PTA Acute Care - Wound Care Flashcards
list the bony prominences at risk for pressure
ear occiput acromion process scapula olecranon thoracic vertebrae lumbar vertebrae sacrum coccyx greater trochanter ischial tuberosity lateral malleolus medial malleolus calcaneus metatarsals lateral knee
what are the 4 different Debridement procedures?
Mechanial
Enzymatic
Autolytic
Sharp
what is the difference between Infection and Contamination?
Infection
- presence of organisms that the patient’s defenses cannot control and localize
Contamination
- presence of organisms that the patient’s defenses can control and localize
What is the difference between Sterile and Clean?
Sterile
- surgical gloves and sterile surface
Clean
- regular gloves and clean surface
What are the principles of wound management?
- debridement
- control infection
- fill dead space
- absorb excess exudates
- maintain moist wound bed
- promote granulation
- cover the wound
what is an Eschar?
a necrotic cap
how does a wound heal?
from the bottom up
what are the Classifications of Pressure Ulcers?
Stage I - nonblanchable erythema (red does not go away)
Stage II - partial thickness skin loss (blister, abrasion)
Stage III - full thickness skin loss involving necrosis (deep crater)
Stage IV - full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, tendon, etc
if totally covered with eschar wound is Unclassifiable
what is the difference between Acute and Chronic?
Acute
- result of surgery or trauma
- healing factors are working
Chronic
- no healing factors are working
- (but can be converted to acute through debridement)
what Nutritional Deficiencies may impair wound healing?
inadequate amounts of:
- vitamins
- proteins !! most important
- ascorbic acid
- carbohydrates
- fats
what is Wound Sepsis?
- a potentially life threatening complication of an infection
- occurs when chemicals released into the blood stream to fight the infection trigger inflammatory responses throughout the body
- -> can trigger a cascade of changes that can cause organ system failure
what organisms are implicated in infections?
staph
bacteria
How does wound infection impair wound healing?
Causes:
- Inefficient cellular activity
- Decreased oxygen in the wound bed; insufficient oxygen to support the regeneration of tissue
- Increased rate of cell necrosis
- Risk of wound sepsis, osteomyelitis, gangrene
Know the five major phases of wound healing
Inflammation Proliferation Granulation Reepithelialization Remodeling (Matrix Formation)
yep, yep, already know these
what are the available options for Wound Cleansing?
- Nonforceful Irrigation - spray cleanser such as saline
- Pulsed lavage – for mechanical debridement; can treat wound itself and doesn’t affect surrounding tissues; can be done anywhere; no maceration of surrounding tissue
- Whirlpool – good for burn wounds, but may need limb in deep position for long time which could cause swelling
- Topical solutions/commercial cleansers - be careful, maybe too harsh
common topical treatments for wound infections:
Antiseptics * Dakin's - for odor * Acetic Acid - to inhibit infection * Hydrogen Peroxide - nonselective debridement Antibacterials * Silvadene - for burn * Neosporin * Bacitracin Analgesics
what is another name for Microenvironmental Dressing?
occlusive or semi-occlusive
p 581
list some pros and cons for conventional Gauze dressing:
Pros
- can be impregnated with useful things like zinc, antimicrobials or petrolatum
- readily available
- can be used alone or with other dressing
- can be used on infected or non-infected wounds
Cons
- leaves fibers
- can be adherent
- highly permeable
- needs frequent changes
- increased infection rate
- prolonged use decreases cost effectiveness
What is a Wet-to-Dry dressing
a Nonselective Debridement Wet gauze - applied to the wound bed - allowed to dry on the wound Removal of the dry dressing - débrides the wound - pulls away any cellular material that has adhered to the gauze - removes necrotic tissue (yay), but also rich endogenous fluids, fibrin, and other cells critical to wound healing (non-selective, boo)
differentiate between the different types of wounds
- Trauma wounds
- Surgical wounds
- Arterial insufficiency wounds
- round with defined edges
- on lower leg
- Venous insufficiency wounds
- Most common with vascular
- weepy and gross
causes
- Pressure wounds
- Applying too much pressure to an area for too long; inability to move frequently
- Neuropathic/ Diabetic Ulcers
- Cutaneous insensitivity: not aware of pressure or cuts
- often on bottom of foot
wound care for burn patient
how to progress?
what are the different categories of dressings we are studying?
- Transparent Films
- Hydrogels
- Hyrocolloids
- Foam dressings
- Alginates
- Gauze
considerations when choosing dressing:
- Infection: absent or present; prevent or treat
- Necrosis: remove or not; autolytic or mechanical
- Drainage: dry (no drainage), adequate (moist) or excessive (too wet); restore, retain, or remove
- Granulation tissue: present or absent; protect, facili-tate formation
- Epithelialization: present or absent; facilitate formation
- Periwound area: intact, at risk or macerated; protector absorb
- Incontinence: present or absent; protect or absorb
- Cavities and tunneling: present or absent; fill andprotect
- Friction: present, some risk, significant risk; cushion,protect, or prevent
- Odor: minimal or needs reduction; ignore or addodor-reducing dressings
what are indications for use of Gauze dressing?
any wound!
- wet to wet
- wet to moist
- wet to dry
what are the primary factors needed to promote healing?
** Nutrition !! good bandage good blood supply moisture pressure relief debridment
