Wound Care + Dressings lec Flashcards
define wounds
any damage leading to break in continuity of skin
what is meant by classifying wound according to aetiology?
what is the cause of the wound
give some different wound aetiologies
trauma
surgical
ischaemic
pressure
burns
malignant
diabetic
what are the two different timescales that wounds can be classified by?
acute and chronic
true or false, all chronic wounds begin as acute wounds?
true
chronic wounds do not follow the correct healing stages and hence lengthens recovery true or false?
true
what are the 2 types of closure that wounds cam be classed as?
primary and secondary intention
what is meant by primary intention closure?
wound edges brought together by stitches etc and wound healing occurs by connective tissue formation
what is meant by healing by secondary wound intention?
wound left open to heal base up by layering of granulation tissue and wound contraction
healing for most chronic wounds
the healing process can be classified, list the 4 different terms that are associated with the proliferation stage of healing?
granulation
contraction
epithelialisation
slough
outline the main steps of the healing process that aims to heal a wound?
haemostasis
inflammation
proliferation
remodelling
what is meant by haemostasis ?
wound closed by clotting
different steps of haemostasis?
- blood vessels contract to restrict blood flow
- platelets stick together to seal break in BV wall
- coagulation reinforces platelet plug with fibrin
what is the second stage of wound healing?
inflammation
what controls bleeding and prevents infection?
inflammation
fluid engorgement allows healing and promotes cells to move to the site of the wound, true or false?
true
when does inflammation become a problem?
if its prolonged or excessive
what happens in proliferation?
wound rebuilt of tissue with collagen and extracellular matrix
in proliferation wound contracts and new blood vessels constructed so tissue can recieve? 2
oxygen and nutrients
remodelling/maturation is when the wound fully closes and collagen matures from type 3 to type ?
1
cells no longer needed to repair wound are removed, then collagen is laid down, what happens do it during maturation phase?
aligned along tension line, water reabs, fibres crosslink to reduce scar thickness
what is meant by necrotic?
dead tissue
what type if tissue is devitalised and contains white blood cells and debris?
sloughy
true or false sloughly tissue can not be easily removed but must be to allow healing?
true
what colour is used to describe a sloughy wound?
yellow
describe granulating tissue
newly formed capillary loops that grow into damaged tissue to form new tissue, characteristically red
final stage of wound healing is epithelisation, describe what it would look like?
keratinocytes migrate from wound margins or hair follicles and sebaceous glands to cover wound surface, pink
list 5 different factors that can affect healing?
age
nutrition
comorbidities
medications
lifestyle
what effect does ageing have on healing?
collagen production decreases and weaker so increases risk
in terms of nutrition why carbs better for wound healing
body burns aa’s and proteins for energy, needed for repair
depletion -> impaired inflamm, poor immune response
tissues need O2 to survive, amny disease affecting tissues and O2 -> poor wound healing
give examples
COPD
peripheral vasc disease
anaemia
high dose X can affect wound healing due to suppression of the immune system
steroids
what effect can abuse of alcohol and smoking have on healing?
impairs
give 2 causes for diabetic foot ulcers?
peripheral diabetic neuropathy and peripheral arterial disease
what causes the initial foot damage in diabetic patients?
lack of nerve sensation in feet
what exmaination checks for peripheral pulses in feet?
doppler
peripheral arterial disease is a result of X, less blood flow to lower limbs -> diab foot ulcer
atherosclerosis
what would be the purpose of angiography
check for peripheral circ and rectify blockages w angioplasty/ stenting
what may cause a diabetic foot ulcer
poor fitting shoes
rubbing
stone in shoe
step on sharp
walk on hot sand
step in hot bath
in what different ways can leg ulcers be classified? 5
venous
arterial
mixed
diabetic
autoimmune
why do venous leg ulcers occur?
failure of calf muscle to pump blood effectively
risk factors for venous leg ulcers
dvt
varicose veins
lower limb surgery
trauma
patients with brachial arterial diease have a ABPI below 1, what is indicated by a lower number?
more significant damage and atherosclerosis
how is ABPI calc?
highest ankle systolic over highest brachial systolic
tx of venous ulceration normal abpi
graduated compression hosiery
inc pressure gradient from ankle to knee = assisted venous return
what is a pressure ulcer?
damage to skin and deeper layer of tissue under skin due to pressure applied to same area for period of time that cuts off blood supply
eg sat for long time wheelchair etc
early signs of pressure ulcers
discoloured skin, red or purple patches, warm spongy or hard patch, pain
what grade of pressure ulcer is non blanchable erythema of intact skin?
1
what grade of pressure ulcer is partial thickness skin involving epidermis dermis or both?
2
what grade of pressure ulcer is it where there is full thickness skin loss involving damage to or necrosis of sb tissue that may extend down to fascia?
3
what grade of damage would a pressure ulcer where there is full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle bone and supporting structures?
4
pressure ulcers more common in what areas of body
bony parts: heels elbows hips spine
gradually develop sometimes quick if px in poor state of health
list some different properties of an ideal dressing?
control moisture around wound
protect from microorganisms and infection
mechanical protection
easy to use
non toxic
cost effective
what 2 things to think about before choosing dressing
is wound wet/ dry
is dressing complete
list 2 different simple dressings?
low adherence dressings and absorbent dressings
list 3 different advanced wound dressings?
hydrogels, films and foams
what are sorbsan and algosteril examples of?
alginates
alginates are obtained from seaweed and absorb exudate. They are suitable for wounds with what properties?
moderate to heavily exuding wounds
alginates come in 2 parts what are these?
flat sheets for packing wound cavity and secondary dressing to hold in place
alginates are avaiable with silver for
infected wounds
what type of dressings are allevyn and tegaderm
foam dressings
foam dressings are suitable for all exudating wounds but vary in their ability to absorb. They come as complete dressings with adhesive border or not and can be used as a secondary dressing. Are they more or less absorbing than alginates?
less
where are foam dressings best used?
to cushion fragile skin
what type of dressings are jelonet or bactigras examples of?
paraffin impregnated gauze
paraffin impregnated gauze is cotton and viscose impregnated with yellow or soft white paraffin and is X, Y, Z
greasy, waterproof and non stick
paraffin impregnated gauze is used as primary dressing for which wounds
partial thickness burns
what are duoderm and tegaderm examples of
hydrocolloids
hydrocolloids are semi permeable to oxygen and water and turn into a gel in the prescence of ?
exudates
what type of wounds are hydrocolloids useful for?
lightly exudating or dryer
true or false, hydrocolloids do not promote granulation?
false
give some benefits of hydrocolloids
complete dressings, waterproof, available in different sizes and shapes
community advice that you can give to someone with burns?
cool with cool or lukewarm running water for 20 mins
dont rip off stuck clothes
cover with clingfilm
analgesia
a patient with burns should attend A&E if?
chemical
electrical
covers area larger than hand
white or charred skin
forms blisters
if a burn blisters what dressing would be the likely choice?
paraffin impregnated gauze
what would imply infection in a sloughy wound?
green and redness around area, check markers for infection
give some markers of infection that could be checked for a sloughy wound?
temp
wcc
what type of dressing would be most suitable for an infected sloughy wound?
alginate or hydrocolloid fibrous depending on amount of exudate
why might an infected sloughy wound require a secondary dressing as a cover?
prevent maceration and further breakdown
which bacteria would systemic antibiotics need to cover and why?
staphylococcus because stays on the skin
give 2 abx choices for skin infections
flucloxacillin, clindamycin
doxacycline if allergy
what is maceration?
too much moisture on surrounding skin of wound
what is the risk if primary dressing has not absorbed enough exudate?
maceration
what dressing would be appropriate for a wound that is healing well and undergoing granulation and epithelilisation?
simple protection eg low adherence dressing, vapour permeable film or hydrocolloid
where does sterile larvae come from?
greenbottle fly
what is debridement?
removing sloughy necrotic or infected tissue
when would larvae or maggot therapy be used?
where other options fail
how does larvae therapy work?
saliva contains chemicals that break down dead tissue into liquid form that larvae digest
does larvae therapy affect healthy tissue, yes or no?
no
how is larvae therapy prescribable on a fp10 prescription?
biofilm dressing (preferred by px) or free range larve
