Wound Care

Question 1

What is an acute wound?

Answer 1

Wound that heals quickly (typically healed within 4 weeks)

Examples: bites, scrapes, minor lacerations, punctures, burns, etc

Question 2

What is a chronic wound?

Answer 2

A wound that fails to progress through normal healing within 4 weeks. Healing is delayed or impaired
Requires referral
Examples: pressure ulcers, diabetic ulcers, etc.

Question 3

What are the three phases of the normal healing process?

Answer 3

Phase 1: inflammatory phase (begins immediately after homeostasis is completed)
Phase 2: proliferative phase (begins to rebuild with new granulation tissue)
Phase 3: maturation phase (also called the remodelling phase as the dermal tissue strengthens)

Question 4

Describe the inflammatory phase

Answer 4

Immune system reaction: complex process with multiple cells involved
Characteristics: starts at the time if injury and continues for 24-48 hours
Appearance: redness, oedema, production of exudate

Question 5

Describe the proliferative phase

Answer 5

Immune system reaction: granulation tissue formed, wound contraction and new epithelium formed (still sensitive to further injury)
Characteristics: rebuilding phase which can last from 4 to 24 days
Appearance: bright red tissue and raised, scar tissue is starting to be formed

Question 6

Describe the maturation phase

Answer 6

Immune system reaction: collagen forms early scar tissue and continues to be deposited to increase strength of the tissue
Characteristics: starts approximately 3 weeks after injury and complete healing can take up to 2 year
Appearance: changes from pink or red to white

Question 7

What are factors that affect wound healing

Answer 7

DIDNT HEAL
Diabetes (decreased circulation, long term condition)
Infection (prolongs inflammatory phase delaying healing)
Drugs (steroids, ASA, anticoagulants, cancer medications)
Nutritional problems (normal wound healing impaired)
Tissue necrosis
Hypoxia (inadequate tissue oxygenation)
Excessive tension on wound edges (drying)
Another wound
Low temperature (slower healing in the extremities)

Question 8

What are some patient factors that need to be assessed that could lead to referral?

Answer 8

Tetanus immunization status
Medical conditions that affect healing (e.g., diabetes, immunocompromised)
Factors that delayed healing
Bleeding is over 10 minutes
Age?

Question 9

What are some causes that need to be asses that could lead to referral?

Answer 9

Animal or human bite?

Second or third degree burn?

Question 10

What are some red flags?

Answer 10

Wound is over 2 cm
Lacerations on the face or hand where edges do not fall together
Wound is deep
Patient is unable to move injured part
Dirt and debris cannot be removed without scrubbing
Wound in infected

Question 11

What are signs of infection of a wound?

Answer 11

Redness extending from wound after two days
Pus or yellow discharge
Area around the wound is red, swollen and warm to touch
Abnormal smell

Question 12

What is some basic wound care management steps?

Answer 12

1. Cleanse the wound (remove dirt and debris, wash wound with water)
2. Stop the bleeding (use a clean dressing or gauze to apply pressure to the wound for 10 minutes)
3. Protect the wound (apply a dressing to protect the wound and improve healing process)
4. Debridement (removal of dead or contaminated tissue; only done by a health care professional)

Question 13

What is recommended for cleaning the wound?

Answer 13

Drinkable water used to remove dirt and debris (lukewarm water)
Normal saline used to remove dirt and debris
Both are equally as effective cleaning acute wounds

Question 14

What is not recommended for cleaning the wound?

Answer 14

Hydrogen peroxide 3% (may impair healing and cause tissue toxicity)
Isopropyl alcohol 70% (may dry and irritate the skin)
Iodine (may irritate tissue and impair healing)
Povidone-iodine (may impair healing)

Question 15

What are signs of skin infection?

Answer 15

Localized erythema
Localized pain
Warm to touch around affected area
Oedema
Drainage/pus
Fever

Question 16

How are topical antibiotics used in wound management?

Answer 16

Treatment (superficial, mildly infected wounds only)
Prophylaxis (wound that are high risk for infection, chronic wounds or those that have not been cleaned properly)
Concern with prolonged use (resistance or secondary fungal infection)

Question 17

What are some antibiotics that are used topically?

Answer 17

Bacitracin
Gramicidin
Polymyxin B
Neomycin
Fusidic acid
Mupirocin

Question 18

What is the spectrum, dosage and adverse effects of bacitracin?

Answer 18

Spectrum: active against gram positive, minimal gram negative
Dosage: apply 1 to 3 times daily
Adverse effects: common sensitizer, itching, burning, redness
Cross-sensitivity potential with neomycin and polymyxin

Question 19

What is the spectrum, dosage and adverse effects of gramicidin?

Answer 19

Spectrum: active against gram positive
Dosage: apply 1 to 3 times daily
Adverse effects: low risk of sensitivity, itching, burning
Damages sensory epithelium of nose. Do not apply to nasal membranes

Question 20

What is the spectrum, dosage and adverse effects of polymyxin B?

Answer 20

Spectrum: active against gram negative
Dosage: apply 1 to 3 times daily
Adverse effects: low risk sensitivity, itching, burning
Contact allergy uncommon, cross-sensitivity with bacitracin

Question 21

What is the spectrum, dosage and adverse effects of neomycin?

Answer 21

Spectrum: active against gram negative, partially active against gram positive
Dosage: apply 1 to 3 times daily
Adverse effects: low risk of sensitivity, itching, burning
Prescription only

Question 22

What is the spectrum, dosage and adverse effects of fusidic acid?

Answer 22

Spectrum: active against gram positive
Dosage: apply 2 to 3 times daily for 7 to 10 days
Adverse effects: dryness, itching, burning, some local irritation
Number 1 choice for impetigo. Prescription only.

Question 23

What is the spectrum, dosage and adverse effects of mupirocin?

Answer 23

Spectrum: active against gram positive including some strains of MRSA
Dosage: apply 2-3 times daily for 7 to 10 days
Adverse effects: dryness, itching, burning, some local irritation possible
Should not be used for more than 10 days

Question 24

What are some combination topical anesthetics?

Answer 24

Polysporin complete

Polysporin triple

Question 25

What is polysporin complete?

Answer 25

10 000 units Polymyxin B (as sulfate)
500 units bacitracin zinc
0.25 mg gramicidin
50 mg lidocain

Question 26

What is polysporin triple?

Answer 26

10 000 units Polymyxin B (as sulfate)
500 units bacitracin zinc
0.25 mg gramicidin

Question 27

What are monitoring parameters for wound care?

Answer 27

Bleeding should stop within 10 minutes for most people (within 15 minutes for those on anticoagulants)
Monitor daily for infection for 48 hours
Monitor wound healing daily for 4 to 14 days (or more). If not closing within 2 to 4 weeks, further assessment should be done

Question 28

What is a primary dressing?

Answer 28

Placed directly on the wound, absorbs fluids, prevents infection and adhesion of the secondary dressing

Question 29

What is a secondary dressing?

Answer 29

Placed over the primary dressing for protection, absorption, compression and occlusion

Question 30

What are the different kinds of dressings?

Answer 30

Gauze
Transparent films
Hydrogels
Hydrocolloids
Alginates
Foams
Liquid tissue adhesives

Question 31

What is the purpose, the types of gauze dressings and how should they be applied?

Answer 31

Purpose: absorbent and protectant, may be used for wet or dry wounds
Types: non-adherent (dose not stick to the wound), self-adherent (clings to itself)
Application:
-place directly on wound
-moisten with saline, wring out excess fluid and apply secondary dressing
-used as primary dressing

Question 32

What is the purpose of transparent films?

Answer 32

Provide a moist environment, protective, waterproof
May be used for superficial, clean wounds where it is required to frequently view the wound
Example: Tegaderm transparent

Question 33

How should transparent films be applied?

Answer 33

Gently lay dressing over the wound, avoid wrinkling and don’t stretch
Overlap wound by 2.5 cm and apply tape

Question 34

When should transparent films be avoided?

Answer 34

Moist wounds (does not absorb moisture)

Question 35

What is the purpose of hydrogels?

Answer 35

High moisture content, some absorption properties
May be used for dry wounds, painful wounds, pressure ulcers, burns
Example: Restore, Tegaderm

Question 36

How should hydrogels be applied?

Answer 36

Apply a moderate amount to the wound and cover with gauze
May require a secondary dressing
If self-adhesive, may be used as a primary dressing

Question 37

When should hydrogels be avoided?

Answer 37

In gangrenous wounds

Weeping wounds

Question 38

What is the purpose of hydrocolloid dressings?

Answer 38

Retains moisture
May be used for burns or small abrasions
Example: Duoderm

Question 39

How should hydrocolloid dressings be applied?

Answer 39

Apply adherent side to skin and hold in place

Painless to remove

Question 40

When should hydrocolloid dressings be avoided?

Answer 40

Dry wounds that are infected

Weeping wounds

Question 41

What is the purpose of alginates?

Answer 41

Create a moist environment, highly absorbent
May be used for packing cavities and wounds, wound drainage, pressure ulcers
Can reduce pain
Example: Algisite, Tegaderm, Kaltostat

Question 42

How should alginates be applied?

Answer 42

Apply dressing to area, cover with a secondary dressing and tape in place
May require a secondary dressing
Change 1-2 times a day for 3-5 days

Question 43

When should alginates be avoided?

Answer 43

Dry wounds (can dry wound bed more)

Question 44

What is the purpose of foam dressings?

Answer 44

Retains moisture, highly absorbent, protective
May be used for wounds with mild to moderate exudate, partial to full thickness wounds
Example: Allevyn

Question 45

How are foam dressings applied?

Answer 45

Gently lay dressing over the wound, cover with gauze and tape in place and if necessary, may need a secondary dressing

Question 46

When should foam dressings be avoided?

Answer 46

Dry wounds

Wounds that need to be frequently checked

Question 47

What are the uses for liquid adhesives? How long do they last for? How should they be applied?

Answer 47

Used for minor cuts, paper cuts, skin cracks (don’t use in deep wounds)
Lasts for 5-10 days
Wash cut first, apply pressure to stop bleeding then apply adhesive
Example: Nexcare liquid bandage, Band-Aid J&J Bandage, New Skin liquid bandage

Question 48

What are the different types of adhesive tape?

Answer 48

Cloth tape
Plastic tape
Paper tape
Hypoallergenic tapes are preferred

Question 49

Describe cloth tape use

Answer 49

Use over bone, difficult to tape areas or with bulky dressings due to high tensile strength

Question 50

Describe plastic tape use

Answer 50

Stretched with movement, good for mobile areas

Question 51

Describe paper tape use

Answer 51

Porous, light adhesive, good for tender or painful area and for wounds that should breathe
Tend to break with movement

Question 52

Describe adhesive skin closures

Answer 52

Generally used to hold wounds closed after suture removal
Steri-strips (think strips of sterile, non-woven tape)
Butterfly closures (two sterile, waterproof strips connected by a non-adhesive bridge)