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254 > Surgical Wounds & Drains > Flashcards

Surgical Wounds & Drains Flashcards

1
Q

Lpn role around staples and sutures?

A

Removal

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2
Q

How does vacuum assisted closure work?

A

Assist with healing by negative pressure (continual gentle suction)

  • removes copious amounts of exudate, drainage, and draws wound edges together (secondary intention)
  • promotes granulation
  • it’s a specialty wound care nurse
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3
Q

How do surgical wounds normally heal?

A

Primary intention

-healing by approximation (direct union of skin edges)

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4
Q

Purpose of staples and sutures?

A

To close surgical wounds

To repair lacerations

Promote healing by primary intention

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5
Q

Benefits of healing by primary intention?

A

Attempts to:

  • bring the wound edges together neatly and evenly
  • stop bleeding
  • preserve function of the tissue
  • prevent infection
  • restore cosmetic appearance
  • promote rapid healing
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6
Q

Healing for primary intention?

A

Inflammatory phase: 0-4 days

  • hemostatsis
  • blood to area and phagocytosis by WBCs
  • epithelial cell migration

Proliferation phase: 5th day- 3 weeks
-pink granulation tissue fills wound

Maturation: up to 1 year
-collagen scar gets stronger

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7
Q

What is the key to wound healing?

A

Blood supply

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8
Q

Factors that affect wound healing?

A 
Pulling or tension on wound edges
Malnutrition 
Impaired inflammatory response
Infection 
Foreign bodies
Age
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9
Q

Incision vs lacerations?

A

Incision: purposeful cut into tissues for surgical purposes

Laceration: wound or irregular tear of flesh or other body tissue

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10
Q

Staples?

A

Common for surgical wound closure

Generally removed after 7-10 days

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11
Q

Staple removal?

A

Ensure order for removal

Remove alternate staples first
Remove the rest of staples of incision line remains closed, if edges separate discontinue removal and notify RN

Count # of staples for documentation

Apply steristrips to prevent wound dehiscence

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12
Q

Types of sutures?

A

Continuous

Interrupted

Retention

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13
Q

Continuous sutures?

A

One lone piece

Advantage of even distribution

Disadvantage if suture or knot breaks wound may dehisce

Not in LPN scope

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14
Q

Interrupted sutures?

A

Individual sutures, cut separately

Most commonly used

Give better security

Removed by LPNs

Knots places on the sides of the wound to avoid wound depression

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15
Q

Retention sutures?

A

Wire sutures covered in rubber to provide greater strength

Use in patients with impaired healing or suffering from conditions of increased abdominal pressure

For patients debilitated d/t malnutrition, old age, immune deficiency or advanced cancer

Removed by doctor

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16
Q

What to do before removing sutures?

A 
Doctors order
Preparing patient 
-ABCs, safety, comfort/pain
Gather supplies
Collaborate with team 
Document
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17
Q

What do you document after suture removal?

A 
Wound assessment
Patient response
Amount removed
Intactness
Any complications 
Teaching
18
Q

4 types to wound closure?

A

Skin glue
Steristrips
Staples
Sutures

19
Q

Purpose of drains?

A

Removes air or fluid from peri-wound area

Enhances healing the

20
Q

Gentle suction closed drainage systems examples?

A

HMV
Davol
JP

21
Q

Passive open drainage system examples?

A

Penrose

  • lets air and gas escape
  • no suction
  • drain shortened daily as healing precedes
  • kept in place by safety pin
22
Q

Gentle suction drains characteristics?

A

Perforated tubing connected to a portable vacuum unit
Surgeon places 1 end in or near area to be drained and the other passes through the skin
Usually sutured in place
Suction is lost as drainage accumulates

23
Q

Nursing interventions around drains?

A

Empty drain when half full using clean gloves
Re-establish suction after draining
Pin to gown
Assess site and suture
Cleanse site with NS PRN and apply dry dressing
Documentation
Removal

24
Q

Things to document about drains?

A 
Position of drain
Patency 
Characteristics of drain 
Reporting any increase in amount of drainage 
Removal
25
Q

Process of drain removal?

A 
Physician order
Analgesic 
Empty drain and release suction 
Sterile gloves
Clean site
Remove suture
Apply counter pressure
Remove gently but firmly 
Dry dressing 
Document
26
Q

Complex/chronic wounds?

A

Prolonged healing time
(Weeks, months, years)

Primarily secondary intention healing

Multifactoral, multi steps

More sophisticated thinking

27
Q

Example of chronic wounds?

A 
Diabetic neuropathy 
Pressure ulcer 
Venous stasis and arterial ulcer 
Eviseration, dehiscence of a surgical wound 
Surgeon left body open on purpose
28
Q

Complex wound assessment?

A

Look for trends

Frequent wound assessment based on type, cause and characteristics of the wound to stern one type of treatment required to manage wound effectively

Always compare to previous assessment to determine progress

29
Q

Multidisciplinary team involved in complex wounds?

A

OT
Vascular doctor
Dietician
Plastic surgeon

30
Q

What does a wound assessment include??

A 
Location
Type of wound
Extent of tissue involvement 
Type and % of tissue in wound base
Wound size
Wound exudate 
Presence of odour
Peri wound area
Pain
31
Q

Scope of LPNs with complex wounds?

A

Must be able to see wound bed

No tunnelling

32
Q

Irrigating and packing of wounds?

A

Type of packing is based on wound assessment, wound goals and management objectives

Do not over pack

Most common solution used is NS

Irrigation done with each dressing change

33
Q

Why do we not over pack a wound?

A

Cells cannot grow or mature
-need O2

Pulls good tissue out on removal

34
Q

Purpose of irrigating?

A

Remove debris and pathogens

Concentration ordered is key

35
Q

How to manage pain during packing wounds?

A

Pre analgesic before packing and irrigating

36
Q

What does dry packing indicate?

A

Increased frequency of dressing changes

-cells need moisture

37
Q

Purpose of packing?

A

Loosely fill dead space

Facilitate the removal of exudate and debris

Encourage the growth of granulation tissue

38
Q

What is dead space?

A

The space left in the body as a result of tissue loss

The wound area that is packed

39
Q

Define packing?

A

The process of loosely filling a wound cavity or dead space with appropriate packing material

40
Q

Define sinus or tunnelling?

A

A channel that extends from any part of the wound and tracks into deeper space

41
Q

Define undermining?

A

A separation of tissue that occurs underneath the intact skin of the wound perimeter

42
Q

Scope for wound care?

A

Cleansing, irrigating, packing and dressing wounds where the wound bed can be visualized

Limit: do not carry out sharps debridement and also limited to wound whose care needs follow expected path

Condition: additional training and can care for tunnelled wound, apply compression dressings and provide negative pressure therapy

254 (16 decks)

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