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USAHS Adults Test 2 > Unit 5: Wound Healing & Management > Flashcards

Unit 5: Wound Healing & Management Flashcards

1
Q

AOTA Wound Management White Paper

A
  • AOTA supports OT’s and OTA’s role in wound management related to prevention and amelioration of wounds and their associated impact on daily life activities.
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2
Q

Impact on Daily Life (AOTA Wound Management White Paper)

A

-Wounds may affect one’s ability to participate in daily activities including self care, work, education and other life roles.
-Limitations may contribute to depression, anxiety and decreased social participation.

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3
Q

Wound Healing Incidence

A

Populations at increased risk for wounds include:
* Spinal Cord Injuries
* Cerebral Palsy
* Cancer
* Burns
* Diabetics
* Sensory/Mobility Impairments

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4
Q

Types of Wounds

A
  • Punctures
  • Bites
  • Surgical wounds
  • Traumatic wounds
  • Pressure ulcers
  • Diabetic ulcers
  • Venous stasis ulcers
  • Burns
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5
Q

Red (Classification of Wounds)

A

Properly healing, uninfected, granulating tissue, defined borders

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6
Q

Yellow (Classification of Wounds)

A

Generating exudate- yellow, creamy, pus, debris, thick, sticky (need for wound cleaning)

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7
Q

Black (Classification of Wounds)

A

Covered with black, necrotic tissue. Limits wound closure

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8
Q

Mixed (Classification of Wounds)

A

A wound displaying 2 or even 3 colors

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9
Q

Grade 1(Classifications of Pressure Ulcers)

A

-Non-blanchable erythema (redness) of intact skin
-Discoloration of the skin, warmth, edema induration or hardness, particularly on individuals with darker skin

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10
Q

Grade 2 (Classifications of Pressure Ulcers)

A

-Partial thickness skin loss involving epidermis, dermis, or both
-Ulcer is superficial and presents clinically as an abrasion or blister

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11
Q

Grade 3 (Classifications of Pressure Ulcers)

A

-Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may be extended down to, but not through underlying fascia

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12
Q

Grade 4 (Classifications of Pressure Ulcers)

A

-Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures with or without full thickness skin loss

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13
Q

First Degree: Superficial Thickness (Classification of Burns)

A

Confined to the epithelial layer of skin
-Damage to epidermis only.

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14
Q

Second Degree: Superficial/Deep Partial Thickness (Classification of Burns)

A

-Penetrates the dermis (blisters, thin eschar, severe pain)
-Deep 2nd degree can injury the hair follicles and sweat glands
(moderate eschar, lack of blisters, less pain due to damage to superficial nerve endings)
-Superficial Partial-Thickness Burns: Damage to the epidermis and upper level of dermis
-Deep Partial-Thickness: Damage to epidermis and severe damage to dermal layer

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15
Q

Third Degree: Full Thickness (Classification of Burns)

A

-Full thickness burn that destroys dermis (thick inelastic eschar, not painful).
-Skin graft will be required.
(Epidermis and Dermal layers are destroyed)

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16
Q

Fourth Degree (Classification of Burns)

A

-Full thickness burn that results from prolonged thermal contact (often electrical)
-Skin graft and possibly muscle flap will be needed for coverage

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17
Q

Factors Affecting Healing

A

-Depressed immune system/AIDS
-Medications
-Multiple Traumas
-Diabetes
-Advanced Age
-Sepsis
-Malnutrition
-Smoking
-Chemotherapy
-Radiation

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18
Q

Additional influences affecting healing:

A
  1. Edema
  2. Hematoma
  3. Crusts/Foreign Bodies
  4. Aggressive debridement
  5. Tissue hypoxia
  6. Necrotic tissue
  7. Infection
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19
Q

The Therapists’ Role: To create an environment for optimal healing which includes:

A

-Promoting moist environment
-Decreasing trauma with dressing changes
-Decreasing infection rate
-Cleansing, disinfecting, debridement
-Minimize edema
-Decrease wound tension
-Protect wound from contamination
-Promote healing
-Patient education
-Restore function
-Restore motion
-Decrease pain

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20
Q

Wound Healing: Skin Anatomy

A
  • Largest organ of the body
  • Most injured organ
  • Comprised of the following layers: Epidermis, Dermis, Subcutaneous tissue
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21
Q

Epidermis (Skin Anatomy)

A
  • Outer layer of skin (0.4 mm thick)
  • Comprised of avascular tissue
  • Serves as a barrier to prevent dehydration
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22
Q

Dermis (Skin Anatomy)

A
  • .5 mm thick
  • Vascularized connective tissue
  • Composed of collagen and elastin
  • Provides strength and resilience Contains
  • Sebaceous and sweat glands
  • Hair follicles
  • Lymphatic structures
  • Nerve receptors * Pain
  • Touch
  • Temperature
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23
Q

Subcutaneous Tissue (Skin Anatomy)

A
  • Located below the dermis level
  • Comprised of fat and connective tissue
  • Protects underlying structures
  • Provides insulation/cushion to withstand stress
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24
Q

Functions of Skin

A
  • Protects body from infection
  • Conservation of body fluids
  • Temperature regulation
  • Personal identity/appearance
  • Sensation
  • Excretion/secretion
  • Vitamin D production
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25
Q

3 Phases of Wound Healing

A
  1. Inflammatory Phase
  2. Proliferative Phase
  3. Maturation Phase
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26
Q

Inflammatory Stage: Purpose

A
  • Prepare the wound for healing, Respond to injury
    -Acute Stage (24 to 48 hours)
    -Subacute Stage (2 weeks)
    (Vascular and cellular involvement; body works to control blood loss; skin color changes (red, blue, purple), heat, edema, pain, loss of function. Duration: days to weeks to remove debris like bacteria and dead tissue.)
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27
Q

Inflammatory Stage: Sequence of events

A
  1. Vasoconstriction (hemostasis): Formation of fibrin clots; Attempts to minimize blood loss
  2. Vasodilation: Release of histamine and prostaglandins; Leakage of serous fluid into wound bed; Tissue becomes warm, edematous, red
  3. Leukocytes (WBC) migrate to area (leukocytosis)
  4. Phagocytosis occurs by macrophages: Engulf bacteria; Clean the wound; Breakdown necrotic tissue
  5. Cellular repair beings
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28
Q

Inflammatory Stage: Role of Macrophages

A
  • Engulf bacteria and debris
  • Cleanse the wound and degrade necrotic tissue
  • Secrete growth factor
  • Promote angiogenesis
29
Q

4 cardinal signs of infection

A
  1. Temperature (heat)
  2. Change in color
  3. Swelling
  4. Pain
    When active infection is present, the wound will not progress to Phase 2 in the healing process.
30
Q

Proliferative/Fibroplasia Phase: Purpose

A

-Provide strength and covering to wound/injury
-Repair damaged structures/tissue
When
-Overlaps with the inflammatory stage
-Occurs day 3 thru day 21
(Proliferation of granular tissue, angiogenesis, wound contraction, and epithelialization. Collagen matrix is formed in the wound bed. Angiogenesis is initiated, wound contraction (ex. pulling the borders of the wound together), and epithelialization is initiated.)

31
Q

Proliferative Stage: Sequence of events

A
  1. Epithelialization:
    -Re-establishment of epidermis
    -Uninjured epithelial cells reproduce and migrate to the wound
    -“Contact inhibition” when the migrating cells meet and no longer mobilize
  2. Fibroplasia/Collagen Production:
    -Occurs in connective tissue
    -Migration of fibroblasts to wound site along fibrin strands
    -Fibroblasts synthesize to collagen fibers
    -Cross-linking of collagen molecules
    -Granulation tissue produced (Collagen is thin and weak (15% normal strength), unorganized)
  3. Wound Contracture
    * Occurs day 5 after injury and peaks around 2 weeks
    * Action of the myofibroblasts beneath the epidermis
    * Myofibroblasts attach to margins of intact skin and pull the epithelial layer inward
    * Risk of joint contracture may occur
  4. Neovascularization
    -Angiogenesis: Regrowth of new blood vessels; Development of new blood supply to injured tissue.
32
Q

Maturation/Remodeling

A

-Longest duration
-Occurs day 9 to 2 weeks and continues for as long
as 12 – 24 months
-Balance of collagen synthesis (formation) and collagen lysis (breakdown)
(Maturation of tissue healing where collagen fibers are produced, broken down, modified, and reoriented. Duration is up to 2 years.)

33
Q

Maturation/Remodeling: Sequence of events

A

-Collagen synthesis/lysis balance
-Collagen fiber orientation

34
Q
  1. Collagen Synthesis/Lysis (Maturation Phase)
A
  • Collagen synthesis is oxygen dependent/collagen lysis is not
  • If synthesis exceeds lysis, hypertrophic or keloid formation may occur
  • Hypertrophic scar –within bounds of wound
  • Keloid – outside of wound boundary
35
Q
  1. Collagen Fiber Orientation (Maturation Phase)
A

-Provides scar with maximal tensile strength
-Affects changes in appearance
-Collagen fibers of scar tissue are less organized than surrounding tissue
-Collagen fibers orient and assume some of the characteristics of the tissue they are replacing

36
Q

Scar Documentation

A

-Raised, flat, irregular borders
-Size measured in cm
-Color
-Adhesions/Mobility

37
Q

Wound Documentation

A

-Wound location
-Size measured in cm-length, width, depth (Is tunneling present?)
-Stage of healing
-Describe surround area and borders of wound (diffuse, well defined, or rolled)
-Document if there are any signs of infection (warmth, color, odor)
-Slough (yellow or white)
-Eschar (dark, scabby)
-Granulation
-Exudate/drainage (ooze); Color, smell, amount

38
Q

Ecchymosed

A

Bruised

39
Q

Erythematous

A

Red

40
Q

Indurated

A

Firm

41
Q

Edematous

A

Swollen

42
Q

Serous

A

Clear

43
Q

Serosanguinous

A

Blood-tinged

44
Q

Sanguinous

A

Bloody

45
Q

Wound Cleansing and Dressings

A

-Whirlpool
-Sterile Saline
-Sterile Saline/Hydrogen peroxide (50/50)
-Common Dressings: Gauze, Hydrogels, Alginates, Foams, Adaptic/Xeroform/Bacitracin, Hydrocolloids

46
Q

Gauze (wound dressings)

A

Can utilize to cushion, cover, and pack wounds

47
Q

Hydrogels (wound dressings)

A

-Can provide autolytic debridement
-Replace every 24-72 hours

48
Q

Alginates (wound dressings)

A

Moderate or large amount absorption fluid is converted to gel

49
Q

Foams (wound dressings)

A

-Moderate absorption
-Does not conform well

50
Q

Adaptic, Xeroform (wound dressings)

A

Petroleum based to prevent adhesion to wound bed

51
Q

Hydrocolloids (wound dressings)

A

-Moderate absorption
-Adhesive around the edge

52
Q

Incisions (Types of Wounds)

A
53
Q

Abrasions (Types of Wounds)

A
54
Q

Open/Trauma (Types of Wounds)

A
55
Q

Sterile Dry Gauze

A

-Used over sutures or wounds with mild opaque drainage.
(Apply to the incision site and hold in place with Tubigrip or Paper Tape*. Typically left in place for 8-12 hours at a time)

56
Q

Paper Tape

A

-Over closed incisions for scar management
(Clean the scar site with alcohol for maximum adherence. Use caution when using for extended periods of time as this can cause skin irritation. Typically used for 2-12 hours at a time pending tolerance for adhesive.)

57
Q

Coban

A

-For edema
-To hold dressing in place
(-Coban wrapping of a digit can be beneficial for edema as the client can still perform motion (e.g. tendon gliding) while wearing it. Wrap circumferentially from the distal tip of the finger proximally keeping the wraps as even as possible. Usually used during the day – can cause skin breakdown if too tight overnight. Typically used for 1-8 hours at a time.
-Can be used to hold sterile dry gauze or wet-to-dry dressing in place as it does not usually irritate the skin like paper tape during extended periods of time. Typically used for 4-6 hours at a time.)

58
Q

Wet-to-dry dressing

A

-Primary purpose to remove drainage and dead tissue from wounds (ex. deep wounds with tunneling, or wounds left to close by secondary intention).
-Type of wound debridement.
(Moisten dry gauze with sterile saline and “pack” the wound loosely. Cover with dry gauze and hold dressing in place with something like Coban or Tubigrip. Typically changed one time per day. Stop use of wet-to-dry dressing if bleeding or pain is experienced and transition to dry dressing only)

59
Q

Wound Cleansers

A

-Primary purpose is debridement of wounds.
(Under direct MD order only! These can be used instead of or in addition to wet-to-dry wound cleaning.)

60
Q

When to clean a wound

A

-Gentle non-scented soap and running water can be used over incisions/wounds in some cases but it is per MD direction.
-When in doubt, call the MD.
-No hot tubs, dirty dish water, etc when sutures are in place as this will be a likely cause for infection.
(E.g. Distal Radius Fracture ORIF that is 2-5 days out with dry and closed sutures may be appropriate for a shower with mild soap and running water but must be cleared with MD office first!)

61
Q

Linear (Types of Scarring)

A

Scarring remains in-line with the original injury/insult to the skin

62
Q

Hypertrophic (Types of Scarring)

A

Scarring spreads out beyond the original borders of the injury/insult to the skin

63
Q

Keloid (Types of Scarring)

A

Significant mounded scarring caused by extreme proliferation of collagen tissue.

64
Q

Scar Management Principles

A

-Hydration
-Mobilization
-Compression
-Silicone

65
Q

Hydration (Scar Management Principles)

A

Emollient or Humectant use to maintain hydration. Scarring loses water more readily than normal skin.

66
Q

Mobilization (Scar Management Principles)

A

-Normal skin moves and scarring should do the same.
-Mobilize the scar in multiple directions keeping in mind that when healed it only has 80% of the original tensile strength of skin.
-Scarring should be able to be pinched, lifted, and moved in multiple directions.
-Wounds contract as they heal which can limit motion.
-Mobilization and hydration combined can reduce/eliminate motion loss due to contraction.

67
Q

Compression (Scar Management Principles)

A

-The use of KT or paper tape on scarring will mobilize and compression the scar during normal movements (ex. tape then perform a functional intervention).
-Will also reduce edema (through use of Tubi Grip) which will ultimately reduce adhesion formation.

68
Q

Silicone (Scar Management Principles)

A

-Assists the body with collagen fiber remodeling to reduce appearance and adherence of scarring.
-Combines properties of compression, hydration, and mobilization as it acts as a water barrier to reduce water loss.
-Can be used as a gel or as silicone sheeting.

USAHS Adults Test 2 (6 decks)

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