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Theory II > Week 4 - Pressure Ulcers > Flashcards

Week 4 - Pressure Ulcers Flashcards

1
Q
  • An injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken.
  • Costly to treat
  • Impact on quality of life
A

WOUND

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2
Q

A type of ulcer in which localized areas of prolonged ischemia of soft tissue that occur when pressure applied to the skin over time greater than the normal capillary closure pressure.

A

Pressure Ulcers (Decubitus Ulcer)

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3
Q

An open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal.

A

Ulcer

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4
Q

How often should a client’s skin be assessed?(4)

A 
All clients should be assessed for skin integrity:
– On admission
– On a weekly basis
– Following a change in health status
– Before transfer or discharge
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5
Q

What are some risk factors in developing a wound?

A
  • Immobility
  • Friction and shear
  • Increased moisture (I.e. Incontinence, perspiration)
  • Altered nutritional status (I.e. Deficiencies, anemia)
  • Motor/sensory dysfunction
  • Impaired cognition
  • Decreased tissue perfusion (I.e. DM, obese)
  • Splints, restraints etc.
  • Critically ill
  • Advanced age
  • Medications
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6
Q

What is the goal for promoting skin integrity?

A

Goal is to reverse risk factors and causes; to prevent and treat wounds

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7
Q

What is a example of a susceptible area in developing a pressure ulcer?

A

Weight bearing prominences at risk due to small amount of subcutaneous tissue

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8
Q

Resistance to movement that occurs when two surfaces are moved across each other

A

Friction

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9
Q

An applied force or pressure exerted against the surface and layers of the skin as tissues slide in opposite but parallel planes.
- Created by interplay of gravitational forces & friction

A

Shear

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10
Q

Where in the body are friction and shear most susceptible?

A

Sacrum and heels most susceptible

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11
Q

Likely or liable to be influenced or harmed by a particular thing.

A

Susceptible

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12
Q

An assessment tool for determining a patient’s risk level for incurring skin breakdown.Braden Scale

A

Braden Scale

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13
Q
  • Areas assessed in the Bradn Scale. (7) include:
A 
sensory perception
moisture
activity
mobility
nutrition
friction and shear (SMAMNFS)
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14
Q

Braden Scale Score indicates level of risk of skin breakdown:
- 9 or less- ______

A

very high risk

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15
Q

Braden Scale Score indicates level of risk of skin breakdown:
- 10-12 – _______

A

high risk

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16
Q

Braden Scale Score indicates level of risk of skin breakdown:
- 13-14- _______

A

moderate risk

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17
Q

Braden Scale Score indicates level of risk of skin breakdown:
- 15-16 _____

A

mild risk

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18
Q

Assess the pressure ulcer(s) initially for: (8)

A
  • Stage/Depth
  • Location
  • Surface Area (length x width)
  • Odour
  • Sinus tracts/Undermining/Tunneling
  • Exudate
  • Appearance of the wound bed
  • Condition of the surrounding skin (periwound) and wound edges
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19
Q
  • when a wound diameter is wider at its base (deep in the wound) than at the wound’s skin edge.
  • the wound is spread out underneath the skin that surrounds the visible part of the sore.
A

Undermining

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20
Q
  • when the wound tracks under the skin to another opening in the skin OR to a deeper cavity.
  • Sometimes referred to as a “sinus” or “tract”.
A

Tunneling

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21
Q

Redness or inflammation of the skin

A

Erythema

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22
Q

Breakdown of tissue as a result of moisture

A

Maceration

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23
Q

Healing by the growth of epithelium

A

Epithelization

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24
Q

Draining or oozing of fluid

A

Exudate

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25
Q

Containing pus

A

Purulent

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26
Q

Tissue that is being shed

A

Slough

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27
Q

Dead tissue

A

Necrotic

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28
Q

Scab or dry crust

A

Eschar

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29
Q

Pink fleshy projections that form during the healing process

A

Granulation

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30
Q
  • Pressure Ulcer Stage?
    •Area of erythema on intact skin
    •Erythema does not whiten with pressure
    •Skin temperature elevated (because of the increased vasodilation)
    •Tissue swollen and congested
    •Patient complains of discomfort
    •Erythema progresses to dusky blue-gray (the result of skin capillary occlusion and subcutaneous weakening)
A

Stage I

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31
Q
  • Pressure Ulcer Stage?
    •Skin breaks- involves epidermis, dermis or both
    •Abrasion, blister or shallow crater (superficial)
    •Edema
    •Ulcer may drain
    •Infection may occur
    •Pressure off loading by positioning
A

Stage II

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32
Q 
- Pressure Ulcer Stage?
•Full thickness skin loss involving ulcer extending into subcutaneous tissue
•Necrosis and drainage
•Infection often develops
•Deep crater with no undermining
•Specialty beds often required
A

Stage III

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33
Q
  • Pressure Ulcer Stage?
    •Ulcer extends to underlying muscle and bone
    •Extensive destruction, tissue necrosis or damage to muscle, bone and supporting structures (tendons etc.)
    •Deep pockets of infection develop
    •Necrosis and drainage develop
    •Goal of treatment
A

Stage IV

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34
Q
  • Pressure Ulcer Stage?
    •If you can’t see the wound base the wound is labeled stage X in your documentation
    •Once the eschar is removed, it can be properly staged
    •If healing is not the goal, keep eschar dry and intact; it is done by painting with betadine solution and frequent incontinence care.
    •If healing is the goal, skin grafts are usually done after debridement and stabilizing patient and wound.
A

Stage X

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35
Q

If you can’t see the wound base the wound is labeled stage ___ in your documentation

A

X

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36
Q

Once the ___ is removed in a stage X pressure ulcer, it can be properly staged.

A

eschar

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37
Q

If healing is not the goal, keep eschar dry and intact; it is done by painting with _____ and frequent incontinence care.

A

betadine solution

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38
Q

If healing is the goal, skin grafts are usually done after ____ and stabilizing patient and wound.

A

Debridement

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39
Q
  • refers to a surgical procedure to move tissue from one site to another on the body, or from another person, without bringing its own blood supply with it.
A

Grafting

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40
Q

Open area or tunneling under the edge of a wound

A

Undermining

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41
Q

Types of Exudates

A
  • Serous:
  • Sanguineous:
  • Serosanguineous:
  • Purulent:
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42
Q

Type of Exudate
- Clear ,watery plasma with visual
absence of pus, blood and debris

A

Serous

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43
Q

Type of Exudate
- Bloody drainage, appears entirely
composed of blood

A

Sanguineous

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44
Q

Type of Exudate

- Blood mixed with clear fluid

A

Serosanguineous

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45
Q

Type of Exudate
- Pus-like appearance,
cloudy, thick

A

Purulent

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46
Q

Wound base assessment - Color (3)

A

A) Black - eschar/ necrotic - cleanse & debride
B) Yellow - fibrin or slough - cleanse & debride
C) Pink/Red - granulation - protect

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47
Q

The wound base is “Black” what does it mean? What should the nurse do?

A

eschar/ necrotic - cleanse & debride

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48
Q

The wound base is “Yellow” what does it mean? What should the nurse do?

A

fibrin or slough - cleanse & debride

49
Q

The wound base is “Pink/Red” what does it mean? What should the nurse do?

A

granulation - protect

50
Q

Nursing Diagnosis for Pressure Ulcer.

r/t (6)

A 
Risk for impaired skin integrity
R/T: 
•Immobility
•Decreased sensory perception
•Decreased tissue perfusion
•Decreased nutritional status
•Friction and shear forces
•Increased moisture etc.
51
Q

Nursing Interventions for Pressure relief: (2)

A

–Frequent position changes and turning Q1-2H

–Teach patient to reposition self regularly and to shift weight Q15min

52
Q

Nursing Interventions for Positioning:(3)

A

–Q2H, 30 degree lateral preferred
–Avoid positioning on bony prominences
–Pillows and cushions may be needed

53
Q

Nursing Interventions for Skin Care (4)

A

–Never massage reddened areas
–Minimize irritating moisture
–Wash skin with mild soap
–Barrier ointments/creams may be helpful

54
Q

Nursing Interventions for Nutritional Status

A
  • Select foods high in Protein, Zinc, Vitamin A, C & E
  • Nutritional supplements may be required
  • Administer multivitamin as ordered
  • Consult dietician
55
Q

In pt with risk for skin impairment, what nutrients are needed?

A

Protein, Zinc, Vitamin A, C & E (PZACE)

56
Q

Choice of Dressing Balances: (4)

A

–Moisture
–Bacterial load
–Temperature
–Protection

57
Q

Signs too Little Moisture(5)

A
  • Base non glistening
  • Grey in colour
  • Dressing sticks to base
  • Some products are still dry
  • No break through outer dressing
58
Q

Signs of too Much Moisture(5)

A
  • Base spongy
  • Base after dressing removed - floods
  • Maceration
  • Dressing changed two to three times a day
  • Can’t see base when using transparent film
59
Q

Factors in Choosing a Product(Dressing) - (7)

A
  • Stage of wound
  • Appearance of wound base and borders
  • Exudate and odour
  • Sinus tract/infection
  • Necrotic tissue
  • Age of wound
  • Type of skin of patient
60
Q

Dressing Types (6)

A
  • Transparent dressing
  • Gauze
  • Telfa
  • Hydrocolloidal
  • Hydrogel
  • Calcium Alginates
61
Q

Type of Dressing
–E.g. Op-site, Tegaderm
– Reduces risk of infection by providing a protective barrier, waterproof
– Protects from friction injury and is a barrier to bacteria
– Allows the skin to breathe
– Allows direct visualization
– Stays in place, easy to remove
– Molds to awkward places
– Can be left in place up to 7 days
– Stage I
– Never used on open wounds as a primary dressing

A

Transparent dressing

62
Q

Type of Dressing

- loosely woven or synthetic

A

Gauze

63
Q

Type of Dressing

- nonadherent sterile plastic coated gauze

A

Telfa

64
Q

Type of Dressing

  • dressing for moderate amounts of exudate
  • Interacts with wound fluid to provide a moist environment (Venous ulcers, pressure ulcers, diabetic ulcers, 1st and 2nd degree burns)
  • Absorbency and film dressing (Highly absorbent gel (polyurethane), Oxygen and water vapor permeable)
  • Adhesion and elasticity
  • Bacterial barrier
  • Allows for autolytic debridement
  • Can stay in place for up to 3-5 days or until seal broken
A

Hydrocolloidal

65
Q

Type of Dressing

- dehydrates necrotic tissue in order to debride it

A

Hydrogel

66
Q

Type of Dressing

  • hydrophilic
  • a sterile or non-sterile device intended to cover a wound and to absorb exudate.
  • Indicated for bleeding and/or exudating wounds
  • Helps stop bleeding after debridement
  • Absorbs exudate
  • Put in dry; should come out as gel
  • Packed lightly into a wound since it expands in size
  • Protect periwound
  • Flush out well
A

Calcium Alginates

67
Q

Removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

A

Debridement

68
Q

Examples of Hydrocolloidal Wound Dressing

A
  • Replicare, Cutinova hydro (Smith & Nephew)
  • Comfeel (Coloplast)
  • Tegasorb (3M)
  • DuoDERM (ConvaTec/CVL)
  • NU-DERM (J&J)
69
Q 
Type of Wound Dressing
•Indications:
–Mildly exudating wounds, clean wounds, partial thickness wounds; it applies pressure and removes scabs
•Absorbs 5 times own weight
–Hydrophilic polysaccharide particles
•Cooling soothing effect
•Facilitates autolytic debridement
•Delivered in many forms
–Amorphous gel, Sheets
•Can stay in place for 24 hours
•Need to protect peri-wound to reduce maceration
A

Hydrogel

70
Q

Debridement Methods (6)

A
  • Selective debridement
  • Nonselective
  • Autolytic
  • Enzymatic
  • Mechanical
  • Sharp/surgical
71
Q

Debridement Method

• removal of only nonviable tissue.

A

Selective debridement

72
Q

Debridement Method

• removal of both nonviable and viable tissue and may prolong healing.

A

Nonselective debridement

73
Q

not able to develop, grow, or survive.

A

Nonviable

74
Q

Debridement Method
- process by which the body’s leukocytes and proteolytic enzymes digest nonviable tissue and debris from the wound bed. Selective process.

A

Autolytic

75
Q

Debridement Method

- application of prescriptive topical enzymes to nonviable tissue to breakdown devitalized collagen.

A

Enzymatic

76
Q

Debridement Method
- removal of devitalized tissue by physical forces that are nonselective and maybe painful .
–E.g. wet-to-dry dressings and high pressure wound irrigation.

A

Mechanical

77
Q

Debridement Method

- Removal of nonviable selective tissue by a physician or specially trained or certified wound care nurse.

A

Sharp/surgical

78
Q 
Device that uses negative pressure to
pull edges of wounds together
• Creates healing by:
–Promotes granular tissue formation
–Removes fluid
–Improves circulation
–Decreases bacterial burden
• Requires airtight seal
• Changed 3x a week
• Used in highly exudating wounds
A

Vacuum Assisted Closure Device (VACD)

79
Q

Second most common type of nosocomial infection

A

Wound Infection

80
Q

All ______ are considered contaminated with bacteria and infection inhibits wound healing

A

Chronic skin wounds

81
Q

_______ often have deep pockets of infection

A

Extensive pressure ulcers

82
Q

Wound infections can progress to infection in (4)

A
  • bone (osteomyelitis), joints (pyarthrosis), sepsis and septic shock
83
Q

Infection in the bone.

A

Osteomyelitis

84
Q

Infection in the joints

A

Pyarthrosis

85
Q

Infection in the whole body

A

Sepsis

86
Q

Signs of wound infection (7)

A 
• Delayed healing/dehisence
• Increased wound pain
• Malodour
• Abscess/sinus formation
• Localized swelling/ redness/ heat
• Increased exudates/ purulent discharge
• Pyrexia/Fever
• C&S swab (but may test negative if not taken properly)
• Appearance of infection:
–Contaminated or traumatic wound: 2-3 days
–Surgical wound: 4-5 days post-op
87
Q

Prevention of Wound Infections (5)

A
  • Ongoing wound assessment
  • Proper wound cleansing and dressing technique
  • Removal of non-viable tissue, debris etc.
  • Application of topical antimicrobial agents if ordered
  • Use of dressing material that changes wound pH (I.e. Silver or iodine based products)
88
Q

Improvement of host factors that contribute to infection: (5)

A
  1. Poor tissue perfusion
  2. Poor nutritional status
  3. Local edema
  4. Immunocompromising drug/conditions
  5. Smoking and alcohol use
89
Q

The process of a body delivering blood to a capillary bed in its biological tissue.

A

Perfusion

90
Q

Ulcers that result from rupture of small skin veins and subsequent ulcerations related to arterial or venous disease

  • Occur when inflamed necrotic tissue sloughs off
  • Inadequate oxygen and nutrient delivery to tissue is factor that leads to cell death
  • Ulcers are often chronic and difficult to heal.
  • May recur
A

Stasis Ulcers

91
Q

Manifestations of Arterial Stasis Ulcers (5)

A 
–Intermittent claudication
–Continuous acute pain
–Small, circular, deep ulcerations
–Location- tips of toes, lateral 5th toe, medial side of hallux
–Gangrene may be present
92
Q

Muscle pain caused by too little blood flow during exercise.

A

Intermittent Claudication

93
Q

occurring at irregular intervals; not continuous or steady.

A

Intermittent

94
Q

occurs when tissue dies (necrosis) because its blood supply is interrupted.

A

Gangrene

95
Q

Manifestations of Venous Stasis Ulcers (6)

A 
–Pain- aching, heaviness
–Ankle/foot edema
–Location-medial or lateral malleolous
–Superficial, irregular shape
–Heavy drainage
–Discoloration of ulcer area
96
Q

Assessment & Diagnostics for Stasis Ulcers: (4)

A 
•Need to identify cause of ulcer
•Pulse of lower extremities
•Wound assessment
•Diagnostic tests:
–Doppler and duplex ultrasound studies
–Arteriography
–Venography
–Cultures of ulcer bed for infection
–If not healing in 12 weeks, biopsy of wound edge
97
Q

Diagnostic tests for Stasis Ulcers

A 
– Doppler and duplex ultrasound studies
– Arteriography
– Venography
– Cultures of ulcer bed for infection
– If not healing in 12 weeks, biopsy of wound edge
98
Q
  • Device used to detect a weak peripheral pulse by magnifying pulsatile sounds from the heart and blood vessels
  • Position the person supine
  • Legs externally rotated
  • A couple drops of gel is used.
  • Apply light pressure
A

Doppler Ultrasonic Stethoscope

99
Q
  • the ratio of the blood pressure in the lower legs to the blood pressure in the arms.
    •Use Doppler stethoscope to determine the extent of peripheral vascular disease.
    •Apply a regular arm blood pressure cuff above the ankle and determine the systolic pressure in either the posterior tibial or dorsalis pedis artery.
    •Ankle systolic pressure/Arm systolic pressure = ABI
    •Normal ankle pressure is slightly
    greater than or equal to brachial
    pressure, ABI 1.0 to 1.2
A

Ankle-Brachial Index (ABI)

100
Q

Formula for ABI

A

Ankle systolic pressure/Arm systolic pressure = ABI

101
Q

Normal ankle pressure

A

Slightly greater than or equal to brachial

pressure, ABI 1.0 to 1.2

102
Q

Management of Stasis Ulcers (6)

A
  • To reduce venous stasis and prevention of ulcerations
  • Antigravity measures to improve venous blood return
  • Elevation of leg regularly during day
  • Activity such as walking
  • Compression of superficial veins with TEDs
  • Protection of limb from injury
103
Q

Pharmacological Management of Venous Ulcers

A

•Pharmacological therapy:
–Antibiotics if wound infected
–Oral preferred, topical not proven to be effective

104
Q

Non-pharmacological Management of Venous ulcers (6)

A
  • Wound care, appropriate dressing choice & wound care specialists
  • Debridement to promote healing by cleaning & draining necrotic tissue (Types: sharp surgical, nonselective with wet-to-dry dressings, enzymatic ointments, debriding agents, calcium alginate dressings)
  • Nutritional therapy
  • Compression therapy
105
Q

If there is no decrease in the size of a wound in _____, wound management needs to be reassessed.

A

3 weeks

106
Q

Factors in the treatment of stasis ulcers?

A

Wound status and amt of exudate

107
Q

(Brand of compression) may each be left on up to 2 – 3 days if swelling is controlled and there is no slippage creating more pressure.

A

Comprilan® or Surepress®

108
Q

(Brand of compression) may be changed 2 – 3 times a week, but after a couple of weeks of treatment, it can be left on for 7 days.

A

Profore®

109
Q

When daily changes are required, ______ will guide the type of bandage being used.

A

cost effectiveness

110
Q

Profore Compression Bandage has 4 layers.

A
  1. Orthopedic wool
  2. Cotton layer
  3. Elastic layer
  4. Cohesive layer
111
Q

Goals in Venous Ulcers (4)

A

–Restore skin integrity
–Improve physical mobility
–Adequate nutrition (high in protein, vitamins, iron, zinc)
–Absence of complications (infection, gangrene)

112
Q

Nursing interventions for a patient with impaired skin integrity: (9)

A

1) Relieving pressure
2) Improving mobility
3) Improving Sensory perception
4) Improving tissue perfusion
5) Improving nutritional status
6) Reducing friction and shear
7) Minimizing irritating moisture
8) Promoting pressure ulcer healing
9) Preventing recurrence

113
Q

Nursing Interventions for promoting wound healing.

A

Changing the dressing

  1. maintaining normal body temperature
  2. managing gastrointestinal function
  3. resuming nutrition
  4. promoting bowel function
  5. managing voiding
  6. maintaining a safe environment
  7. providing emotional support to the patient and family
  8. managing potential complications: DVT, Hematoma, Infection, wound dehiscence and evisceration
114
Q

Collection of blood outside the blood vessels

A

Hematoma

115
Q

_____ is the simplest method to use next to the wound bed and cover it with gauze. It maintains a moist environment can be left in place for several days and does not disrupt the capillary bed when removed.

A

Tegapore

116
Q

_____are good to promote granulation tissue and re-epithelialization. They also provide a barrier for protection because they adhere to the wound bed and surrounding tissue

A

Hydrocolloids

117
Q

_______, it is a skin product cultured from human dermal fibroblasts and keratinocytes, it interacts with the patient’s cells to stimulate the production of growth factors

A

Simulated healing tissue-engineered human skin (SHT-EHS)

118
Q

______ it involves placing the patient into a chamber that increases barometric pressure while the patient is breathing 100% oxygen. The edema in the wound area is decreased because high oxygen tension facilitates vasoconstriction and enhances the ability of leukocytes to phagocytize and kill bacteria. HBO is thought to increase diffusion of oxygen to the hypoxic wound, thereby enhancing epithelial migration and improving collagen production. Common side effects are ear barotraumas and confinement anxiety

A

Hyperbaric Oxygenation (HBO)

119
Q

Nursing interventions for a patient who has leg ulcers (4)

A

1) Restoring skin integrity, if it is arterial insufficiency a referral is made, if venous insufficiency dependent edema can be avoided by elevating the lower extremities
2) Improving physical mobility
3) Promoting adequate nutrition
4) Promoting home and community based care

Theory II (2 decks)

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