Wound Care

Question 1

What are the stages of healing

Answer 1

hemostasis
inflammatory
proliferative
maturation

Question 2

What dose the hemostasis consist of

Answer 2

Stop bleeding
Platelets
Thrombin
Cytokines
Growth factors

Question 3

What dose the inflammatory healing stage?

Answer 3

Remove debris
Redness without significant warmth
Neutrophils: destroy bacteria
Macrophage: mediate transition to proliferation, secrete growth factors, and cytokines

Question 4

what dose proliferative stage consist of?

Answer 4

Produce collagen and epithelial tissue
Granulation: fills wound bed
Fibroblasts migration
Angiogenesis – capillary sprouts
Contraction

Question 5

what dose maturation stage consist of?

Answer 5

Remodel and increase tensile strength
Collagen reorganizes
Decrease in fibroblasts
First 12 week are critical

Question 6

what are the wound types

Answer 6

I&D
Wound dehiscence
Abrasions
Burns
Skin tears
Lacerations
Blisters
Bites
Stasis ulcers
Diabetic ulcers
Pressure injuries
Arterial insufficiency ulcers
Moisture associated wounds

Question 7

what is slough mean?

Answer 7

A yellow fibrous tissue that consists of fibrin, pus, and proteinaceous material
Can be found on the surface of a previously clean wound bed.
Thought to be associated with bacterial activity.

Question 8

Sanguineous

Answer 8

Blood or bleeding

Question 9

Serosanguineous

Answer 9

Thin bloody looking or pink

Question 10

Serous

Answer 10

Thin yellow, green, tan or brownish
Can form crusting if dry

Question 11

Purulent

Answer 11

Yellow/greenish, thick

Question 12

wound infection

Answer 12

10^4 or 10^5 organisms per gram of tissue causing a systemic response

Question 13

wound infection

Answer 13

Red, pain, heat, swelling, purulent drainage, drainage odor, discoloration
Delayed healing
Abnormal odor
Friable granulation tissue
New edema
Induration
Increased serous exudate
Change in granulation color or hypertrophy
Change in wound bed color
Increase pain at wound site (check blood flow

Question 14

What is the acid mantle

Answer 14

skins pH of 4 to 5.5
inhibits bacteria and fungi
protects skin from elements

Question 15

dog bites (who, risk of infx, type of injury, and microbes)

Answer 15

Males 6-17
Risk of infection 5-25%
Crush injury
Pasturella multocida or dagmatis or canis
Capnocytophaga canimorsus

Question 16

cat bites (who, risk of infx, type of injury, and microbes)

Answer 16

Females 20-35
Risk of infection 30-50%, Lymphangitis
Puncture injury
Pasturella multocida or dagmatis or canis
Cat scratch fever: bartonella henselae

Question 17

human bites (risk of infx, type of injury, and microbes)

Answer 17

High risk of infections 15-25
Oval or semilunar hematoma and or abrasions
Direct: occlusion bite leave impression of teeth
Indirect: blow from a fist to someone’s teeth
Streptococci, staphylococcus, eikenella corrodens, HIV, HBV, HCV

Question 18

management of bites

Answer 18

Asses depth, location, type, immune status, chronic disease
Irrigation with saline with no pressure
Debridement
Tetanus or rabies
Antibiotic: amoxicillin-clavulanate or doxycycline
Clindamycin if anaerobic
Culture after washing

Question 19

blisters

Answer 19

Something from the outside rubs against the skin
Deep partial thicknes

Question 20

which pressure injury stage is this and how to treat?

Answer 20

stage 1

Painful
Non-blanchable redness
Shorten decrease in blood flow
Oxygen users, elbows on wheelchairs
Take pressure off

Question 21

which stage of pressure injury is this and how to treat

Answer 21

Stage 2
Breaks the skin
Non Granular skin
Moist dressing
Take off pressure

Question 22

what stage of pressure injury is this and how to treat?

Answer 22

stage 3
In subcutaneous tissue
Stop pressure
Moist wound dressing
Granulation tissue and no slough

Question 23

what stage of pressure injury is this and how to treat?

Answer 23

Stage 4
Tendon or bone is exposed
Keep it moist

Question 24

what stage of pressure injury is this?

Answer 24

Deep tissue injury
Complication: Eventually open up

Question 25

What stage of pressure injury is this?

Answer 25

Unstageable Filled with eschar

Question 26

what are the cleansing agents for wounds?

Answer 26

Soap and water: hand or arm No-Rinse Skin and Wound Cleanser and warm water Chloroxylenol 3% impregnated scrub brush: feet and legs Chlorhexidine: new acute wound, soaking an area prior to a procedure, or mixed with water for feet Prontosan: Soak gauze and leave on wound for 10 min, rinse with water Normal Saline: abscess only, fistule, undermining

Question 27

primary dressing

Answer 27

cover the wound directly, manage oozing or bleeding

Question 28

secondary dressing

Answer 28

covers the primary dressing, helps secure

Question 29

What gauze are avalaibe for wounds?

Answer 29

Loose open wave Non-woven Non-adherent (telfa) Petrolatum Rolled fluff Conforming/stretch ¼” and ½” packing – plain or iodoform

Question 30

What type of absorbent dressings are used?

Answer 30

Calcium alginate fluff or pads: venous ulcers Silver impregnated alginates Hydrofibers: breaks down biofilms Foam: retain body heat * “Allevyn/mepilex” (silicon covering) * Hydrophilic Abdominal pads Super absorptive pads (ex. Exu-Dry)

Question 31

what types of contact dressing are used?

Answer 31

Silicon dressing Transparent film Hydrocolloid Wound closure strips

Question 32

What topicals are used for wounds?

Answer 32

Mupirocin: staph Silver sulfadiazine: moisturizer, sulfa Gentamicin sulfate Clindamycin phosphate Medihoney “Xeroform” gauze Cadexomer iodine gel (iodosorb) Lidocaine – injection, ointment, cream and viscous Hydrogel Petrolatum Hydrophor/aquaphor Triamcinolone Ointment Hydrocortisone Ointment Miconazole A&D Ointment “Calmoseptine” Zinc oxide No sting barrier film

Question 33

what is used to secure wounds?

Answer 33

island dressings/border gauze Tape – Hypafix tends to be gentler on skin Clear adhesive dressing (Tegaderm) Cotton tubular dressing (Stockinette) Tubular elastic dressing (Surgi-last) Self adherent wrap (Coban) Adhesive bandages (Band-aids) Tubular elastic support (Surgi-grip)

Question 34

what are the barriers to healing?

Answer 34

Edema Oxygenation/circulation and blood flow Diabetes Nutrition: Protein, Vitamin C, Vitamin A, Zinc, Arginine, Glutamine, Fish oil Osteomyelitis Moisture Temperature Smoking Bacterial burden

Question 35

mechanical debridement

Answer 35

Wet to dry e.g. Pressurized saline Scrubbing, irrigation, pulse lavage, whirlpool, wet to dry Painful Don’t do with epithelialization or granulating wounds Non-selective

Question 36

Autolytic debridment

Answer 36

selective uses the body's own enzymes. better with an occlusive dressing Painless Non-invasive Slow Safe for pts on blood thinners or terminally ill Don’t use with infection, extensive necrotic issue, patients that are immunocompromised Hydrocolloid and transparent film, honey

Question 37

Enzymatic debridement

Answer 37

selective, slow collagenase, daily Not harmful to healthy tissue Dissolves/denatured collagen anchored to wound Can be used with other methods but NOT other topical products or silver products Collagenase (Santyl) Slough not thick Expensive

Question 38

Biological debridement

Answer 38

selective sterile maggots CI: Allergies to Brewer’s Yeast, fly larvae, soy Special storage requirements for some Sterile or wild type

Question 39

Sharps debridment

Answer 39

selective/non-selective, fast Scalpel, scissors, curette, forceps, laser CI: Bleeding D/O, ischemia, arterial insufficiency, dry gangrene, malignant wounds, unidentifiable structures, stable eschar Caution: Anticoagulant tx, immunocompromised, smokers, hands/face, pain tolerance