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Clinical 1 (Part A) > Wound Care (TOSCE) > Flashcards

Wound Care (TOSCE) Flashcards

1
Q

List the 2 types of wounds

A

Acute

Chronic

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2
Q

Describe acute wounds

A

-heal quickly (typically heal within 4 weeks)

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3
Q

Give examples of acute wounds

A

bites, scrapes, minor lacerations, punctures, burns

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4
Q

Describe chronic wounds

A
  • fail to progress through normal healing within 4 weeks

- healing is delayed or impaired

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5
Q

Give examples of chronic wounds

A
  • pressure ulcers

- diabetic ulcers

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6
Q

A normal healing process has __ phases

A

3

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7
Q

The 1st phase is called?

A

Inflammatory phase

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8
Q

The 2nd phase is called?

A

Proliferative phase

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9
Q

The 3rd phase is called?

A

Maturation phase

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10
Q

Describe the 1st phase (Inflammatory phase)

A

Begins immediately after hemostasis is completed

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11
Q

Describe the 2nd phase (Proliferative phase)

A

Begins to rebuild with new granulation tissue

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12
Q

Describe the 3rd phase (Maturation phase)

A

Also called the remodelling phase as the dermal tissue strengthens

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13
Q

Immune system rxn of inflammatory phase:

A

Complex process with multiple cells involved

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14
Q

Characteristics of inflammatory phase:

A

Starts at the time of injury and continues for 24-48 hours

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15
Q

Appearance of inflammatory phase:

A

Redness, edema, and production of exudate

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16
Q

Pain is associated with what phase?

A

inflammatory phase

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17
Q

Immune system rxn of proliferative phase:

A

Granulation tissue formed, wound contraction and new epithelium formed

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18
Q

Characteristics of proliferative phase:

A

Rebuilding phase which can last from 4-24 days

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19
Q

Appearance of proliferative phase:

A

Bright red tissue and raised

Scar tissue is starting to be formed

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20
Q

Maturation phase is referred to as the _____ phase

A

remodelling

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21
Q

Immune system rxn of maturation phase:

A

Collagen forms early scar tissue and continues to be deposited to increase strength of the tissue

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22
Q

Characteristics of maturation phase:

A

Starts approximately 3 weeks after injury and complete healing can take up to 2 years

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23
Q

Appearance of maturation phase:

A

Changes from pink or red to white

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24
Q

Factors that affect wound healing acronym ??

A

DIDNTHEAL

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25
Q

D = ?

A

Diabetes (decreased circulation, long term condition)

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26
Q

I = ?

A

Infection (prolongs inflammatory phase delaying healing)

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27
Q

D = ?

A

Drugs (steroids, ASA, anticoagulants, cancer meds)

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28
Q

N = ?

A

Nutritional problems (normal wound healing impaired)

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29
Q

T = ?

A

Tissue necrosis

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30
Q

H = ?

A

Hypoxia (inadequate tissue oxygenation)

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31
Q

E = ?

A

Excessive tension on wound edges

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32
Q

A = ?

A

Another wound (competition for healing agents)

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33
Q

L = ?

A

Low temperature (slower healing in extremeties)

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34
Q

When do you refer wounds?

A
  • If they haven’t had tetanus immunization for a dirty nail injury
  • Medical conditions that affect healing (diabetes, immunocompromised)
  • Factors that delay healing
  • Bleeding > 10 minutes
  • Age (prob over 75 ??)
  • Animal bite or human bite
  • 2nd or 3rd degree burn
  • Refer if wound is infected
  • Wound > 2cm
  • Lacerations on 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
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35
Q

Signs and symptoms of infection?

A
  • redness extending from wound after two days
  • pus or yellow discharge
  • area around wound is red, swollen and warm to touch
  • abnormal smell
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36
Q

Describe basic would care management

A
  • Stop the bleeding
  • Cleanse the wound
  • Protect the wound
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37
Q

How do you stop the bleeding?

A

use a clean dressing or gauze to apply pressure to the wound for 10 mins

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38
Q

How do you cleanse the wound?

A
  • remove dirt and debris

- wash wound with water

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39
Q

How do you protect the wound?

A

-apply a dressing to protect the wound and improve healing process

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40
Q

What is debridement and who can do it?

A
  • removal of dead or contaminated tissue

- only done by a HCP

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41
Q

What is recommended for cleaning the wound?

A
  • drinkable water

- normal saline

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42
Q

What is not recommended for cleaning the wound?

A
  • hydrogen peroxide (may impair healing and cause tissue toxicity)
  • isopropyl alcohol (may dry and irritate the skin)
  • iodine (may irritate tissue and impair healing)
  • povidone-iodine (may impair healing)
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43
Q

List some signs of skin infection

A
  • localized erythema
  • localized pain
  • warm to touch around affected area
  • drainage/pus
  • fever

*infected skin wounds may also smell

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44
Q

When are topical antibiotics used?

A
  • for wounds that are high risk for infection, chronic wounds or those that have not been cleaned properly
  • for wounds that are already infected
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45
Q

What are 2 concerns with prolonged use of topical antibiotics?

A
  • resistance

- secondary fungal infection

46
Q

What are 3 OTC topical antibiotics?

A

Bacitracin
Gramicidin
Polymyxin B

47
Q

Bacitracin is active against gram ____

A

positive

*although does have minimal gram negative action

48
Q

Dosage for Bacitracin?

A

apply 1-3 times daily

49
Q

Adverse effects for Bacitracin?

A
  • common sensitizer/allergic contact dermatitis

- itching, burning, redness

50
Q

Bacitracin has cross-sensitivity potential with ?

A
  • neomycin

- polymyxin

51
Q

Gramicidin is active against gram _____

A

positive

52
Q

Dosage for Gramicidin?

A

apply 1-3 times daily

53
Q

Adverse effects of Gramicidin?

A
  • low risk of sensitivity
  • itching, burning

*damages sensory epithelium of nose. do not apply to nasal membranes

54
Q

Polymixin B is active against?

A

gram negative

55
Q

Dosage for Polymixin B ?

A

apply 1-3 times daily

56
Q

Adverse effects of Polymixin B?

A
  • low risk of sensitivity

- itching, burning

57
Q

Polymixin may have cross-sensitivity with _____

A

bacitracin

58
Q

What are 3 Rx topical antibiotics?

A

Neomycin
Fusidic Acid
Mupirocin

59
Q

Neomycin is active against?

A

gram negative

*partially active against gram positive

60
Q

Dosage of Neomycin?

A

apply 1-3 times daily

61
Q

Adverse effects of Neomycin?

A
  • low risk of sensitivity

- itching, burning

62
Q

Fusidic acid active against ??

A

gram positive

63
Q

Dosage of fusidic acid?

A

apply 2-3 times daily for 7-10 days

64
Q

Adverse effects of fusidic acid?

A
  • dryness
  • itching, burning
  • some local irritation
65
Q

Fusidic acid is first choice for _____

A

impetigo

66
Q

Do you refer impetigo?

A

yes

67
Q

What is impetigo?

A

highly contagious skin condition

68
Q

Mupirocin is active against?

A

gram positive including some strains of MRSA

69
Q

Dosage for mupirocin?

A

Apply 2-3 times daily for 7-10 days

70
Q

Adverse effects for mupirocin?

A
  • dryness
  • itching, burning
  • some local irritation possible
  • should not be used for more than 10 days
71
Q

Combination products exist: what two things do they combine? (specific for this condition)

A

topical antibiotics

topical anesthetics

72
Q

What do you need to monitor for in wound care?

A
  • Bleeding: should stop within 10 mins for most people (within 15 mins for people on anticoagulants)
  • Infection: monitor daily for 48 hours
  • Wound healing: monitor daily for 4-14 days or more (if not closing within 2-4 weeks further assessment should be done)
73
Q

What is the point of dressing a wound?

A

Protects wounds from further damage, helps to stop bleeding, helps to prevent infection and some help to promote healing

74
Q

Describe: primary dressings

A

placed directly on the wound, absorbs fluids, prevents infection and adhesion of the secondary dressing
ex. gauze pads

75
Q

Describe: secondary dressings

A

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

76
Q

List some types of dressings

A
  • gauze
  • transparent films
  • hydrogels
  • hydrocolloids
  • alginates
  • foams
  • liquid tissue adhesives
77
Q

Purpose of gauze dressings?

A
  • absorbent and protectant

- may be used for wet or dry wounds

78
Q

Types of gauze dressings?

A
  1. Non-adherent (does not stick to the wound)

2. Self-adherent (clings to itself)

79
Q

Application of gauze dressings?

A
  • place directly on wound
  • moisten with saline, wring out excess fluid, and apply secondary dressing
  • gauze is used as a primary dressing
80
Q

Purpose of transparent films?

A
  • provide a moist environment, protective, waterproof

- may be used for superficial clean wounds where it is required to frequently view the wound

81
Q

Application of transparent films?

A
  • gently lay dressing over the wound, avoid wrinkling and don’t stretch
  • overlap wound by 2.5cm and apply tape
82
Q

When should you avoid use of transparent films?

A

moist wounds

*bc transparent films do not absorb moisture

83
Q

Example of transparent films?

A

Tegaderm Transparent

84
Q

Purpose of hydrogels?

A
  • high moisture content, some absorption properties

- may be used for dry wounds, painful wounds, pressure ulcers, burns

85
Q

Application of hydrogels?

A
  • apply a moderate amount to wound and cover with gauze
  • may require a secondary dressing
  • if self-adhesive may be used as primary dressing
86
Q

Avoid use of hydrogels when?

A
  • in gangrenous wounds

- weeping wounds

87
Q

Examples of hydrogels?

A
  • duoderm gel

- intrasite

88
Q

Purpose of hydrocolloid dressings?

A
  • retains moisture

- may be used for burns or small abrasions

89
Q

Application of hydrocolloid dressings?

A
  • apply adherent side to skin and hold in place

* painless to remove

90
Q

Avoid use of hydrocolloid dressings when?

A
  • dry wounds that are infected

- weeping wounds

91
Q

Example of a hydrocolloid dressing?

A

Duoderm

92
Q

Purpose of alginates?

A
  • create a moist environment, highly absorbent
  • may be used for packing cavities & wounds, wound drainage, pressure ulcers
  • can reduce pain
93
Q

Application of alginates?

A
  • apply dressing to area, cover with secondary dressing and tape in place
  • may require a secondary dressing
94
Q

Avoid use of alginates when?

A
  • dry wounds

* it can dry the wound bed out more

95
Q

Examples of alginates?

A
  • algisite
  • tegaderm
  • kaltostat
96
Q

Purpose of foam dressings?

A
  • retains moisture, highly absorbent, protective

- may be used for wounds with mild to moderate exudate, partial to full thickness wounds

97
Q

Application of foam dressings?

A
  • gently lay dressing over the wound, cover with gauze and tape in place and if necessary
  • may need a secondary dressing
98
Q

Avoid use of foam dressings when?

A
  • dry wounds

- wounds that need to be frequently checked

99
Q

Example of foam dressings?

A

Allevyn

100
Q

What are liquid adhesives used for?

A
  • paper cuts
  • skin cracks
  • minor cuts
101
Q

How long do liquid adhesives last for?

A

5-10 days

102
Q

How do you apply liquid adhesives?

A

wash cut first, apply pressure to stop bleeding then apply adhesive

103
Q

Examples of liquid adhesives?

A
  • Nexcare liquid bandage
  • Band-Aid J & J Liquid bandage
  • New skin liquid bandage
104
Q

What is adhesive tape used for?

A

-used to secure dressings in place

105
Q

What are the 3 types of adhesive tape?

A

cloth tape
silicone tape
paper tape ?

106
Q

____ tape:

  • breathable but not water resistant
  • can adhere to dry or damp skin
  • generally used if the dressing needs to stay intact or area is damp/moist
A

cloth

107
Q

____ tape:

  • adheres well
  • used for sensitive or “at risk” skin or if dressings are to be replaced often
A

silicone

108
Q

____ tape:

  • breathable but does not adhere as well as others
  • generally used for sensitive areas or if dressings are to be replaced often
A

paper

109
Q

What are adhesive skin closures used for?

A

Generally used to hold wounds closed after suture removal

110
Q

What are steri-strips used for?

A
  • used once stitches are out

- thin strips of sterile, non-woven tape

111
Q

What are butterfly closures?

A

-two sterile, waterproof strips connected by a non-adhesive bridge

Clinical 1 (Part A) (15 decks)

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