Wound Care (TOSCE) Flashcards
1
Q
List the 2 types of wounds
A
Acute
Chronic
2
Q
Describe acute wounds
A
-heal quickly (typically heal within 4 weeks)
3
Q
Give examples of acute wounds
A
bites, scrapes, minor lacerations, punctures, burns
4
Q
Describe chronic wounds
A
- fail to progress through normal healing within 4 weeks
- healing is delayed or impaired
5
Q
Give examples of chronic wounds
A
- pressure ulcers
- diabetic ulcers
6
Q
A normal healing process has __ phases
A
3
7
Q
The 1st phase is called?
A
Inflammatory phase
8
Q
The 2nd phase is called?
A
Proliferative phase
9
Q
The 3rd phase is called?
A
Maturation phase
10
Q
Describe the 1st phase (Inflammatory phase)
A
Begins immediately after hemostasis is completed
11
Q
Describe the 2nd phase (Proliferative phase)
A
Begins to rebuild with new granulation tissue
12
Q
Describe the 3rd phase (Maturation phase)
A
Also called the remodelling phase as the dermal tissue strengthens
13
Q
Immune system rxn of inflammatory phase:
A
Complex process with multiple cells involved
14
Q
Characteristics of inflammatory phase:
A
Starts at the time of injury and continues for 24-48 hours
15
Q
Appearance of inflammatory phase:
A
Redness, edema, and production of exudate
16
Q
Pain is associated with what phase?
A
inflammatory phase
17
Q
Immune system rxn of proliferative phase:
A
Granulation tissue formed, wound contraction and new epithelium formed
18
Q
Characteristics of proliferative phase:
A
Rebuilding phase which can last from 4-24 days
19
Q
Appearance of proliferative phase:
A
Bright red tissue and raised
Scar tissue is starting to be formed
20
Q
Maturation phase is referred to as the _____ phase
A
remodelling
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
22
Q
Characteristics of maturation phase:
A
Starts approximately 3 weeks after injury and complete healing can take up to 2 years
23
Q
Appearance of maturation phase:
A
Changes from pink or red to white
24
Q
Factors that affect wound healing acronym ??
A
DIDNTHEAL
25
D = ?
Diabetes (decreased circulation, long term condition)
26
I = ?
Infection (prolongs inflammatory phase delaying healing)
27
D = ?
Drugs (steroids, ASA, anticoagulants, cancer meds)
28
N = ?
Nutritional problems (normal wound healing impaired)
29
T = ?
Tissue necrosis
30
H = ?
Hypoxia (inadequate tissue oxygenation)
31
E = ?
Excessive tension on wound edges
32
A = ?
Another wound (competition for healing agents)
33
L = ?
Low temperature (slower healing in extremeties)
34
When do you refer wounds?
- 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
35
Signs and symptoms of infection?
- redness extending from wound after two days
- pus or yellow discharge
- area around wound is red, swollen and warm to touch
- abnormal smell
36
Describe basic would care management
- Stop the bleeding
- Cleanse the wound
- Protect the wound
37
How do you stop the bleeding?
use a clean dressing or gauze to apply pressure to the wound for 10 mins
38
How do you cleanse the wound?
- remove dirt and debris
| - wash wound with water
39
How do you protect the wound?
-apply a dressing to protect the wound and improve healing process
40
What is debridement and who can do it?
- removal of dead or contaminated tissue
| - only done by a HCP
41
What is recommended for cleaning the wound?
- drinkable water
| - normal saline
42
What is not recommended for cleaning the wound?
- 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)
43
List some signs of skin infection
- localized erythema
- localized pain
- warm to touch around affected area
- drainage/pus
- fever
*infected skin wounds may also smell
44
When are topical antibiotics used?
- for wounds that are high risk for infection, chronic wounds or those that have not been cleaned properly
- for wounds that are already infected
45
What are 2 concerns with prolonged use of topical antibiotics?
- resistance
| - secondary fungal infection
46
What are 3 OTC topical antibiotics?
Bacitracin
Gramicidin
Polymyxin B
47
Bacitracin is active against gram ____
positive
| *although does have minimal gram negative action
48
Dosage for Bacitracin?
apply 1-3 times daily
49
Adverse effects for Bacitracin?
- common sensitizer/allergic contact dermatitis
| - itching, burning, redness
50
Bacitracin has cross-sensitivity potential with ?
- neomycin
| - polymyxin
51
Gramicidin is active against gram _____
positive
52
Dosage for Gramicidin?
apply 1-3 times daily
53
Adverse effects of Gramicidin?
- low risk of sensitivity
- itching, burning
*damages sensory epithelium of nose. do not apply to nasal membranes
54
Polymixin B is active against?
gram negative
55
Dosage for Polymixin B ?
apply 1-3 times daily
56
Adverse effects of Polymixin B?
- low risk of sensitivity
| - itching, burning
57
Polymixin may have cross-sensitivity with _____
bacitracin
58
What are 3 Rx topical antibiotics?
Neomycin
Fusidic Acid
Mupirocin
59
Neomycin is active against?
gram negative
| *partially active against gram positive
60
Dosage of Neomycin?
apply 1-3 times daily
61
Adverse effects of Neomycin?
- low risk of sensitivity
| - itching, burning
62
Fusidic acid active against ??
gram positive
63
Dosage of fusidic acid?
apply 2-3 times daily for 7-10 days
64
Adverse effects of fusidic acid?
- dryness
- itching, burning
- some local irritation
65
Fusidic acid is first choice for _____
impetigo
66
Do you refer impetigo?
yes
67
What is impetigo?
highly contagious skin condition
68
Mupirocin is active against?
gram positive including some strains of MRSA
69
Dosage for mupirocin?
Apply 2-3 times daily for 7-10 days
70
Adverse effects for mupirocin?
- dryness
- itching, burning
- some local irritation possible
* should not be used for more than 10 days
71
Combination products exist: what two things do they combine? (specific for this condition)
topical antibiotics
| topical anesthetics
72
What do you need to monitor for in wound care?
- 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
What is the point of dressing a wound?
Protects wounds from further damage, helps to stop bleeding, helps to prevent infection and some help to promote healing
74
Describe: primary dressings
placed directly on the wound, absorbs fluids, prevents infection and adhesion of the secondary dressing
ex. gauze pads
75
Describe: secondary dressings
placed over the primary dressing for protection, absorption, compression and occlusion
76
List some types of dressings
- gauze
- transparent films
- hydrogels
- hydrocolloids
- alginates
- foams
- liquid tissue adhesives
77
Purpose of gauze dressings?
- absorbent and protectant
| - may be used for wet or dry wounds
78
Types of gauze dressings?
1. Non-adherent (does not stick to the wound)
| 2. Self-adherent (clings to itself)
79
Application of gauze dressings?
- place directly on wound
- moisten with saline, wring out excess fluid, and apply secondary dressing
- gauze is used as a primary dressing
80
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
81
Application of transparent films?
- gently lay dressing over the wound, avoid wrinkling and don't stretch
- overlap wound by 2.5cm and apply tape
82
When should you avoid use of transparent films?
moist wounds
| *bc transparent films do not absorb moisture
83
Example of transparent films?
Tegaderm Transparent
84
Purpose of hydrogels?
- high moisture content, some absorption properties
| - may be used for dry wounds, painful wounds, pressure ulcers, burns
85
Application of hydrogels?
- 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
Avoid use of hydrogels when?
- in gangrenous wounds
| - weeping wounds
87
Examples of hydrogels?
- duoderm gel
| - intrasite
88
Purpose of hydrocolloid dressings?
- retains moisture
| - may be used for burns or small abrasions
89
Application of hydrocolloid dressings?
- apply adherent side to skin and hold in place
| * painless to remove
90
Avoid use of hydrocolloid dressings when?
- dry wounds that are infected
| - weeping wounds
91
Example of a hydrocolloid dressing?
Duoderm
92
Purpose of alginates?
- create a moist environment, highly absorbent
- may be used for packing cavities & wounds, wound drainage, pressure ulcers
- can reduce pain
93
Application of alginates?
- apply dressing to area, cover with secondary dressing and tape in place
- may require a secondary dressing
94
Avoid use of alginates when?
- dry wounds
| * it can dry the wound bed out more
95
Examples of alginates?
- algisite
- tegaderm
- kaltostat
96
Purpose of foam dressings?
- retains moisture, highly absorbent, protective
| - may be used for wounds with mild to moderate exudate, partial to full thickness wounds
97
Application of foam dressings?
- gently lay dressing over the wound, cover with gauze and tape in place and if necessary
- may need a secondary dressing
98
Avoid use of foam dressings when?
- dry wounds
| - wounds that need to be frequently checked
99
Example of foam dressings?
Allevyn
100
What are liquid adhesives used for?
- paper cuts
- skin cracks
- minor cuts
101
How long do liquid adhesives last for?
5-10 days
102
How do you apply liquid adhesives?
wash cut first, apply pressure to stop bleeding then apply adhesive
103
Examples of liquid adhesives?
- Nexcare liquid bandage
- Band-Aid J & J Liquid bandage
- New skin liquid bandage
104
What is adhesive tape used for?
-used to secure dressings in place
105
What are the 3 types of adhesive tape?
cloth tape
silicone tape
paper tape ?
106
____ 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
cloth
107
____ tape:
- adheres well
- used for sensitive or "at risk" skin or if dressings are to be replaced often
silicone
108
____ tape:
- breathable but does not adhere as well as others
- generally used for sensitive areas or if dressings are to be replaced often
paper
109
What are adhesive skin closures used for?
Generally used to hold wounds closed after suture removal
110
What are steri-strips used for?
- used once stitches are out
| - thin strips of sterile, non-woven tape
111
What are butterfly closures?
-two sterile, waterproof strips connected by a non-adhesive bridge
