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Module 14 > Small Animal Wounds: Initial Approach > Flashcards

Small Animal Wounds: Initial Approach Flashcards

1
Q

what are the 3 stages of wound healing

A
  1. inflammatory stage
  2. debridement stage
  3. maturation stage
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2
Q

what occurs in the repair stage

A

granulation tissue forms

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3
Q

what occurs in the maturation stage

A

wound contraction, remodelling

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4
Q

what stages are managed with dressings

A

inflammatory, debridement, repair

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5
Q

what occurs in the inflammation stage

A
  1. hemorrhage + clot formation: scaffold for repair
  2. increase blood flow: increase oxygenation, source of inflammatory cells
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6
Q

what are the cells in the inflammatory stage

A

neutrophils which control the bacteria infection by phagocytosis

die and sit in the wound as dead white cells

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7
Q

what occurs in the debridement stage

A
  1. the neutrophils phagocytose bacteria and then die
  2. macrophage stakes over
  3. exudate
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8
Q

what is the major cell type of the debridement stage

A

macrophages

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9
Q

what are the functions of macrophages in the debridement stage (3)

A
  1. phagocytosis of debris
  2. proteases digest protein debris
  3. release cytokines to drive the cellular response
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10
Q

what is the exudate made up of in the debridement stage

A

sloughing of tissue, cells (dead neutrophils) and bacteria

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11
Q

what occurs in the repair stage (2)

A
  1. granulation tissue forms
  2. epithelialization
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12
Q

how does granulation tissue form (3)

A
  1. macrophages promote fibroplasia and angiogenesis
  2. vessels migrate into fibrin clot
  3. collagen matrix is laid down
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13
Q

how does epithelialization occur

A

migration between eschar and granulation tissue

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14
Q

why is granulation tissue important

A

framework for wound to epithelialize

reorganizes to increase wound strength and contraction

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15
Q

what is healthy granulation tissue

A
  1. highly resistant to infection
  2. lattice for scar formation
  3. nutrient and oxygen supply –> red, flat, epithelializing
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16
Q

what is unhealthy granulation tissue

A
  1. pale
  2. not progressing
  3. usually due to necrotic debris or infection
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17
Q

what factors promote epithelialization

A
  1. absence of infection
  2. absence of necrotic debris
  3. oxygen at wound surface (vessels)
  4. moist wound environment
  5. healthy granulation bed
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18
Q

what is the maturation phase (3)

A
  1. scar contracts
  2. collagen remodels increasing strength
  3. continues for weeks and months
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19
Q

what are local factors that impede wound healing

A
  1. foreign material in wound
  2. infection (including infected biofilm)
  3. surface trauma (inadequate bandaging)
  4. desiccation (failure to keep wound covered)
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20
Q

what are host factors that can delay healing (5)

A
  1. debility (geriatric patient)
  2. endocrine disease: cushings, diabetes mellitus
  3. metabolic disease: uremia
  4. hypoalbuminemia
  5. exogenous steroids
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21
Q

what things can be done to promote wound healing (5)

A
  1. removal of non-viable tissue (debride)
  2. control infection
  3. promote good blood supply
  4. maintain moist surface (keep covered)
  5. prevent surface trauma (dress properly)
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22
Q

what is the endpoint of initial wound management

A

granulation tissue with epithelialization

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23
Q

what is primary wound closure

A

immediate closure of healthy wounds (free of necrotic debris, free of infection)

ex. surgical wounds, some traumatic wounds (<6 hours)

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24
Q

what is delayed primary closure

A

ex. dog bite injury

closure after bacteria and debris have been eliminated but before granulation starts

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25
what is secondary closure
closure once granulation tissue has formed healthy granulation implies no infection or necrotic debris ex. degloving injuries
26
what is second intention helaing
granulation, epithelialization and contraction
27
what are examples of open wound management
traumatic, contaminated wound not suitable for primary closure so manage to the point of granulation formation, then close the wound in any way you want
28
what is phase 1 of open wound management
initial assessment and preparation debridement
29
what is phase 2 of open wound management
encouraging active granulation
30
what are the 3 layers of bandages
1. contact layer 2. intermediary 3. tertiary
31
what is the purpose of contact layer
controls wound environment
32
what is the intermediary layer
pads to prevent trauma and absorbs excess fluid
33
what is tertiary layer
secures dressing in place
34
what is the difference between adherent and non-adherent layer
adherent: debrides wound surface, used in initial stages, speeds debridement phase non-adherent: protects surface, promotes granulation, cover surgical wounds
35
what is the difference between adherent and adhesive layers
many non-adherent dressings have an adhesive backing to stick to skin these adhesives are inactivated by moisture so the dressing doesn't adhere to the wound surface
36
how do you prevent further contamination of the wound (3)
1. use clean or aseptic technique 2. cover wound with sterile dressing 3. clip widely --\> pack wound sterile KY jelly to trap hair
37
how else can you remove contaminants from the wound
lavage with sterile saline/isotonic crystalloid moderate pressure
38
how is the initial debridement done
sharp dissection and scraping with the blade rub with dry swab
39
what tissue should you remove when debriding
1. devitalized tissue 2. contaminated tissue 3. redundant compromised tissue
40
how does debridement help the wound
speeds up the inflammatory phase
41
what is devitalized tissue
white, green, black doesn't bleed when nicked loss of skin pliability thinning of skin
42
what is the best method for debriding
sharp (scapel) because it causes the least secondary injury
43
what are wet to dry dressings
rarely used as causes injury adheres to wound over 12-24 hours rips top layer of wound away
44
is on-going debridement necessary
active debridement causes injury initial is good to remove detritus and dead tissue on-going can be counterproductive dressings encouring granulation promote sloughing of tissue
45
what are the aims of dressings (5)
1. non-adherent contact layer 2. moist wound environment 3. no surface trauma 4. promotes granulation formation 5. initiate epithelialization
46
what are foam dressings
absorbent, non-adherent, semi-occlusive keeps wound moist promote granulation
47
what is hydrogel
fits irregular wounds well and maintain moisture and encourage natural sloughing
48
what is the funciton of the intermediary layer
hold contact layer in place absorb exudate passing through the contact layer provide padding and support
49
what is the purpose of the tertiary layer
hold intermediary layer in place protect from environment contamination apply pressure to dressing
50
how would you apply dressing to a difficult area
tie-over bolus: suture anchor loops in skin, apply dressing, weave tape through suture anchors
51
when are antibiotics indicated
most traumatic or open wounds intially
52
what are topical wound dressings
1. silver dressings 2. manuka honey 3. hydrochlorous acid 4. PHMB/betaine
53
why are silver dressings used
bactericidal
54
what are manuka honey dressings used (5)
1. antibacterial 2. encourage sloughing 3. moist wound environment 4. osmotic effect 5. accelerate wound healing
55
why should the biofilm reduction be a priority
organized matrix by bacteria that coats wounds delayed healing
56
what products can be used to manage the biofilm
1. hypochlorous acid: disinfectant 2. PHMB/betaine: betaine disrupts the biofim, PHMB kills bacteria
57
what are wet-to-dry dressing
adherent dressing
58
how long are wet-to-dry dressings left on
48-72 hours
59
when are wet-to-dry dressings used
when wound is exudative
60
what is the contact layer of wet-to-dry dressings
moistened swabs ideal
61
what are the secondary layer in wet-to-dry dressings
swabs dry, sterile, absorbent
62
how do you change a wet-to-dry dressing
don't moisten or will lose adherent action painful so anesthesia causes trauma and bleeding
63
how often do you change wet-to-dry dressings
every 24 hours typically 12-24 hours before dressing is saturated and before strike through

Module 14 (29 decks)

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