Wound Care Flashcards
What is an acute wound?
Wound that heals quickly (typically healed within 4 weeks)
Examples: bites, scrapes, minor lacerations, punctures, burns, etc
What is a chronic wound?
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.
What are the three phases of the normal healing process?
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)
Describe the inflammatory phase
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
Describe the proliferative phase
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
Describe the maturation phase
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
What are factors that affect wound healing
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)
What are some patient factors that need to be assessed that could lead to referral?
Tetanus immunization status Medical conditions that affect healing (e.g., diabetes, immunocompromised) Factors that delayed healing Bleeding is over 10 minutes Age?
What are some causes that need to be asses that could lead to referral?
Animal or human bite?
Second or third degree burn?
What are some red flags?
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
What are signs of infection of a wound?
Redness extending from wound after two days
Pus or yellow discharge
Area around the wound is red, swollen and warm to touch
Abnormal smell
What is some basic wound care management steps?
- Cleanse the wound (remove dirt and debris, wash wound with water)
- Stop the bleeding (use a clean dressing or gauze to apply pressure to the wound for 10 minutes)
- Protect the wound (apply a dressing to protect the wound and improve healing process)
- Debridement (removal of dead or contaminated tissue; only done by a health care professional)
What is recommended for cleaning the wound?
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
What is not recommended for cleaning the wound?
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)
What are signs of skin infection?
Localized erythema Localized pain Warm to touch around affected area Oedema Drainage/pus Fever
How are topical antibiotics used in wound management?
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)
What are some antibiotics that are used topically?
Bacitracin Gramicidin Polymyxin B Neomycin Fusidic acid Mupirocin
What is the spectrum, dosage and adverse effects of bacitracin?
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
What is the spectrum, dosage and adverse effects of gramicidin?
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
What is the spectrum, dosage and adverse effects of polymyxin B?
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
What is the spectrum, dosage and adverse effects of neomycin?
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
What is the spectrum, dosage and adverse effects of fusidic acid?
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.
What is the spectrum, dosage and adverse effects of mupirocin?
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
What are some combination topical anesthetics?
Polysporin complete
Polysporin triple
What is polysporin complete?
10 000 units Polymyxin B (as sulfate)
500 units bacitracin zinc
0.25 mg gramicidin
50 mg lidocain
What is polysporin triple?
10 000 units Polymyxin B (as sulfate)
500 units bacitracin zinc
0.25 mg gramicidin
What are monitoring parameters for wound care?
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
What is a primary dressing?
Placed directly on the wound, absorbs fluids, prevents infection and adhesion of the secondary dressing
What is a secondary dressing?
Placed over the primary dressing for protection, absorption, compression and occlusion
What are the different kinds of dressings?
Gauze Transparent films Hydrogels Hydrocolloids Alginates Foams Liquid tissue adhesives
What is the purpose, the types of gauze dressings and how should they be applied?
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
What is the purpose of transparent films?
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
How should transparent films be applied?
Gently lay dressing over the wound, avoid wrinkling and don’t stretch
Overlap wound by 2.5 cm and apply tape
When should transparent films be avoided?
Moist wounds (does not absorb moisture)
What is the purpose of hydrogels?
High moisture content, some absorption properties
May be used for dry wounds, painful wounds, pressure ulcers, burns
Example: Restore, Tegaderm
How should hydrogels be applied?
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
When should hydrogels be avoided?
In gangrenous wounds
Weeping wounds
What is the purpose of hydrocolloid dressings?
Retains moisture
May be used for burns or small abrasions
Example: Duoderm
How should hydrocolloid dressings be applied?
Apply adherent side to skin and hold in place
Painless to remove
When should hydrocolloid dressings be avoided?
Dry wounds that are infected
Weeping wounds
What is the purpose of alginates?
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
How should alginates be applied?
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
When should alginates be avoided?
Dry wounds (can dry wound bed more)
What is the purpose of foam dressings?
Retains moisture, highly absorbent, protective
May be used for wounds with mild to moderate exudate, partial to full thickness wounds
Example: Allevyn
How are foam dressings applied?
Gently lay dressing over the wound, cover with gauze and tape in place and if necessary, may need a secondary dressing
When should foam dressings be avoided?
Dry wounds
Wounds that need to be frequently checked
What are the uses for liquid adhesives? How long do they last for? How should they be applied?
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
What are the different types of adhesive tape?
Cloth tape
Plastic tape
Paper tape
Hypoallergenic tapes are preferred
Describe cloth tape use
Use over bone, difficult to tape areas or with bulky dressings due to high tensile strength
Describe plastic tape use
Stretched with movement, good for mobile areas
Describe paper tape use
Porous, light adhesive, good for tender or painful area and for wounds that should breathe
Tend to break with movement
Describe adhesive skin closures
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)
