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Patient Evaluation > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

First 3 step in the inflammatory phase ?

A

Hemostasis with a fibrin-platelet clot

Platelets release platelet-derived growth factor (PDGF)

Provisional matrix develops in first 24 hours

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2
Q

What are PMN role in the inflammatory phase in wound healing ?

A

They arrive through leaky capillaries, attracted by the PDGF growth factor releases by the platelets

Enhance cell migration

Phagocytose the clot

Kill bacteria

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3
Q

Inflammatory phase Last step: By __-__ hours, macrophages release growth factor

A

48-72

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4
Q

Proliferative Phase ?

A

72 hours after the wound started, fibroblasts provide structure to the wound in the form of collagen

Intramolecular cross-linking occurs, giving strength

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5
Q

What cell is mostly involved in the Proliferative Phase ?

A

fibroblasts

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6
Q

Remodeling / Maturation phase ?

A

By 2-3 weeks after the wound, the density of inflammatory cells and new capillaries start to resolve by apoptosis

Simultaneous collagen increase and breakdown

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7
Q

Remodeling phase can last months to ______ as collagen fibrils get more organized and cross-linked

A

2 years

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8
Q

Remodeling phase: Visible scars that remain are due to ?

A

residual disorganized collagen

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9
Q

If the inflammatory process lasts too long, persistent ___ and __________ activity cause increased collagen synthesis, leading to ?

A

PMN and macrophage

Hypertrophic scars

Keloids

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10
Q

Last 2 steps in the remodeling phase ?

A

Wound contraction occurs

Fibroblasts attach to the collagen matrix and contract the network

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11
Q

In surgical wounds, contraction can _____ or ___________ – undesirable look

A

shorten or depress scars

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12
Q

In circular incisions (anastomosis) contraction can cause ?

A

stenosis

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13
Q

Contraction occurs less over tighter skin (eg. shoulder) than over _______ (eg. groin)

A

loose skin

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14
Q

Epithelialization specific to ?

A

skin and gut tissue

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15
Q

Epithelialization occurs in what phase ?

A

Inflammatory

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16
Q

In a well-approximated wound, epithelialization is nearly complete at __-__ hours

A

24-48

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17
Q

In an open wound, this would take days to months

A

Epithelialization

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18
Q

Epithelialization benefits/facts ?

A

Provides a barrier on the skin to water, bacteria and other items in the environment

Multilayered by a few days

Sterile dressing in OR – do not remove for 3-4 days unless it gets wet

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19
Q

In a_____________ wound, minimal dermis is lost so wound heals by epithelialization

A

partial-thickness

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20
Q

Partial-thickness wound heals from ?

A

Wound heals from edges and from epidermal islands

1-2 mm/day

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21
Q

In open, ____________ wounds, epithelial cells can migrate only from the edges of the wound

A

full-thickness

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22
Q

full-thickness healing time ?

A

Takes longer, 1-2 cm/month

A 3-4 cm lower leg ulcer will take optimally 2-4 mos to close

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23
Q

Partial-thickness Wounds facts ?

A

If a wound is allowed to dry out, upper cell layers die and depth of injury extends

so

Keep wound occluded with a cream or polyurethane film – maintains moisture without eschar formation

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24
Q

______ is inelastic, putting shearing forces on underlying tissue during motion – painful

A

Eschar

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25
Q

Full-thickness Wounds facts ?

A

Historically – “leave it open to air”

But epithelial cells migrate significantly faster in moist environment

Dressings, creams

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26
Q

What can slow down cell migration during wound healing ?

A

Eschar

necrotic tissue

excess exudate

dry material

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27
Q

Epithelialization: Epithelium has no _______ , so it is sensitive to ______ and will ?

A

strength

Sensitive to shearing forces

Will blister or break down with trauma

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28
Q

Epithelialization: As it matures over months, it anchors to the dermis by______

A

fibers

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29
Q

Epithelialization: May appear different from surrounding skin due to ?

A

altered collagen and

any absence of hair or glands

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30
Q

Well-approximated wounds have epithelial cover by __ hours so okay to bathe…..unless ?

A

24

prosthesis or foreign
material in wound

Early washing helps to rid exudate, blood and bacteria

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31
Q

An open wound continuously releases exudate which is_______ to tissue so it can Get colonized and becomes a ____________

A

adherent

culture medium

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32
Q

Colonization and culturing of bacteria is improved with ?

A

Frequent dressing changes

Irrigation

Mechanical removal of
debris - debridement

Detergents

Sterile saline

Tap water better than a dirty wound

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33
Q

With cutaneous sutures, epithelium starts to migrate down suture track ________

A

immediately

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34
Q

If sutures are too tight or if there is swelling, suture will cut through the dermis – causing ?

A

“railroad tracks”

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35
Q

Remove cutaneous sutures within ______

A

1 week

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36
Q

So remove cutaneous sutures within 1 week

…. BUT tensile strength at 1 week is __ of normal

A

3%

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37
Q

Tensile strength at 3 weeks, it is ___ of normal

A

10%

38
Q

Tensile strength at 6 weeks, it is ___-___ of normal

A

35-50%

39
Q

Wound Strength: ______________- sutures help (last 3 weeks)

A

Subcuticular

40
Q

Wound Strength: Wounds of abdominal fascia or tendons need to be protected for ______ (at 35-50% of normal by then)

A

6 weeks

41
Q

Wounds over high tension areas need support for several weeks to allow ?

A

collagen remodeling and cross-linking

42
Q

High tension wounds need support like ?

A

Steristrips

Wound immobilizers

Semiocclusive dressing

Silicone gel sheeting

Goal is to keep wound moist and absorb exudate

43
Q

Wound Complications ?

A

Hematoma

Seroma

Dehiscence

44
Q

Hematoma, patho, RF, and tx. ?

A

Collection of blood and clot

Higher risk in pts on ASA or low-dose heparin, coughing, HTN

Tx – evacuate the clot under sterile conditions, ligate, reclose

45
Q

Seroma, patho, RF, and tx. ?

A

Fluid other than pus or blood

Mainly when lymphatics are cut

Compression dressing, vacuum device

46
Q

Dehiscence definition ?

A

Partial or total disruption of any or all layers

47
Q

___________ – all layers of abdominal wall with extrusion of abdominal organs

A

Evisceration

48
Q

Wound dehiscence RF ?

A

*Inadequate closure - #1 reason

Increased intraabdominal pressure

Deficient wound healing

49
Q

What is the #1 reason for wound dehiscence ?

A

Inadequate closure

50
Q

Wound dehiscence tx. ?

A

Reclose using heavy gauge suture/wire

If due to infection – tx infection and delay

51
Q

Options for Optimizing Healing ?

A

Regranex - GF (PDGF)

Apligraf - Artificial Skin Equivalents

Hyperbaric oxygen - Seems effective though no clinical trials

Electrical stimulation - By physical therapists

52
Q

Growth factors – PDGF (Regranex) usually for ?

A

For diabetic foot ulcers

53
Q

Artificial Skin Equivalents – Apligraf - usually for ?

A

Engineered skin for chronic wounds, venous ulcers

54
Q

Factors that Impair Healing ?

A

Diabetes

Aging

Ischemia

Malnutrition or catabolic state

Edema

Radiation

Steroids or chemotherapy

Collagen vascular disease

55
Q

________ is a common cause of fever after 3rd postop day

A

Phlebitis

56
Q

A post-op fever is more likely infectious if ?

A

Preoperative trauma

Onset after the second post op day

WBC above 10,000

BUN above 15

Surgery class above a 2

Temp above 38.6

57
Q

5 Ws of post op fever ?

A 
Wind
Wound
Water
Walk
Wonder drugs
58
Q

________ is the most common pulmonary postop complication

A

Atelectasis

59
Q

Fever ______ in the immediate postoperative period (1st 48 hours) is usually due to atelectasis

A

<102

60
Q

atelectasis PE ?

A

Decreased breath sounds, esp bases in a patient taking shallow breaths. CXR can confirm

61
Q

atelectasis prevention anf tx. ?

A

deep breath, cough, ambulation

62
Q

What decrease the tidal volume ?

A

Pain, anesthesia, analgesia

63
Q

Pneumonia fever level and sxs. ?

A

102 fever,

confusion, hallucination, tachypnea, hypoxia, elevated WBC, purulent sputum

<102 in first 48 hours is usually atelectasis

64
Q

Chemical pneumonitis patho ?

A

Aspiration of gastric contents

65
Q

Chemical pneumonitis

RF ?

A

Elderly, chronically ill, pts with GERD, food in stomach, pregnant at higher risk

66
Q

Chemical pneumonitis

tx. ?

A

supportive

Antibiotics only if the pneumonitis becomes a bacterial pneumonia (purulent sputum)

67
Q

Most common nosocomial infection ?

A

UTI

indwelling foleys

68
Q

If UTI develops, give empiric antibiotics until culture results are back, which organisms are you wanting to cover ?

A

E. coli

Klebsiella

Pseudomonas

69
Q

Early fever, 1st 48 hours ?

A

Atelectasis

No work up needed, if patient is otherwise okay

70
Q

Fever days __-__ could be infectious or not

A

2-5

71
Q

Fever lasting after 5th day, what is much more likely ?

A

Wound infection

72
Q

Signs and Symptoms of Infection, other ?

A

Fever, chills

Malaise, fatigue, loss of appetite

~N/V

Tachycardia, tachypnea

Hypovolemia

73
Q

Sxs. of hypovolemia ?

A

Dry mucous membranes

Hypotension

Oliguria, concentrated urine, anuria

74
Q

____________ – most appear during surgery or in first 3 postop days

A

Dysrhythmias

75
Q

Postop MI - ____ of all patients

A

0.4%

76
Q

Postop cardiac failure – ____ of pts over 40 yo, usually due to fluid overload

A

4%

77
Q

Postoperative Parotitis ?

A

rare

staph infxn of parotid gland

78
Q

Postop fecal impaction due to ?

A

colonic ileus

opioids

79
Q

Postop fecal impaction

Dx, ?

A

rectal exam

80
Q

Postop fecal impaction

tx. ?

A

manual disimpaction

then enema

81
Q

Bowel obstruction due ?

A

paralytic ileus

mechanical obstruction

82
Q

Bowel obstruction what to look for ?

A

Look for air-fluid levels in loops of small bowel

83
Q

Fat embolism ?

A

Common but usually asymptomatic

Resp and neuro symptoms when severe

84
Q

Hemoperitoneum ?

A

Rapid and life-threatening

85
Q

Clostridium difficile colitis ?

A

Common nosocomial infection

Asymptomatic to severe

IV metronidazole or oral vancomycin

86
Q

Postop pancreatitis ?

A

Usually after surgery near the pancreas

Often necrotizing type

87
Q

Postop urinary retention ?

A

Inability to void, common, often due to over distention

Risk of UTI

88
Q

Postop cholecystitis ?

A

After any surgery, but esp GI

Usually no stones and more common in men

Often becomes necrotic

89
Q

CNS complications ?

A

Postop CVA

Seizures – esp patients with Crohn or UC

90
Q

Postop CVA ?

A

Usually due to poor perfusion

Elderly with atherosclerosis, hypotensive

91
Q

Psychiatric complications ?

A

“Postop psychosis”

92
Q

“Postop psychosis” ?

A

On 3rd postop day, confusion, fear, disorientation

Rule out metabolic derangement, infection

Patient Evaluation (29 decks)

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