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Advanced Veterinary Patient Care > Wound Care > Flashcards

Wound Care Flashcards

1
Q

Open Wounds

What is an incision?

A

Created by a sharp tool e.g., scalpel blade with minimal tissue trauma.

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2
Q

Open Wounds

What is an abrasion?

A

damage with loss of epidermis and a portion of dermis.

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3
Q

Open Wounds

What is an avulsion?

A

Tearing of tissue away from attachments, underlying tissue and structures.

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4
Q

Open Wounds

What is a laceration?

A

Irregular wound, damage to superficial and underlying tissue.

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5
Q

Open Wounds

What is a puncture?

A

Penetrating wound created by a sharp object. Can introduce contaminations deep into tissue resulting in high risk infection.

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6
Q

Closed Wounds

What is a contusion?

A

Blunt force trauma that doesn’t break the skin but causes damage to the skin and underlying tissue.

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7
Q

Closed Wounds

What is a crushing injury?

A

Force applied to the tissue for a period of time.

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8
Q

What is meant by ‘duration of contamination’?

A

The time between the wound being inflicted and treatment.

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9
Q

What is meant by a ‘clean wound’?

A

No break in the surgical asepsis.

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10
Q

What is meant by a ‘clean contaminated wound’?

A

Minor break in the surgical asepsis.

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11
Q

What is meant by ‘contaminated wound’?

A

Major break in surgical asepsis.

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12
Q

What is meant by ‘dirty wound’?

A

Purulent inflammation.
Presence of gross foreign material and necrotic tissue.

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13
Q

What are the 4 phases of wound healing and when do they occur?

A
  1. Haemostasis - immediately after injury.
  2. Inflammation - within 6 hours and lasts 3-5 days.
  3. Proliferative (Repair) - 3-7 days post injury.
  4. Maturation (Remodelling) - 5-7 days post injury and can last up to 2 years.
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14
Q

What is haemostasis? (6 points)

A

Blood and lymph flows from damaged vessel. The initial bleeding flushes wound.

Vasoconstiction occurs immediately and lasts 5-10 mins.

Vasodilation then occurs and intravascular cells and fluid pass into the extravascular space.

Platelet plug formation - triggered by damage to blood vessel wall.

Formation of fibrin plug and scab.

Injured cells release thromboplastin, which activates the extrinsic coagulation process.

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15
Q

What is inflammation? (5 points)

A

Lasts 3-5 days after injury.

Blood vessels dilate, increasing blood flow and bringing transudates into the wound, causing the heat, redness, and swelling of inflammation.

White blood cells in the exudate initiate debridement.

Neutrophils help break down bacteria and debris while stimulating monocytes.

Monocytes convert to macrophages, which continues to phagocytise debris and release growth factors that aid in tissue repair.

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16
Q

What is Proliferation? (6 points)

A

Occurs from day 4-12 and is characterised by replacement of lost tissue with normal, functioning cells of the same type.

Angiogenesis begins as capillaries grow into the wound from the surrounding healthy vasculature.

Growth factors allow for migration of fibroblasts, which leads to creating of collagen (providing wound strength) and my-fibroblasts (causing wound contraction).

Granulation tissue begins to form (4-7 days), followed by epithelialisation and wound contraction.

Epithelialisation may take weeks to months to fully stratify, may be incomplete or be thin and delicate.

Wound contraction (5-7 days), area of wound reduces and surrounding skin stretches.

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17
Q

What is Maturation? (4 points)

A

Begins when collagen fibres begin to orient along lines of stress and can continue for years.

Wound edges meet and epithelialisation is complete.

Redness reduces.

The ultimate strength of skin will be about 10% at 14 days, 25% by 4 weeks, and up to 80% at several months.

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18
Q

What are factors that promote wound healing?

A

Moist wound environment.
Good nutrition.
Tissue oxygenation.
Limited movement of wound
edges.
Clean wound and good immune system.

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19
Q

What are factors that delay wound healing?

A

Excessively dry or exudating wound.

Poor circulation - shock, concurrent conditions, age, recumbency.

Lack of essential nutrients - anorexia, poor perfusion, malnourished.

Lack of oxygen delivery and waste removal from tissues - poor perfusion, respiratory problems, lack of mobility.

Excessive wound edge tension, patient interference, damage at dressing changes.

Infection.

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20
Q

What is the aim of wound management?

A

Produce a functional and cosmetic repair.

Relief of pain and distress to the animal.

Economic and time efficient procedures.

Prompt decision making in the event of signs of delayed healing.

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21
Q

How is the wound assessed initially?

A

Assess the whole patient and stabilise.
Record:
time since injury, what caused wound, degree of contamination, degree of trauma at the site, necrosis, concurrent disease/medication.
Is treatment/cost viable for owner?

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22
Q

What is a primary wound and its management?

A

A clean wound.

Management:
Immediate closure.
No tension.

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23
Q

What is a delayed primary wound and its management?

A

Clean-contaminated or contaminated.

Management:
Lavage and debridement until healthy.
Appropriate dressing.
Closure after 2-3 days.

24
Q

What is a secondary wound and its management?

A

Contaminated or dirty.

Management:
Lavage and debridement.
Appropriate dressing.
Closure after 5-7 days once granulation bed has begun to form.

25
Q

What is secondary-intention wound and its management?

A

Unsuitable for surgical closure.
Extensive contamination and devitalisation.

Management:
Open wound management.
Lavage and debridement.
Appropriate dressing.
Allowed to heal.

26
Q

What is involved in wound preparation?

A

Wear gloves.
Ensure adequate analgesia is provided and had time to take effect.
GA usually required.
Keep covered with sterile, non-linting dressing prior to preparation.
Swab wound bed for culture and sensitivity.
Insert sterile water soluble jelly into wound.
Clip around would - 2cm margin.
Debridement.

27
Q

What is lavage?

A

Helps to remove debris, reduce contamination and significantly reduce risk of infection.

28
Q

What procedures should be carried out when performing lavage?

A

Wear gloves and use towel/liner to protect from environment.

Lavage solution should be compatible with tissues - isotonic, nontoxic solution.

Dilute antiseptic solution may be used in contamination/dirty wounds - Chlorhexidine

Large volume = minimum 100ml/cm of wound.
Pressure 8-12psi (20ml syringe and 19g needle).
Prevent cross contamination.

29
Q

What is wound debridement?

A

Prepares the wound bed by removing debris, contamination and necrotic tissue remaining after lavage. Debriding will reduce the risk of infection and promote healing.

30
Q

What is ‘bioburden’?

A

The number of micro-organisms that the wound is contaminated with.

Causes prolonged inflammation and delayed healing.

31
Q

What is ‘biofilm’?

A

Forms when multi species bacterial communities organise into a wound surface and form an extracellular matrix of polysaccharides, proteins and nucleic acids to provide protection and ensure survival.

32
Q

What are the 3 forms of wound debridement?

A

Autolytic
Mechanical
Surgical

33
Q

What is Autolytic debridement?

A

Use of primary layer applications such as alginates, hydrocolloids, hydrogels, honey or sugar.
Most selective form of debridement because it spares healthy cells and intact matrix molecules while removing damaged cells and metric with microscopic precision.

34
Q

What is Mechanical debridement?

A

Physical removal of tissue adhered to a dried-on dressing.
Non-selective and least desirable form of debridement.
Very painful so requires anaesthetic and analgesia.

35
Q

What is Surgical debridement?

A

Gold standard technique.
Tissue removed by surgeon according to characteristics such as colour, texture, vascular supply, and temperature.
Selective on a macroscopic level.

36
Q

What is wound fluid?

A

Discharge from the wound.
Contains essential nutrients, growth factors, and provides a moist environment for cell viability.

37
Q

What is exudate?

A

Plasma leaking from the capillaries.

Should reduce with time towards the end of the inflammatory phase as granulation tissue and epithelialisation forms.

38
Q

What is granulation tissue?

A

Built by fibroblasts which secrete new extracellular matrix molecules, and endothelial cells, which build new blood vessels.

Healthy = bright red and moist.

39
Q

What is epithelialisation?

A

Process when epithelial cells on the skin edge migrate onto the granulation tissue providing oxygen, moisture, and surface required for epithelial cells to proliferate, cross the wound, and create a new epidermis.

40
Q

Dressing Types

What are hydrogels?

A

Hydrogels are used in wounds at risk of drying out.
The main role is a fluid donator for dry wounds.
Hydrogels can both donate and trap water; therefore, they are useful for absorbing wound exudate, as well as hydrating and debriding necrotic material within the wound.

41
Q

Dressing Types

What are hydrocolloids?

A

Used in wounds that require additional moisture and natural debridement.
They actively stimulate wound healing and encourage debridement as they degrade on interaction with wound exudate.
They are best used in dry to semi-dry wounds.

42
Q

Dressing Types

What are polyurethane foam dressings?

A

These foams are highly absorbent and act by drawing excess exudate away from the wound, maintaining some moisture through humidity, which keeps the wound moist.
They are commonly applied on top of other products – for example, hydrogels or honey.

43
Q

Dressing Types

What is Polyhexamethylene biguanide (PHMB)?

A

An antimicrobial agent exhibiting broad spectrum activity against bacteria and fungi.
This PHMB within the dressing attacks bacteria in wound exudate as it is absorbed.
This type of foam dressing is effective against Staphylococci (including MRSA), Pseudomonas, Proteus etc.

44
Q

Dressing Types

What is Alginates?

A

Alginate dressings are fine, fibrous dressings used to absorb moisture.
These dressings are derived from kelp.
The wound exudate interacts with the alginate to release cations that actively stimulate wound.

45
Q

Dressing Types

What is Sodium chloride?

A

A gauze dressing saturated in a 20% hypertonic saline solution.
This dressing promotes biological cleaning and the autolytic debridement process in non-infected and highly exuding wounds.

46
Q

Dressing Types

What are super-absorbent dressings?

A

New dressings have been designed to cope with very high volumes of exudate by incorporating polyacrylate crystals into the dressings in combination with hi-tech silicone adhesives to make them very “wearable”.

47
Q

What is laser therapy?

A

Use of low level laser waves to enhance wound healing and reduce/prevent infection.

  • Increases blood flow and oxygenation.
  • Reduces inflammation and pain.
  • Speeds up wound healing.
48
Q

Wound Complications

What is devitalised tissue?

A

Provide optimum conditions for growth of bacteria.
Delays the inflammatory process.
Reduces the viability of the wound bed.

49
Q

How would you treat an infected wound?

A

Place animal in isolation.
Wear PPE - gloves, gown, face mask.
Use aseptic techniques.
Swab wound for culture and sensitivity to allow antibiotic treatment.
Lavage.
Debridement and isotonic solutions.
Use antimicrobial dressings and control exudate.
Redress often.

50
Q

Drains

Why are drains used in practice?

A

Remove exudate and fluid from wounds and surgical sites.

Allow monitoring of fluid composition from surgical sites.

Aid wound healing and reduce the risk of wound opening.

51
Q

Drains

What are passive drains?

A

Advantages:
Use capillary flow.
Gravity.
Made of rubber latex.
Wider = more effective draining.

Disadvantages:
Increase risk of infection of site and surrounding areas.
Cause irritation of the skin.

52
Q

Drains

What are active drains?

A

Advantages:
Closed system, collects fluid into a reservoir.
Apply an artificial pressure gradient to pull fluid or gas from a wound or body cavity.
Less risk of infection.
Higher efficacy.
Can be positioned in any way and less reliant on gravity.

Disadvantages:
More expensive.
Continuous or intermittent negative pressure.

53
Q

Drains
When is a drain removed?

A

When fluid production is <2ml/kg/24hrs

54
Q

Drains

What is the procedure when handling drains?

A

Barrier nurse.
Excellent hygiene.
Minimum PPE of gloves.

Passive - clean regularly to prevent irritation and infection.

Active - Empty when +ve pressure

If reservoir/canister is full, they must be replaced not emptied and reused.
Check fluid/air volume when emptied and record.
Prevent patient interference.

55
Q

What are examples of wound closure techniques?

A

Stapling
Tissue adhesive
Suturing
Tension relieving techniques
Skin flaps/grafts
Drains

56
Q

What is the RVN’s ability to suture wounds?

A

Nurses are able to perform suturing under Schedule 3 of the Veterinary Surgeon’s Act 1966 when supervised by a veterinary surgeon.

57
Q

What are the 4 main suture needle shapes?

A

Round bodied - designed to separate tissue fibres rather than cut

Straight - one cutting surface

Half-curved - straight in shaft but curved cutting tip

Curved - arc shaped

Advanced Veterinary Patient Care (12 decks)

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