Wound Care Flashcards
1
Q
What is a wound?
A
Any injury to the body (i.e. bruises, tendonitis, lacerations)
2
Q
What type of tissue comprises skin?
A
- Epidermis
- Dermis
- Subcutaneous tissue
3
Q
What is epidermis?
A
- Thin outer layer of skin
- Regenerates every 4 to 6 weeks
- Functions to maintain skin integrity
- Acts as a barrier
- Protects from UV light
- Provides sensation
- Controls temperature
- Vitamin D is produced (Vitamin D is important for absorption of Ca)
4
Q
What is dermis?
A
- Blood vessels (remove waste via capillaries)
- Hair follicles
- Lymphatic vessels (removes waste via lymphatic gates; lymphatic system is in dermis and not blood vessels)
- Sweat glands
- Nerves (sensation)
- Fibroblast (the repair squad), collagen, and elastic fibers
- Ground substance (assists in healing)
- Proteins (assists in healing)
- Provides support and strength
5
Q
What gives skin strength?
A
- Collagen
- Collagen bundles anchor to the subcutaneous tissue
- Collagen is normally organized and alighned in a smooth collagen matrix
- Collagen deteriorates as we age
6
Q
What happens following any injury?
A
- All tissues undergo a similar process of repair. Whether it be a sprain, strain, laceration, surgery, pressure sore, scratch, scrape, or contusion
- Injury to vascular tissue initiates a series of responses collectively known as inflammation (1st stage of wound healing) and repair
- The ultimate goal of these responses is to eliminate the pathological or physical insult, replace the damage tissue, promote regeneration, and restore function
7
Q
What are the three types of wound healing closures?
A
- Primary intention
- Secondary intention
- Tertiary intention
8
Q
What is primary intention?
A
- Wound closure
- Ex: sutures
- Sutures are the best type of healing for a wound. It heals the fastest, cleanest, and with the least amount of scarring
9
Q
What is secondary intention?
A
- The wound heals from the body out
- The wound is not closed surgically
- Ex: blisters, pressure sores, contusions
10
Q
What is tertiary intention?
A
- There is a delay in wound closure
- Needs to be irrigated, debrided, and pumped full of antibiotics before closing
- Wound is usually dangerous due to bacteria
- Ex: cat bites, human bites, burns
11
Q
What happens during primary intention healing?
A
- Edges of wound are approximated and held together with sutures, steri-strips, or surgical adhesive
- Wound bed is closed and covered with skin
12
Q
What happens during secondary intention healing?
A
- The wound is left open to fill from the bottom up and from the sides from outside in
13
Q
What happens during tertiary intention healing?
A
- There is a delayed primary closure
- The wound is left open to drain or be irrigated in order to prevent infection
- There is a combination of primary and secondary healing
- Types of injuries include dog, cat, or human bites, traumatic injuries or injuries that occur in dirty environments where debris might be present
14
Q
What is tensile strength?
A
- Load is applied per unit of cross-section area (kg/cm2)
- Measured in newtons of force
- It is how much force the tissue can take before breaking or rupturing
- It increases with collagen synthesis
- Fibrin contribute to its strength
15
Q
When is peak tensile strength achieved?
A
- By 60days post injury in a healthy individual and continues on to eight weeks
- The scar tissue has decreased vascularity
- Scar tissue strength returns to 70% to 80% of normal strength
16
Q
What is the timeline for tensile strength recovery?
A
- 4 weeks: 40% to 50%
- 6 weeks: 60%
- 8 weeks: 70-80%
- Tensile strength will never be 100% strength post injury
17
Q
What is the tensile strength recovery timeline for flexor tendon injuries?
A
- 4 weeks: 50% strength signals that it is safe to do active motion
- 6 weeks: 60% signals that person can usually come out of splint if injury is hand
- 8 weeks: 70% to 80% signals that person can start working on strengthening with resistance
18
Q
What are the stages/phases of wound healing?
A
1) Inflammatory phase (3-5 days)
2) Proliferative, fibroblastic stage, latent or reparative phase (between days 5-21). This is the stage therapists have the greatest effect - before 3 months
3) Maturation, remodeling phase (after 3 months - 2 years). Everyday the scar may feel different because it is remodeling
Hemostasis/vasodilation > vasoconstriction > vasodilation because blood has coagulated and then macrophages come in to clean up
19
Q
What is the timeline of wound healing?
A
- Inflammatory stage: 0-6 days
- Proliferative/Fibroblastic stage: day 7 to day 21
- Maturation/Remodeling stage: day 21 up to 2 years
20
Q
What are characteristics of the inflammatory stage?
A
In this stage, leukocytes migrate into the wound, followed by monocytes which convert to macrophages to clean up the area. Clotting occurs to stop the bleeding
21
Q
What are characteristics of the proliferative/fibroblastic stage?
A
This stage is characterized by wound contraction, scar synthesis, blood vessel proliferation, and epithelialization (when skin seals shut, closure of the skin). Collagen is being laid down at a rapid rate
22
Q
What are characteristics of the remodeling/maturation stage?
A
In this stage the collagen matrix is remodeled and tissue changes over time
23
Q
What is epithelialization?
A
- Tissue closure
- Fibroblasts synthesize and secrete collagen
- Rapid capillary proliferation activates fibrinolysis allowing fibroblast migration and collagen production
- Collagen closes or seals the opening of the skin
- Scar tissue can be hypersensitive due to cortical remapping. Scar tissue is not vascularized
24
Q
What is partial thickness wound?
A
- Tissue injury that extends partially through the dermis. It is not a full dermal injury
- Heals by epithelialization
If painful it is secondary to exposure of nerve endings
25
What are examples of partial thickening wounds?
- Skin tears
- Abrasions
- Tape and burns or damage from improper removal
- Non-bloody blisters
- Dermatitis - allergies to adhesives, detergents, etc.
26
How can skin tears be prevented?
- Soften skin: use moisturizer liberally
- Treat tears quickly
- Teach proper nutrition - increase protein intake
- Protect the arms and sleeves
- Safety check the environment for sharp edges, fall hazards
- Keep needed items in reach
- Avoid aggressive adhesives on fragile skin
- Encourage intake of fluids
27
What is a full thickness wound?
- Tissue destruction extending through the dermis to subcutaneous tissue
- Healing process: granulation, contraction, and epithelialization
- Appearance can be snowy white, gray, or brown
- Firm leathery texture
28
What are clinical examples of full thickness wounds?
- Donor sites for grafting for full thickness graft
- Venous ulcers
- Arterial/ischemic wounds
- Surgical wounds
Blood flow issues are common in people with diabetes or cardiac problems
29
What are tidy and untidy wounds?
- Classification of wounds
- Tidy (pt had surgery)
- - Incised or sliced (with flaps or with tissue loss)
- Untidy (pt experienced a burn, infection, etc.)
- - Contusion, burn (thermal, chemical, mechanical/abrasion), contortion (crush, avulsion, torsion, traction), toothed blade, injection, multiple level, indeterminate viability, devascularized areas, infection
30
What are the classifications of wounds by color?
- Red wound: uninfected, granulation tissue (beefy), revascularization, does not have streaking or heat
- Yellow wound: drainage, slough (has to be debrided because it blocks epithelialization ),
- Black wound: eschar, necrotic tissue
31
What characterizes a red wound?
- It is beefy red, without infection, with epithelial, endothelial myofibroblast, and fibroblast cellular activity taking place
- Healthy tissue
- Granulating tissue is dark pink or red
- Treatment focus is on protection and wound closure
32
What characterizes a yellow wound?
- It contains pus and debris. It could signify infection
- Macrophages respond to inflammation
- Drainage, slough/dead skin, delayed epithelialization
- Odor in a wound is a sign of infection
- Requires debridement
- Redness, fever and streaking redness is a sign of infection and the doctor should be notified
33
What characterizes a black wound?
- Eschar, necrotic tissue
- Requires meticulous and timely debridement to decrease the risk of infection and promote healing by facilitating normal cellular response
- Healing cannot progress until surgery
34
What is cellulitis?
- Inflammation of cellular or connective tissue
- Pearl: inflammation may be diminished or absent in immunosuppressed patients
- People with circulatory problems are at high risk of cellulitis
- Massage should not be used because it can spread the cellulitis
35
What are signs of advancing cellulitis?
- Cellulitis is visibly spreading in the area of the wound
- Inflammation of subcutaneous tissue with local redness, warmth, and pain. Tender red streaks may be seen
- TIP: advancement can be monitored by marking outer edge of the cellulitis and assessing the area for advancement or spreading 24 hours later
36
What does wound care entail?
- Clean wound immediately with mild diluted soap and water, saline, or purified water. Do not use peroxide or iodine. These are too harsh and can damage tissue
- Do apply pressure to stop bleeding ASAP. Maintain pressure for 5 minutes
- Keep wounds covered and moist. Wounds were found to heal in 12 to 15 days when kept covered and moist versus 25 to 30 days when wounds were left open to dry out
- Do monitor the healing of a wound. If wound does not seem to be healing or if it seems to get worse then contact physician
37
What are topicals used for wound care?
- Gauze 4X4
- Vaseline is the current preferred ointment
- Neosporin contains Neomycin and can cause allergic reactions
- Polysporin or a triple antibiotic contains zinc or Bacitracin
- Do not use hydrogen peroxide unless instructed to do so by physician. Dilute with water and use only to remove blood or crust around sutures that won't come off with saline
38
What are products to have at the clinic?
- Primary dressings: 4x4, 2x2, Adaptic, Xeroform, Telfa pads
- Secondary dressings: 1", 2", and 3" gauze wrap, stockinette, knitted webbing, Tubigrip, digisleeves, coban
- Vaseline, Bacitracin (no Neosporin)
- Band-Aids of various size
- Long cotton applicators
- Gloves
- Scissors
- Paper tape and silk tape
- Saline solution
- Alcohol
39
What is Aquacel?
- A primary wound dressing
- Absorbs and interacts with wound exudate to form a soft, hydrophilic, gas-permeable gel that traps bacteria and conforms to the contours of the wound whilst providing a micro-environment that is believed to facilitate healing
40
What is debridement?
The removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue
- Tweezers (sterile)
- Scissors
- Scalpel
OTs must have orders to perform sharp debridement
41
What are goals of wound care treatment?
- Prevent infection
- Prevent rupturing of sutures
- Protect wound
- Promote healing
- Scar management
- Patient education
- Desensitization
42
What are some characteristics of scars?
All wounds heal by scarring
- All scars contract or shorten
- Scars can adhere to surrounding tissues
- Scars can become thick (hypertrophy or keloid)
- Scars can be sensitive or painful
43
What are adhesions?
- Can result around a primary injury to tissue as a result of prolonged swelling and inflammation
- Not only limits motion in extremities but can also limit motion in tendons, nerves, vessels, and other soft tissues
44
What are therapeutic interventions for scars?
- Pt education
- Heat, paraffin, fluidotherapy
- Scar massage
- Silicone gel sheeting
- Tape
- Kinesiotape
- Topical scar medication
- Cortisone injections
- Compression
- Ultrasound: continuous 3.3 MHZ no more than .9 Wcm2: softens scar and aligns matrix
- Iontophoresis (potassium iodide or sodium chloride/saline
- Scar extractor
- Otoform
- Splinting
- Scar release surgery (tenolysis and neurolysis)
- Grafting
