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Advanced Wound Care > Surgical Wounds, Trauma Wounds and Debridement > Flashcards

Surgical Wounds, Trauma Wounds and Debridement Flashcards

1
Q

What are the Langer’s Lines?

A

Lines surgical incisions should follow the natural skin direction

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2
Q

Classify a clean wound

A

Wounds made under aseptic surgical conditions, that do not enter the genitourinary, respiratory or alimentary tracts or oropharyngeal cavity.

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3
Q

Classify a clean contaminated wound

A

Wounds are contaminated by the resident flora or the cavities but there is no host reaction

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4
Q

Classify a contaminated wound

A

Contaminated by bacteria with no host reaction

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5
Q

Classify an infected wound

A

Clinical signs of infection present, with increase leukocyte and macrophage levels

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6
Q

What is primary intention?

A

Wound healing in which the edges are bought together by sutures, staples or glue.

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7
Q

What is delayed primary intention?

A

The would is left open for treatment with untied sutures insitu until deemed clean, in which it is then closed

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8
Q

What is secondary intention?

A

The would is left open to heal spontaneously with out mechanical intervention

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9
Q

Name the primary suture techniques

A 
Simple square interrupted
Continuous subcuticular
Vertical mattress
Horizontal mattress
Steri-strips
Tension sutures
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10
Q

Why are tension sutures used?

A

To provide additional support by inserting sutures into deeper layers

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11
Q

What are the principles for wound healing by primary intention?

A

1) Protect from physical and pathological assult
2) Absorb exudate
3) Maintain wound and body temperature
4) Oxygenation
5) Avoid stress (analgesia)
6) Observe the suture line for complications

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12
Q

What are the indications for a drainage tube?

A

1) Abscessed cavity - prevent premature closure
2) Insecure intra-abdominal wound - compromised healing
3) Anticipated exudate - tissues that contain secretory glands
4) Risk of peritonitis - bowel, gastric and biliary
5) Extensive dissection
6) Traumatic Injury

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13
Q

Name three types of drains

A

1) Capillary Wicking
2) Negative pressure suction devices
3) Percutaneous

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14
Q

What are the indications for percutaneous tubes

A 
Gastrostomy - feeding or decompression
Jejunostomy - Feeding
Nephrostomy - Draining urine
Suprapubic Catheter - Draining urine
Biliary - Draining bile
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15
Q

Identify three primary aspects of peri-tubular skin care

A

1) Keep skin dry and clean
2) Peri-tubular leakage indicated french gauge is too small
3) Hypergranulation around tube indicates tube friction

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16
Q

What are the principles of drain management?

A 
Client support and education
Secure drain
Maintain patency 
Maintain skin integrity
Contain exudate
Observe type & amount of exudate
Prevent infection
Observe for complications (discomfort, infection, dislodgement, blockage, loss of suction for VAC)
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17
Q

What are the primary surgical complications?

A 
Haemorrhage 
Haematoma
Seroma
Oedema
Infection
Occulsion of blood supply - necrosis
Dehisence
Evisceration
Adhesions
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18
Q

Define Dehisence

A

Seperation of a sutured would resulting in a cavity that requires either a second attempt at primary intention or will heal by secondary intention

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19
Q

What causes dehisence?

A

Trauma
Haematoma
Seroma
Infection

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20
Q

What is a fistula?

A

An abnormal track connecting one viscus to another viscus or to the skin

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21
Q

What causes a fistula?

A

1) Leaking surgical anastomosis
2) Spontaneous rupture due to obstruction, disease, trauma, radiotherapy damage
3) Mesenteric ischaemia
4) Sepsis - diverticulitis and appendicitis

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22
Q

What are examples of an internal fistula?

A

Vesicovaginal
Enterocolonic
Rectovaginal

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23
Q

What are examples of an external fistula?

A

Enterocutaneous
Buccul
Vesciocutaneous

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24
Q

What are the principles of fistual management?

A

1) Patient comfort and support
2) Fluid and electrolyte replacement
3) Nutritional assessment & supplementation
4) Prevention and management of infection
5) Maintenance of skin integrity
6) Containment of effluent & odur
7) Cost effective care

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25
Q

What medication management is involved with a fistula?

A

Anti-motility agents
Cholestyramine
Somastatin Analogues

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26
Q

Define fistulocysis

A

Re-feeding via a distal fistula

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27
Q

Define evisceration

A

A spontaneous rupture of the abdominal suture line and intestines protrude through the opening

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28
Q

4 types of abberant healing

A

1) Hypergrannulation
2) Contracture
3) Hypertrophic Scar
4) Keloid Scar

29
Q

Define hyper grannulation

A

Raised granulation tissue above the level of the surrounding skin which commonly occurs as a result of friction, increased bacterial burden or infection

30
Q

Define contracture

A

Abnormal scar formation that can inhibit movement or function due to excessive myofibroblast activity.

31
Q

Define hypertrophic scar

A

Excessive scar that remains within the perimeter of the original wound

32
Q

Define keloid scar

A

Excessive scar that extends outside the perimeter of the original wound

33
Q

What factors but a surgical site at risk?

A 
Age extremes
Aetiology (trauma or planned)
Uncontrolled comoridities
Poor pre-op skin preparation
Peri-operative hypoxia, pain, anxiety, temperature
Length of operation
Method of wound closure
Post-op care (drainage tubes, wound care, activities)
34
Q

What are the 10 principles for packing a wound?

A

1) Determine the goal of care
2) Ascertain extent of the sinus
3) Do not pack a fistula
4) Select appropriate packing dressing
5) Avoid probes in favor of safer instruments
6) Pack lightly and gently
7) Protect the surrounding skin
8) Select appropriate secondary dressing
9) Support peri-wound tissue
10) Ensure all packing is removed

35
Q

What are the 6 ‘F’ of when not to pack?

A

1) Fistula
2) Fascial plan separation
3) Facilitate exudate drainage
4) Foreign bodies
5) Formed track - lined with epithelium
6) Fear of the unknown

36
Q

What are the 7 steps of the reconstructive ladder?

A

1) Spontaeous healng
2) Linear closure
3) Skin graft
4) Bio-engineered tissue
5) Pedicle Flap
6) Rotational flap
7) Free flap

37
Q

Define a skin graft

A

A skin graft is a segment of dermis and epidermis which has been completely separated from its blood supply and donor site attachment before being transplanted to another area of the body.

38
Q

Name and define the 5 types a grafts

A

1) Autografts - Transfer tissue from one site to another on the same persone
2) Allografts/Homografts - Transfer of tissue from one person to another
3) Xenografts/Heterografts - Transfer of tissue from on species to another
4) Tissue culture - Epidermal cells cultured in a laboratory
5) Bio-engineered skin - dermagraft, apligraft

39
Q

What is the difference between split thickness thin and thick graft?

A

Thin - contracts within the first few months, has no hair, higher survival rate as vascularisation occurs easily
Thick - Less contraction and usually contains hair follicles

40
Q

Define a full thickness graft

A

All of the epidermis and dermis and the donor site has to be directly closed or grafted

41
Q

What are the three stages of skin graft vascularisation?

A

1) Plasmatic inhibition: the graft takes to the recipient bed and absorbs plasma from it. A fibrin network is also formed between the graft and the recipient bed
2) Inosculation: Vascular buds grow into the fibrin network that binds the skin graft to the recipient
3) True circulation: New capillary activity establishes in the graft. The lymphatic system establishes concurrently with these stages.

42
Q

What are some factors that inhibit graft take?

A

1) Poorly vascularised recipient bed
2) Shearing movement
3) Fluid collection beneath the graft
4) Infection
5) Inadequate graft support
6) Patient intrinsic and extrinsic factors

43
Q

What are two patient factors that inhibit graft healing?

A

Lack of education and support and Impaired healing (anaemia,immunocompromised, diabetes, malignancy ect)

44
Q

What are three treatment options for incomplete grafts?

A

1) Regrafting
2) Healing by secondary intentions
3) Antimicrobial dressings to treat infections

45
Q

What is the definition of a flap?

A

A surgical relocation of tissue from one part of the body to another in order to reconstruct a primary defect

46
Q

Name and define the two types of flaps.

A

Cutaneous - Consisting of skin and superficial fascia

Compositie Tissue - Fasciocutaneous flap, myocutaneous flap or osteomyocutaneous flap

47
Q

Name four styles of flaps.

A

1) Free flaps - relocation of skin and subcutaneous tissue as a complete segment with an anastomosis of blood supply
2) Pedicle Flap - Transfer of skin and tissue to another site. Blood supply to the flap is maintained via a vascular pedicle
3) Rotational
4) Z plasty

48
Q

Name some flap observations that nurses need to conduct?

A 
Vital signs
Fluid Balance chart
Oxygen therapy and continuous saturation 
Drains for sudden increased drainage
Type and amount of exudate
Pain management
Signs of infection
Change in tissue turgor
Skin colour changes
Bleeding 
Peripheral pulses
49
Q

What medication interrupt grafting and why?

A

1) Diuretics - cause sudden change in flap perfusion
2) Asprin - can inhibit the aggregation of platelets
3) Heparin - can inhibit thrombin clot formation
4) Caffine - is a cardisc stimulant
5) Nicotine - Inhibits oxygenation of tissues

50
Q

What are the 5 aetiological factors of a burn?

A

1) Thermal
2) Radiaton
3) Chemical
4) Electrical
5) Friction

51
Q

What are the 2 assessment models used for burns?

A

1) Wallace’s rule of 9

2) Lund & Bowlers TBSA (children)

52
Q

What is the characterisation of a superficial burn?

A

1) Painful
2) Erythema
3) Blanching on pressure
4) Mild Oedema
5) May blister or peel
6) Spontaneous heeling

53
Q

What is the characterisation of a deep partial thickness burn?

A

1) Fluid filled blisters
2) Erythema
3) Shiny wet surface
4) Severe pain
5) Mild to moderate oedema
6) Requires surgical intervention for healing

54
Q

What is the characterisation of a full thickness burn?

A

1) Involves epidermis, dermis and may extend into sub-dermal tissue
2) Dry waxy white leather skin
3) Thrombosed vessels
4) Insensitivity to pain and pressure
5) May involve muscle, bone and tendons
6) Required surgical intervention for healing

55
Q

What are the goals of care for burns?

A

1) Alleviate pain
2) Control microbial colonization and prevent infection
3) Prevent wound conversion to a deeper burn
4) Achieve wound coverage as early as possible
5) Promote function of healing skin
6) Preserve function of the body part

56
Q

What is the definition of a skin tear?

A

A skin tear is a traumatic wound occurring principally on the extremities of older adults, as a result of friction alone or shearing and friction forces which separate the epidermis from the dermis (partical thickness wound) or which separates both the epidermis and dermis from underlying structures (full thickness wound)

57
Q

Define a STAR 1A skin tear

A

Edges can be realigned with no bruising

58
Q

Define a STAR 1B skin tear

A

Edges can be realigned with brusing

59
Q

Define a STAR 2A skin tear

A

Edges can not be realigned with no bruising

60
Q

Define a STAR 2B skin tear

A

Edges can not be realigned with bruising

61
Q

Define a STAR 3 skin tear

A

The skin flap is completely absent.

62
Q

Priorities of treatment of a skin tear

A 
Control bleeding (calcium alginate)
Realign edges
Observe dusky skin for viability
Assess surrounding skin
Dress with silicone dressing
Preventative care
63
Q

Define debridement

A

The removal of foreign material and all contaminated and devitalized tissue from or adjacent to a traumatic or infected lesion until health tissue is exposed.

64
Q

What are the implications of necrotic tissue?

A 
Hinders assessment of tissue damage
Interferes with granulation
Inhibits wound contraction
Obstructs epithelial migration
Promotes bacterial proliferation
May cause malodur
65
Q

Name and define different types of debridement?

A 
Surgical - Surgeon under aseptic conditions
CSWD - Competent nurses
Mechanical - friction or water pressure
Autolytic - hydrogel and hydrocolloid
Enzymatic 
Chemical - Cadexomer iodine, honey
Biological - Maggots
66
Q

Define CSWD

A

The removal of loose avascular tissue without pain or bleeding

67
Q

What are the contraindications of CSWD?

A

1) Densely adherent necrotic tissue - can not distinguish between viable and non-viable tissue
2) Impaired clotting mechanism
3) Increased risk of bleeding - malignant wounds
4) Non-infected ischaemic ulcer covered with dry eschar

68
Q

What are the guidelines for CSWD?

A

1) Assess the wound and decided if CSWD is appropriate
2) Use sterile sharp instruments
3) Identify type and amount of avascular tissue to be removed
4) Be aware of underlying and adjacent anatomical structures
5) Avoid all vascular structures
6) Exercise caution at periphery wound
7) Be conservative
8) Flush the wound with sterile saline following debridement
9) Control bleeding

Advanced Wound Care (6 decks)

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