Wound Care

Question 1

Most appropriate technique for acute care hospitals?

Most appropriate technique for home care, LTC facilities, outpatient, routine procedures?

Answer 1

Sterile technique

Clean technique

Question 2

Negative-pressure wound therapy (vacuum-assisted closure)

1. Open-cell ____ placed into wound
2. Controlled sub atmospheric pressure (typically ___ mmHg below ambient pressure) applied
3. Helps maintain ___ wound environment, control __, increase ___, reduce ____

Answer 2

1. Foam dressing
2. 125
3. Moist, edema, localized blood flow, infectious material

Question 3

Surgical intervention is indicated for ___ ulcer, enhancing ___ and resurfacing wound (grafts), preventing __ and ___. May be indicated for what staging of ulcers?

Answer 3

Excising
Vascularity
Sepsis
Osteomyelitis
III, IV

Question 4

What is hyperbaric oxygen therapy (HBO)?

Answer 4

Pt breathes 100% O2 in a sealed, full-body chamber with elevated atmospheric pressure (between 2-2.5 ATA)

Question 5

What does HBO therapy do?

Answer 5

Hyperoxygenation reverses tissue hypoxia and facilitates would healing due to enhanced solubility of O2 in the blood

Question 6

Who is HBO therapy contraindicated for?

Answer 6

1. Untreated pneumothorax

2. Some antineoplastic medications (doxorubicin, disulfiram, cisplatin, mafenide acetate)

Question 7

Cleanse the wound how often?

Answer 7

Initially and at each dressing change

Question 8

Normal saline (0.9% NaCl) is recommended for what?

Answer 8

Most ulcers; nontoxic effect in wounds

Question 9

Cleansing topical agents contain ____ that lower surface tension. Limited use due to ?

Answer 9

Surfactants

Possibly toxic to healing tissues

Question 10

Dakin’s solution, acetic acid solution, hydrogen peroxide, sodium hypochlorite solution

Answer 10

Cleansing topical agents

Question 11

Minimize mechanical force of cleaning by using what?

Answer 11

Gauze, cloth, sponge

Question 12

Irrigation: recommended pressure?

Answer 12

4-15psi

Question 13

What is-
Delivery of irrigating solution under pressure that is produced by electrically powered device.
What is another type that assists in removal of wound debris?

Answer 13

Pulsed lavage

Pulsed lavage with vacuum (PLWV)

Question 14

Use of whirlpool therapy— supported for wound care? Why/why not?

Answer 14

NOT- contamination, infection, higher unregulated pressures can damage granulation tissue, limbs placed in dependent position

Question 15

What types of washes shouldn’t you use on skin? Why?

Answer 15

Harsh soaps, alcohol-asked products, harsh antiseptic agents —> may erode skin

Question 16

Removal of necrotic or infected tissue that may interfere with wound healing

Answer 16

Wound debridement

Question 17

Wound debridement reduces ___ concentration in wound, improves ___

Answer 17

Bacterial

Wound healing

Question 18

What are some topical agents used to manage non-healing or infected wounds?

Answer 18

1. Antiseptics and wound cleanser (Dakin’s solution, acetic acid)
2. Antimicrobials (antifungals, antibacterial-Bacitracin/Neosporin) 3. Anesthesia and analgesia agents (topical lidocaine)
3. Enzymatic debridement (Santyl)

Question 19

Ideal wound dressings maintain ___ environment, control for ___, facilitate gaseous exchange, ___, prevent contamination, and are ___ to the wound.

Answer 19

Moist
Excess exudate
Insulate
Non-traumatic

Question 20

moist environment facilities ___ debridement and promotes faster wound healing with less pain

Answer 20

Autolytic

Question 21

Sorbsan, Kaltostat

Answer 21

Alginates

Question 22

Biocclusive, OpSite, Tegaderm

Answer 22

Transparent film

Question 23

LYOfoam, Flexzan

Answer 23

Foam

Question 24

Vigilon, Carryson, Second Skin, Clearsite

Answer 24

Hydrogels

Question 25

DuoDerm, Crusaderm, 3M Tegasorb

Answer 25

Hydrocolloid

Question 26

Kerlix, 4x4s, Nugauze, Telfa

Answer 26

Standard gauze, non-impregnated

Question 27

Silver-, iodine-, Vaseline/petroleum- ... Adaptic, Xeroform

Answer 27

Impregnated gauze

Question 28

Silver dressings are common ____ agent found in foams, films, alginates, hydrocolloids, hydrogels

Answer 28

Antimicrobials

Question 29

Specialty dressings: wound matrix dressings provide ___ for cellular deposit. Typically collagen or hyluronan based

Answer 29

Scaffold

Question 30

2 methods for edema management

Answer 30

Leg elevation and exercise, compression therapy

Question 31

E-stim for wound healing is used for ? 1. ____ waveform, ___current. 2. ___ voltage ___ current. 3. ___ ____ current.

Answer 31

For improving circulation, facilitating debridement, enhancing tissue repair. 1. Continuous, direct 2. High, pulsed 3. Pulsed biphasic

Question 32

Delayed wound healing is associated with ___ and ___.

Answer 32

Malnutrition and poor hydration

Question 33

What is the normal albumin level? What level = malnutrition?

Answer 33

Normal: 3.5-5.5 mg/dL | <3.5 = malnutrition

Question 34

BMI of ___ with ___ has increased risk for pressure ulcer

Answer 34

21 or under, weight loss

Question 35

Individuals with wounds require approx ___ or more L of H2O a day

Answer 35

3L+

Question 36

Patients on air-fluidized beds require greater ___. How much?

Answer 36

Hydration | 40-60ml/Kg/day

Question 37

Provide adequate nutrition: frequent ___ calorie/high ___ meals; energy intake (____kcal/kg/body weight) and protein (____ gm/kg/body weight)

Answer 37

High Protein 25-35 1.5-2.5

Question 38

Patients with ___ and ___ require even higher nutritional intake

Answer 38

Trauma stress | Burns

Question 39

7 ways to prevent/reduce skin injury

Answer 39

1. Daily, comprehensive skin inspection 2. Therapeutic positioning to relieve pressure/allow tissue reperfusion 3. Techniques to ensure skin protection- avoid friction/shear/abrasion 4. Pressure-relieving devices (PRDs) 5. Avoid restrictive clothing 6. Avoid maceration injury 7. Patient and caregiver education

Question 40

In bed: pressure relief by turning/repositioning every ___ during acute and rehab phases.

Answer 40

2 hrs

Question 41

In wheelchair: pushups every ___ for pressure relief

Answer 41

15 min

Question 42

Use techniques to ensure skin protection: 1. ___, not dragging 2. Use of turning and ___, trapeze, manual, or electric __. 3. Use of cornstarch, lubricants, pad protectors, thin film dressings, or ___ dressing over friction risk sites 4. Use of ___ for sliding W/C transfers

Answer 42

1. Lifting 2. Draw sheets, lifts 3. Hydrocolloid 4. Transfer board

Question 43

Static pressure relieving devices (PRD): use if patient can assume variety of positions. What are some examples?

Answer 43

1. Foam/air/gel mattress overlay 2. Water-filled mattress 3. Pillows or foam wedges 4. Protective padding (heel relief boots)

Question 44

Dynamic pressure relieving devices (PRD): use if pt cannot assume variety of positions. examples?

Answer 44

1. Alternating pressure air mattress | 2. Fluidized air/high-air-loss bed

Question 45

Seating supports (PRD): for chair-bound or w/c bound pts. Examples?

Answer 45

1. Cushions made out of foam, gel, air, combination

Question 46

How does pt avoid maceration injury?

Answer 46

1. Prevent moisture accumulation and temp elevation where skin contacts support surface 2. Incontinence management strategies

Question 47

Pt/caregiver education for skin protection: 1. Mechanisms of pressure ulcer development 2. Daily ___ 3. Avoidance of ___ 4. ___, weight shifts, lifts 5. Safety during self-care 6. Safety with use of devices and equipment 7. Importance of ongoing activity/exercise program

Answer 47

2. Skin checks and hygiene 3. Prolonged positioning 4. Repositioning