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RRPA Clinical Med II > Principles Of Wound Care Schoenwald (Exam 2) > Flashcards

Principles Of Wound Care Schoenwald (Exam 2) Flashcards

1
Q

When assessing a wound what are you looking for?

A
  1. Tissue type
  2. Wound exudate
  3. Periwound condition
  4. Pain level
  5. Size
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2
Q

What are the types of granulation tissue?

A
  1. Hypergranulation tissue - overdrive = not great for wound healing
  2. Beefy red granulation tissue = this is what you are looking for
  3. Hypogranulation - hardly any possibly due to decreased blood flow to that area
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3
Q

What are pressure ulcers a result of and where do they often develop?

A
  • Result from pressure or repetitive pressure at the same anatomical locatin
  • Often develop at bony prominences
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4
Q

How would you describe a Stage 1 pressure ulcer?

A

Nonblanchable erythema of intact skin (heel is common)

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5
Q

How would you describe a Stage 2 pressure ulcer?

A

Partial thickness skin loss with exposed dermis

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6
Q

How would you describe a Stage 3 pressure ulcer?

A

Full thickness skin loss

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7
Q

How would you describe a Stage 4 pressure ulcer?

A

Full thickness skin and tissue loss

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8
Q

What does it mean for a pressure ulcer to be unstageable?

A

Obscured full thickness skin and tissue loss (eschar)

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9
Q

What is a deep tissue pressure injury?

A
  • Persistent, non-blanchable deep red, maroon, purple injury
  • (Might need imaging and close f/u)
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10
Q

What is the treatment for pressure ulcers?

A
  1. Relieve/remove pressure
    1. air beds, padded seat covers, sheep skin, boots
  2. Treat wound as it is assesses
    1. Maceration
    2. Eschar
    3. Infection
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11
Q

What is the function of an Alginates dressing?

A
  • Made from seaweed - silver in it to help keep microbes at bay
  • Exudate absoprtion
  • Pulls wetness away from wound
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12
Q

What is the function of Foams dressings?

A
  • Retain moisture
  • Absoprtion
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13
Q

What is the function of Gauze dressings?

A
  • Retain mositure
  • Debride (wound sticks to gauze - upon removal, takes good tissue too)
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14
Q

What is the function of Hydrocolloid dressings?

A
  • Occlusion
  • Good for skin tears
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15
Q

What is the function of Wound Filler dressings?

A
  • Obliterate dead space
  • Absorb
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16
Q

What should you do when addressing nonhealing wounds?

A
  1. Assess the entire patient
  2. Systemic problems impair wound healing
    1. Smoking delays wound healing!
  3. Consider endocrinology problems
17
Q

What should you be documenting for wounds?

A

Characterize the wound:

  • Size and depth measurements
  • Appearance of wound (foreign body, debris?)
  • Amount of drainage (type)
  • Appearance of surrounding tissue
18
Q

If a wound is nonhealing what else should you consider?

A
  • Malnutrition
  • Vit C and Zinc common supplements for woundcare
  • Treat infection is present
19
Q

What is the protein requirement in a healthy patient? What about for wound healing?

A
  • 1.25 - 1.5 grams of protein/kg
  • More for wound healing (increase as tolerated)
20
Q

What are risk factors for venous ulcerations (stasis)?

A
  • Varicose veins
  • DVT
  • Chronic venous insufficiency
  • Poor calf muscle function
  • Ovesity
21
Q

Where do 95% of venous ulcerations occur on the body?

A

Gaiter area of the leg (think “sock distribution” of the leg)

22
Q

Common signs and sypmtoms of a venous ulcer?

A
  • Edema often present
  • Hemosiderin staining
  • Hair loss of extremity
  • Weeping and itchin gof skin often present
23
Q

What is the treatment for a venous ulceration?

A
  1. Compression therapy (stockings)
    1. Appropriate for ulcers caused by edema
    2. Avoid if arterial flow compromised
    3. 40-60 mmHG of pressure (Unna boot)
  2. Elevation of extremity
  3. Woundcare and assessment
24
Q

What causes arterial ulcerations and what do they result in?

A
  • Due to decreased arterial blood supply to the LE
    • PVD, DM, Sickle Cell
  • Results in tissue hypoxemia and damage
  • Reduced capillary refill time
25
Q

What are common signs and symptoms of arterial ulcers?

A
  • Painful
  • Ulcer appeared “punched out”
  • Well demarcated edges
  • Pale, often necrotic base
  • Surrounding skin dusky, shiny, hairless
  • Usually occur over the toes, foot, and ankle
26
Q

What is the treatment for arterial ulcers?

A
  1. Restore arterial function if possible
    1. SX usually
  2. Wound treatment
  3. Smoking cessation

Note: Medication susually not helpful

27
Q

What is an ankle brachial index (ABI) helpful in determining?

A

The extent of peripheral vascular disease

28
Q

How is an ABI performed?

A
  • Systolic BP measure in both brachial arteries
  • Systolic BP then measure in both dorsal pedis/psoterior tibial arteries
  • Pt should be at rest and supine for 10 mins.
29
Q

What is a normal value for an ABI?

A

1.0 - 1.4

30
Q

What does an ABI value > 1.4 suggest?

A

A noncompressible calcified vessel

31
Q

What does an ABI value < 0.9 indicate? What about < 0.5?

A
  • <0.9 = moderate PAD –> Refer to vascular specialist
  • < 0.5 = Severe PAD –> Refer to vascular specialist
32
Q

What are the 3 main ways negative pressure wound therapy (wound vac) enhances wound healing?

A
  1. Reducing edema
  2. Increasing rate of granulation tissue formation
  3. Stimulation of circulation
33
Q

What types of wounds are wound vac used for?

A
  • Chronic and Acute wounds
  • Traumatic wounds
  • Partial thickness
  • Dehisced wounds
  • DM ulcers
  • Pressure ulcers
34
Q

What are contraindications for the use of wound vac therapy?

A
  • Malignancy of wound
  • Untreated osteomyelitis
  • Placement of dressing in contact with exposed blood vessels, organs, or nerves
  • Nonenteric or unexplored fistulas
35
Q

What are the 2 types of growth factors we talked about called?

A
  1. Apligraf - human derived
  2. Dermagraft
36
Q

What are some debridement methods?

A
  1. Enzymatic-chemical agents (most taken off market)
  2. Mechanical-wet to dry dressings- gauze (peroxide debridement controverial)
  3. Sharp-surgical removal (done by surgeon)
37
Q

What is involved in the follow up care of wounds?

A
  • Close monitoring
  • Weekly visits
  • Careful documentation

RRPA Clinical Med II (45 decks)

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