Wound Care: Wound Management, Cleaning, Debridement, and Dressings

Question 1

what are 3 electrotherapeutic modalities good for wound healing

Answer 1

• e-stim
• high voltage pulsed current
• transcutaneous electrical nerve stimulation

Question 2

goal of wound cleansing

Answer 2

remove necrotic tissue and maintain a clean wound bed for promotion of healing

Question 3

according to insurance, a chronic wound is greater than ____ days

Answer 3

30

Question 4

4 things you look at when preparing a wound bed

Answer 4

TIME
T = tissue
I = infection/inflammation
M = moisture imbalance
E = epidermis/edge

Question 5

what are some indications to debride

Answer 5

1 - eschar or non-viable tissue
2 - purulence
3 - infection
4 - foreign objects

Question 6

precautions to debride

Answer 6

• bone or tendon exposure
• complications like cellulitis, gross purulence, excessive underminding, excessive bleeding

Question 7

contraindications to debridement

Answer 7

• clean, non-infected wounds
• stable eschar
• dry gangrene/ischemia
• pulseless wound
• extreme pain at wound
• bleeding tendencies
• goal is to maintain comfort

Question 8

mechanical debridement

Answer 8

physically removing something from the wound

Question 9

forms of mechanical debridement

Answer 9

• dressing changes
• whirlpool/pulsed irrigation
• sharp/scrub debridement
• low frequency ultrasound

Question 10

autolytic debridement

Answer 10

using body’s own mechanism to remove nonviable tissue

Question 11

autolytic debridement can be facilitated through

Answer 11

dressings
e-stim
ultrasound

Question 12

enzymatic debridement

Answer 12

pharmaceutical

Question 13

Do pTs do selective or nonselective debridement

Answer 13

selective (non-surgical)

Question 14

contraindications of whirlpool

Answer 14

-incontinence
-epilepsy
-danger of hemorrhaging
-post-op incisions w/ dehiscence, sutures, staples
-infection
-skin grafts
-venous insufficiency, edema, lymphedema

Question 15

whirlpool parameters

Answer 15

frequency
duration
water temp
additives
vitals
expected outcomes

Question 16

which has better evidence: whirlpool or pulsed irrigation

Answer 16

pulsed irrigation

Question 17

T or F: pulsed irrigation involves single use machines

Answer 17

T

Question 18

what psi should you set for pulsed irrigation

Answer 18

4-15psi

Question 19

what temp should saline be for pulsed irrigation (cold or warm?)

Answer 19

warm b/c you want to keep the wound close to body temp

Question 20

pulsed irrigation documentation

Answer 20

pt position
fluid pressure
duration
water additives
outcomes

Question 21

when would you not want to use a wet to try dressing and why

Answer 21

if there is a lot of healthy tissue b/c it is a form of mechanical debridement

Question 22

what is the fastest type of debridement

Answer 22

sharps

Question 23

you should do sharps debridement for no more than _____. mins at a timw

Answer 23

15

Question 24

according to their license, can PTAs debride? what does the APTA say about it

Answer 24

yes, but the APTA says that debridement requires assessment and that is something only a PT can do

Question 25

T or F: when debridement is done in conjunction with WP or PI you cannot bill them seperately

Answer 25

T

Question 26

you should debride from the ______ edge up

Answer 26

inferior

Question 27

autolytic debridement is highly __ but it is slow

Answer 27

selective

Question 28

what medication is used for enzymatic debridement

Answer 28

santyl digests native and denatured collagen in necrotic tissue

Question 29

T or F: debridement is a single event

Answer 29

F: you have the initial phase (which may take multiple sessions) and then the maintenance phase

Question 30

function of dressings

Answer 30

-moist wound environment -thermal insulation -barrier to microorganisms -protect exposed nerve endings -hemostasis -edema control -elimination of dead space -assists with removal of necrotic tissue -provide adequate gas exchange

Question 31

primary dressing

Answer 31

goes directly onto wound bed

Question 32

secondary dressing

Answer 32

wound dressing placed over the primary dressing to hold it on *for deeper wounds

Question 33

T or F: gauze dressings are highly permeable and can be used as primary or secondary dressings

Answer 33

T

Question 34

impregnated gauze dressings

Answer 34

mesh gauze dressings into which materials such as petroleum, bismuth or zinc have been incorporated

Question 35

is impregnated gauze primary or secondary

Answer 35

primary

Question 36

semipermeable film dressings

Answer 36

thin, flexible sheets of transparent polyurethane with an adhesive backing *used a lot for protection (ex. while showering) - can be primary or secondary

Question 37

hydrogels

Answer 37

80-90% water or glycerin based dressing available in sheets, amorphous gels, or impregnated gauzes

Question 38

are hydrogels primary or secondary

Answer 38

primary

Question 39

foam dressings

Answer 39

made of polyurethane foam with a hydrophilic wound side and hydrophobic outside

Question 40

what kind of wounds are foam dressings good for? are they primary or secondar>

Answer 40

good for wounds with excess moisture can be primary or secondary

Question 41

hydrocolloids

Answer 41

- contain hydrophilic colloidal particles with a very strong adhesive backing - works good for protection but not absorption

Question 42

is a hydrocolloid primary or secondary

Answer 42

primary

Question 43

alginates

Answer 43

salts of alginic acid extracted prom certain types of brown seaweed and converted into calcium/sodium salts

Question 44

are alginates primary or secondary

Answer 44

primary

Question 45

silver dressings are good for...

Answer 45

infections burn

Question 46

T or F: iodine harms healthy tissue

Answer 46

F: it is non-cytotoxic

Question 47

medicinal honey

Answer 47

donates moisture and cleans wound bed

Question 48

alpigraft and dermagrafts are both approved for...

Answer 48

diabetic foot ulcers

Question 49

what is the theory behind wound vacs?

Answer 49

-reduce bacterial load and chronic wound exudate -increased vascularity -increased cytokines -physically contract wound margins

Question 50

contraindications for wound vac

Answer 50

-malignancy -untreated osteomyelitis -fistulas -necrotic tissue w/ eschar -over exposed vessels/organs

Question 51

what kind of primary dressing do you use with wound vacs?

Answer 51

foam (black, white, or silver)

Question 52

how often do you change wound vac dressings?

Answer 52

48-72 hours

Question 53

what is the pressure set at on wound vacs

Answer 53

125mmHg can be continuous or intermittent