, best used after granulation to encourage epithelialisation and contraction

33
Q

what are alginate dressings

A

natural polymer from brown algae, composed of mannuronic or guluronic acid complexes, good gel and film forming properties
calcium alginate is mainly used in the formation of wound dressing and used in hemostatic agent which encourages the clotting cascade within a bleeding wound

34
Q

what are the indications of alginate dressings

A

burns, shearing/avulsion injuries, cavity wounds
encourages wound healing and best at early repair phase
highly absorptive, encourages epithelialisation, promotes autolytic debridement and granulation

35
Q

what are film dressings

A

semi-permeable dressings, primary and secondary dressings, comfortable dressings, resistant to shear and tear, prevent bacterial solonisation but do not absorb exudate, vapour permeable, allow fluid to evaporate while keeping the wound moist

36
Q

what natural polymers are used in wound healing

A

animal, microbial, vegetal

37
Q

what are natural polymers made of

A

protein (fibrinogen, thrombin, collagen, gelatin, albumin)

polysaccharide (chitosan, chitin, polyN-acetyl glucosamine, cellulose)

38
Q

what are the advantages of natural polymers

A

biocompatibility, biodegradability and hydrophilicity

39
Q

what are the limitations of natural polymers

A

batch to batch variability, large heterogeneity, prone to high biodegradability

40
Q

what is collagen

A

natural polymer, most abundant protein in the body, promotes healing by allowing attachment and migration
causes blood clotting through a pathway similar to physiological haemostasis

41
Q

how many types of collagen are there

A

25

42
Q

what is collagen made from

A

three polypeptide chains with triple helical domains

43
Q

what is dry collagen used for

A

physically absorb blood by trapping blood cells and effectively adhere them to the wound site, providing mechanical strength

44
Q

what is chitin

A

versatile materials processed into fibres, sponges, membranes, beads and hydrogels

45
Q

what are the two main polysaccharides in hemorrhage control

A

randomly distributed beta-1,4-linked D-glucosamine and N-acetyl-D-glucosamine

46
Q

how is chitosan prepared

A

from deacetylation of chitin by enzymatic or alkaline hydrolysis

47
Q

what is chitosan

A

natural polymer used in wound dressing

48
Q

what is the source of chitosan

A

exoskeleton of crustaceans

49
Q

what are the properties of chitosan

A

bioactive in slightly acidic media, depolymerises to release beta-1,4-linked D-glucosamine which initiates fibroblast proliferation and aids collagen deposition during the wound healing; it has hemostatic properties
involved in rapid mobilisation of platelet and red blood cells to the injured site during the healing process; also helps in vasoconstriction and activates blood clotting factors

50
Q

what are the advantages of synthetic polymers involved in wound healing

A

overcome shortcomings of the natural polymers

synthesised and modified in a controlled manner

51
Q

what are the disadvantages of synthetic polymers involved in wound healing

A

biologically inert, so do not offer the therapeutic advantage of natural polymers

52
Q

what is polyvinyl alcohol

A

moulded in many dressing forms such as foams, films, particles, sponges and fibres

53
Q

what is polyethyleneoxide and polyethylene glycol

A

advantageous in healing process; non-toxic, biocompatible, non-immunogenic, hydrophilic and flexible
can be used to further incorporate mediators such as growth factors to assist the healing process

Respiratory Diseases & Dermatology (34 decks)

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