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Modalities > Wound Care > Flashcards

Wound Care Flashcards

1
Q

3 Wound Categories

A
  1. Healable
    - progresses through normal healing in oderly fashion
    - adequate blood flow
    - 30% smaller at week 4; healed at 12 weeks
  2. Chronic: Non-Healable
    - >6 months unable to heal
    - inadequate blood supply
    - can’t treat cause
    - wound-exacerbating factors can’t be fixed
  3. Chronic: Maitnence
    - >6 months with no significant progression
    - refuses treatment of cause
    - health system error/barrier
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2
Q

DIME Categories

A

D: Debriedment

  • problem: defective matrix/cell debris
  • treatment: debried
  • goal: restore wound base/ECM proteins

I: Infection/Inflam

  • problem: high bacterial counts/prolonged inflam
  • treatment: antimicrobials
  • goal: low bacteria counts/control inflam

M: Moisture Imbalance

  • problem: dessication or excess fluid
  • treatment: dressings or compression
  • goals: restore cell migration/avoid maceration

E: Edge of Wound [non-advancing/undermining]

  • problem: non-migrating keratinocytes; non-responsive wound cells
  • treatment: bio agents, adjunct therapies, debried
  • goals: stimulate keratinocyte migration
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3
Q

5 Goals of Debriedment

AIBNS

A
  1. Enhance wound assesment
  2. Decrease infection potential
    - necrotic tissue can mask signs/serve as medium for bacteria prolif
  3. Remove biofilms with bacteria
  4. Remove necrotic tissue
    - physical barrier to healing via excessive amounts of proteases
    - supports bacterial growth
  5. Remove senescent
    - no cellular activity
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4
Q

Autolytic Debriedment

A

OCCLUSIVE dressing
-traps wound fluid; enzymes break down non-viable tissue
NOTT for infected wounds
-risk of maceration to periwound

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5
Q

Autolytic Contraindications

A 
infected wounds
exposed tendon/bone
friable skin
deep extensive wounds
severe neutropenia
immunocompromised
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6
Q

3 Mechanical Debriedment

A
  1. Wet-to-dry: non-selective
    - painful, maceration, disperse bacteria
  2. Whirlpool: non-selective
    - NO!
  3. PLWS: selective (
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7
Q

Biological Debriedment

A

Maggot larvae- consumes necrotic tissue/bacteria
-potential increase in pain in ischemic wound

-selective and rapi
-painless
FOR INFECTED WOUNDS!

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8
Q

Enzymatic Debriedment

A

Topical med- breaks down necrotic tissue in wound
-collegenase in petroleum base breaks down necrotic collagen (use with sharp debriedment)

FOR INFECTED!
Selective; cross0hatch for more surface area

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9
Q

Ultrasound Debriedment

A

low frequency US ~25kHz
.1-2Wcm2
Saline drip with US

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10
Q

Surgical & Sharp Debriedment

A

Surgical: Removes VIABLE and Non-viable

Sharps: removes only NON-viable

  • can be painful, risk of bleeding
  • costly, need patient consent
  • no for anticoagulant therapy
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11
Q

Surgical & Sharp Contraindications

A

malignancy, clotting probs, ischemic tissue, fistula, immunocompromised

WOUND contras:!!!!!

  • non-infected heel ulcers in dry eschar
  • dry gangrene (arterial insufic)
  • non-draining wounds w/ limited perfusion
  • blood floww compromised
  • Precaution with anticoag patients
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12
Q

Infection/Inflammation
Superficial Compartment= TOPICAL therapy
NERDS

A 
Non-healing
Exudate increase
Red, friable
Debris 
Smell

-critical collinization

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13
Q

Infection/Inflammation
Deep Compartment= SYSTEMIC therapy
STONEES

A 
Size increasing
temperature increasing
Osteomyelitis
New/satelite wounds
Erythmeia
Edema
Smell

-infection

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14
Q

Moisture Imbalance

3 Types of Treatment Categories

A
  1. Passive: absorbs drainage; cover to prevent contam
  2. Interactive: antimicrob agents, growth factors, lysis of necrotic tissue
  3. Bioactive: migration/cell mitosis, live cells introduced, gives collagen
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15
Q

5 Types of Passive Dressings

[Moisture Imbalance]

A
  1. Transparent Films
    - NOT for infected
    - autolytic debriedment, secondary dressing, or to anchor catheters
  2. Impregnated Gauze
    - flat/dry partial thickness wounds, secondar dressing
  3. Hydrocolloids
    - NOT for infected
    - thick sponge w/ little absorption
    - shallow/flat wounds w/ minimal drainage
  4. Hydrogels
    - hydrates
    - dry wounds for autolytic debriedment
    - tendon, muscle, bone-> prevents dessication
  5. Foams
    - abosrbs A LOT
    - heavy exudate wounds, flat wounds
    - donor sites, skin tears, surgical incision
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16
Q

4 Types of Interactive Dressings

[Moisture Imbalance]

A
  1. Calcium Alginates
    - salts from seaweed become gel once hit exudate; absorbs 5-15x wt
    - draining cavity wounds
  2. Cellulose/Hydrofiber
    - absorbs exudate/becomes gel; absorbs 35x
    - keeps moist environ; conforms well
    - wounds w/ heavy exudate, flat or cavity
  3. X-Cell
    - cellulose layers, can have antimicrob
    - flat w/ minimal exudate, painful, donor sites, venous wounds, burns
  4. Honey
    - antibacterial, can have CaAlginate for cavity/drainage
    - partial thickness burn, wounds with odor or eschar
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17
Q

4 Types of Bioactive Dressings

[Moisture Imbalance]

A
  1. Collagen
    - cells dissolve in bed and use as scapholding
    - clean/granulating wounds; faciliates migration to bed
  2. ORC-Collagen
    - dissolve into wound, bind to excess matrix, release growth factor
    - NOT for infection!
    - promotes granulation in clean wound, secondary dressing needed, chronic wounds that are stalled
  3. Allograft
    - harvested cadavar skin, scaffold for dermal/epidermal
    - burn therapy, clean full thickness wounds
  4. Living Skin Equivalents
    - neonatal fibroblasts in collagen/nylon mesh
    - clean granulated wounds, promotes closure/protects before skin graft
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18
Q

Scar Dressing

[Moisture Imbalance]

A

Silicone

  • reduces hypertrophic carring
  • sheet/lining for casts in burn patients
  • adherant layer for foam dressings
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19
Q

Antimicrobial Dressings

[Moisture Imbalance]

A

Restore balance between bioburden and local immune system

-tpoical: ionic silver, cadexomer iodine, PHMB, honey

20
Q

Silver Dressings

[Moisture Imbalance]

A

Destroy spectrum of bacteria

  • block cell respiration, destroy membrane, leaks cytoplasmt
  • replication, respiration, and repair disabled
  • decrease MMP- decrease zinc levels
  • improve healing rates!!; decrease odor, pain, exudate
21
Q

Cadexomer Iodine Dressings

[Moisture Imbalance]

A
  • time released iodine
  • partial thickness burns, drainage w/ bacteria
  • NOT for allegic to iodine!
22
Q

IF Healable wound-> Avoid these 4 dressings

A

Povidone iodine: skin disinfectant
Acetic Acid: okay for pseudomonas
Dakin’s solution: okay for necrotic/infected
Hydrogen peroxide: okay to dissolve clots

23
Q

Biophysical tech

ELECTRO MODALS

A

-increase rate of healing
modulate pain
reduce swelling, inflam, or restriction

24
Q

Biophysical tech

PHYSICAL AGENTS

A

increase rate of healing for open wounds/soft tissue
modulate pain
reduce swelling, inflam, or restriction

25
Q

Biophysical technologies appropriate WHEN:

A

comorbities that delay healing: periph art disease, SCI, diabets, venous insuf, deep tissue injury/pressure ulcer

  • wound not responding to other methods
  • into subcutan tissue/deeper interfereing w/ function
26
Q

Electrical Energy

E-STIM

A

Capacitative coupled electrial current trasfers energy to wound

  • monopolar=direct: treatment electrode in wound
  • bipolar=indirect: both on periwound saddling wound
27
Q

E-STIM Contraindications

A

basal/squamous carcinoma/melanoma
osteomyelitis
placement of electrodes in heart muscle, phrenic nerve, ganglia, larynx, or by pacemaker

28
Q

5 E-STIM Benefits to Wound Healing

A 
bacteriostatic
increases tissue perfusion
improve venous flow
increase granulation tissue formed
faster reduction in wound area
29
Q

2 E-STIM Electrical Current Properties

A
  1. Cell Migration
    - “Skin battery”: exterior skin electronegativity
    - “current of injury: movement of charged particles to uninjured dermis
    - Elextrotaxis/Galanotaxis: direct migration of cells due to endogenous firleds or ES
  2. Activation of Cutaneous Nerves
    - increase circulation= increase nutrients and decrease waste
    - sensory stim causes response regionally but NO stron stim causing pain (results in muscle contraction=decreased circulation)
30
Q

Mechanical Energy

PLWS

A

Irrigation under pressure w/ suction to remove irrigant and drain debris
-4-15 psi removes bacteria from surface

31
Q

PLWS COntraindications

A

No absolute-> clinical judgement based on fistulas, cavity lining, tunnels

Precautions: insensate areas, anticoags, tunnels, tracts, undermining

32
Q

5 PLWS Benefits to Wound Healing

A 
clean tunnels/undermining
no maceration to periowound
bedside/ less caregiver time
facilitates sharp debried
disposable supplies
33
Q

Mechanical Energy

Negative Pressure Wound Therapy

A

Vacuum dressing to enhance healing- sealed to pump for controlled negative pressure

  • Addresses I, M, and E but no debriedment
  • Clean wound BEFORE NPWT
34
Q

NPWT Precautions

A 
active bleeding/clotting probs
exposed blood vessels
can't maintain seal
uncontrolled pain
non-adherance to POC
35
Q

NPWT Contrindications

A 
malignancy
necrotic tissue/eschar
osteomelitis
exposed artery/vein/organ
untreated coagulopathy
allergy to dressing
36
Q

4 NPWT Wound Healing Benefits

A

non-invasive
active therapy-> removes fluid from wound bed
moist wound healing environ
stimulates angiogenesis via mechanical stress

37
Q

2 Mechanical Stresses of NPWT

A
  1. Macrostrain
    - stretch of edges when vacuum turned on
    - pulls together; drains/gets rid of infectious material
  2. Microstrain
    - microdeformation at cellular level (cell stretch)
    - reduces edema
    - promotes perfusion, granulation tissue formation by facilitating cell migration/prolif
38
Q

NPWT Indications

A 
acute wounds once hemostasis
traumatic
sub-acute
dehiscised surgical incision
chronic
diabetic ulcer
skin graft
stage III/IV pressure ulver
enteric fistula
39
Q

NPWT Goals of Treatment

A 
DECREASE WOUND VOLUME!
gran tissue growth/contraction of edges
drainage
reduce bioburden
wound bed prep
decrease LOS, morbid, mortal
decrease dressing change frequency
prevent deterioration
minimize contam/odor
40
Q

NPWT Expected vs. Abnormal outcomes

A

Expected

  • beefy red
  • increased gran tissue
  • decrease size
  • decrease drainage

Abnormal

  • bruised dark gray
  • more slough
  • more odor
  • -rule out osteomyelitis/infection; evaluate change frequency; evaluate pressure setting
41
Q

Sound Energy

Low Frequency Ultrasound

A

20-60kHz; deeper peneatration than MHz US

  • contact better for adherant slough
  • Saline as coupling medium
42
Q

LFUS Precautions/Contraindications

A

Precautions:
acute inflam- do non-thermal
fractures
lowest intensity to produce desired effect!

Contrindications:
cancer
pregnant
CNS tissue
joint cement/plastic
pacemaker near
thrombophlebitis
reprod organs
eyes
43
Q

2 Non-Thermal Effects of LFUS

A
  1. Cativation
    - vibrational effect of microsized gas bubbles
    - stable: enhances acoustic microstreaming
    - Unstable/Transient: increase in size/explode
    - - good: tiny shock waves cause PREFERENTIAL debiredment of necrotic/slough/bacteria
    - -bad: tissue damage/free rad formation
  2. Acoustic Microstreaming
    - fluid movement along membrane/stable cat bubbles
    - -good: increase permeability of wall/membrane, increase protein synthesis, degran mast cells, increase growth factor by macrophages
44
Q

NC NT LFUS

Mist Therapy

A

40 kHz non-contact

  • time varies on wound, single use, no aerosolization
  • continuous method
45
Q

Thermal and Bacteriocidal Effects of LFUS

A

Thermal:

  • contact continuous method
  • NOT for ischemic tissue or impaired circ

Bacteriocidal:
-bacterial death: acinetobacter, e coli, staph, strep

46
Q

Fibrinolytic Effects of LFUS

A

Debriedment Effects

  • 50-60 kHz removes debris/bacteria from surface
  • removes necrotic NOT healthy
  • 25kHz for tissues with adherent fibrins in chronic wounds
  • selective removal!; no macroscopic changes of gran
47
Q

3 types of LFUS for Debriedment

SONOC

SONICONE

QOUSTIC

A

SONOCA

  • 25kHz; continuous contact
  • probe autoclaved, aerosolization possible
  • debrieds immediately; diff probes for agressiveness

SONICONE

  • 22.2kHz contact continuous or pulsed
  • probe autoclaved, erosolization possible
  • debrieds immediately; diff probe colors

QOUSTIC

  • 35kHz; contact
  • 3 treatments per week/ 2 weeks
  • autoclaved, potential aerolization
  • debrieds immediately
  • lease painful!

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