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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
Q

what is secondary closure

A

closure once granulation tissue has formed

healthy granulation implies no infection or necrotic debris

ex. degloving injuries

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26
Q

what is second intention helaing

A

granulation, epithelialization and contraction

27
Q

what are examples of open wound management

A

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
Q

what is phase 1 of open wound management

A

initial assessment and preparation

debridement

29
Q

what is phase 2 of open wound management

A

encouraging active granulation

30
Q

what are the 3 layers of bandages

A
  1. contact layer
  2. intermediary
  3. tertiary
31
Q

what is the purpose of contact layer

A

controls wound environment

32
Q

what is the intermediary layer

A

pads to prevent trauma and absorbs excess fluid

33
Q

what is tertiary layer

A

secures dressing in place

34
Q

what is the difference between adherent and non-adherent layer

A

adherent: debrides wound surface, used in initial stages, speeds debridement phase

non-adherent: protects surface, promotes granulation, cover surgical wounds

35
Q

what is the difference between adherent and adhesive layers

A

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
Q

how do you prevent further contamination of the wound (3)

A
  1. use clean or aseptic technique
  2. cover wound with sterile dressing
  3. clip widely –> pack wound sterile KY jelly to trap hair
37
Q

how else can you remove contaminants from the wound

A

lavage with sterile saline/isotonic crystalloid

moderate pressure

38
Q

how is the initial debridement done

A

sharp dissection and scraping with the blade

rub with dry swab

39
Q

what tissue should you remove when debriding

A
  1. devitalized tissue
  2. contaminated tissue
  3. redundant compromised tissue
40
Q

how does debridement help the wound

A

speeds up the inflammatory phase

41
Q

what is devitalized tissue

A

white, green, black

doesn’t bleed when nicked

loss of skin pliability

thinning of skin

42
Q

what is the best method for debriding

A

sharp (scapel) because it causes the least secondary injury

43
Q

what are wet to dry dressings

A

rarely used as causes injury

adheres to wound over 12-24 hours

rips top layer of wound away

44
Q

is on-going debridement necessary

A

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
Q

what are the aims of dressings (5)

A
  1. non-adherent contact layer
  2. moist wound environment
  3. no surface trauma
  4. promotes granulation formation
  5. initiate epithelialization
46
Q

what are foam dressings

A

absorbent, non-adherent, semi-occlusive keeps wound moist

promote granulation

47
Q

what is hydrogel

A

fits irregular wounds well and maintain moisture and encourage natural sloughing

48
Q

what is the funciton of the intermediary layer

A

hold contact layer in place

absorb exudate passing through the contact layer

provide padding and support

49
Q

what is the purpose of the tertiary layer

A

hold intermediary layer in place

protect from environment contamination

apply pressure to dressing

50
Q

how would you apply dressing to a difficult area

A

tie-over bolus: suture anchor loops in skin, apply dressing, weave tape through suture anchors

51
Q

when are antibiotics indicated

A

most traumatic or open wounds intially

52
Q

what are topical wound dressings

A
  1. silver dressings
  2. manuka honey
  3. hydrochlorous acid
  4. PHMB/betaine
53
Q

why are silver dressings used

A

bactericidal

54
Q

what are manuka honey dressings used (5)

A
  1. antibacterial
  2. encourage sloughing
  3. moist wound environment
  4. osmotic effect
  5. accelerate wound healing
55
Q

why should the biofilm reduction be a priority

A

organized matrix by bacteria that coats wounds

delayed healing

56
Q

what products can be used to manage the biofilm

A
  1. hypochlorous acid: disinfectant
  2. PHMB/betaine: betaine disrupts the biofim, PHMB kills bacteria
57
Q

what are wet-to-dry dressing

A

adherent dressing

58
Q

how long are wet-to-dry dressings left on

A

48-72 hours

59
Q

when are wet-to-dry dressings used

A

when wound is exudative

60
Q

what is the contact layer of wet-to-dry dressings

A

moistened swabs ideal

61
Q

what are the secondary layer in wet-to-dry dressings

A

swabs

dry, sterile, absorbent

62
Q

how do you change a wet-to-dry dressing

A

don’t moisten or will lose adherent action

painful so anesthesia

causes trauma and bleeding

63
Q

how often do you change wet-to-dry dressings

A

every 24 hours

typically 12-24 hours

before dressing is saturated and before strike through

Module 14 (29 decks)

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