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EVNS > Wound healing and management > Flashcards

Wound healing and management Flashcards

1
Q

What is a wound?

A

The disruption in continuity or the integrity of the surface of body or organ

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2
Q

What are the 6 aetiologies of a wound?

A
  • External violence
  • Mechanical stress
  • Chemical agents
  • Infective agents
  • Thermal agents
  • Radiation
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3
Q

What are the 3 process of healing?

A
  • Inflammatory phase
  • Proliferative phase
  • Remodelling phase
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4
Q

What happens during the inflamamtory phase?

A
  • Takes 24-48 hours
  • Platelets release cytokines and growth hormones, which causes inflammation
  • Fibrin attracts neutrophils
  • Macrophages reduce bacteria and debride necrotic tissue, which stimulates angiogenesis (making new blood vessels)
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5
Q

What happens during the proliferative stage?

A
  • Fibroblasts lay down a new matrix and endothelial cells lay down capillaries and epithelial cells
  • Granulation tissue is produced
  • Wound contraction occurs 5-9 days post injury
  • Collagen laid down
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6
Q

What happens during the remodelling phase?

A
  • 7-10 days post injury
  • Scar formation
  • Tissue heals through resolution (little inflammation and restores back to normal state), regeneration (damaged tissue completely replaced) and organisation (replacement tissue, which is the scar)
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7
Q

What are the different factors impairing wound healing?

A
  • Age
  • Medication
  • Genetics
  • Quality of circulation
  • Pre-exisiting conditions
  • Diet
  • Hydration status
  • Stress
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8
Q

What are the 5 classifications of wounds and describe them?

A
  • Closed wound (contusion)
  • Clean (no contamination)
  • Clean contaminated (minimal contamination)
  • Contaminated (Heavily contaminated)
  • Dirty (Active infection)
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9
Q

What is a 1st degree contusion?

A

Bruise rupture of capillaries and sub-cut area

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10
Q

What is a 2nd degree contusion?

A

Rupture of larger vessels causing an accumulation of blood

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11
Q

What is a 3rd degree contusion?

A

More extensive tissue damage with possibility of infection; internal organs may be injured

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12
Q

What are the two things wound healing is dependent on?

A
  • Level of contamination
  • Viability of wound tissues
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13
Q

What are the 4 methods of wound healing?

A
  • Primary wound closure
  • Delayed primary closure
  • Second intention healing
  • Secondary closure
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14
Q

How is a bacterial infection assessed?

A
  • Tissue biopsy
  • Swab samples
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15
Q

How do you intially clean a contaminated wound?

A
  • Cover wound with gel or saline covered swab
  • Flush wound with sterile saline, tap water, lactated ringers, 0.05% chlorohexidine, 0.01-1% povidone-iodine
  • Take a bacterial swab for culture
  • Apply sterile dressing and bandage
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16
Q

What is debridement?

A
  • Removal of a bioburden and foreign material from a wound, which promotes wound healing
  • Can happen naturally, which is driven by neutrophils and macrophages
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17
Q

What are the two types of debridement technqiues and describe them?

A
  • Non-selective: physical removal of necrotic tissue, but can cause trauma to healthy tissue
  • Selective: will only target necrotic tissue
18
Q

What are the 2 types of non-selective debridement?

A
  • Mechanical
  • Sharp and surgical
19
Q

What are the 3 mechanical non-selective debridement technique?

A
  • Wound irrigation
  • Wet to dry or dry to dry
  • Monofilament debridement pads
20
Q

What is wound irrigation?

A

Surface bacteria, foreign material and necrotic debris is flushed away to clean the wound bed

21
Q

What is wet to dry or dry to dry?

A

When the dressing is removed the necrotic tissue is removed along with it; however healthy tissue and cells can be removed as well

22
Q

What are monofilament debridement pads?

A

Remove the necrotic tissue without removing healthy tissues and cells

23
Q

What is sharp debridement?

A

Removing devitalised tissue to the tissue margin

24
Q

What is surgical debridement?

A
  • En-bloc: wound is packed with sterile swabs and suture is closed temporarily. The wound as well as healthy tissue is then excised to leave a clean wound
  • Layered surgical debridement: tissue is removed gradually in layers
  • Hydrosurgery: bursts of water
25
Q

What are the 5 types of selective debridement?

A
  • Autolytic debridement
  • Hydrogel
  • Honey
  • Enzymatic debridement
  • Biosurgical (Larval therapy)
26
Q

How do manage autolytic debridement?

A
  • Change daily and lavage each time, but leave longer if granulation tissue present
  • Use saline wash
  • Apply hydrating dressing
  • Can be accelerated using negative pressure wound therapy (NPWT) or vac-assisted closure (VAC)
27
Q

What are the disadvantages of using autolytic debridement alone?

A
  • A slow process
  • Infection can occur within the wound as it may be open for a long period of time
28
Q

How do you dress different dressings?

A
  • Necrotic/dirty: dry dressing
  • Sloughy lots of exudate: need absorbent dressing
  • Granulate starts to dry out and crust over: keep it moist
29
Q

What are the 2 functions of dressings?

A
  • Aid wound healing
  • Support or protect deeper tissues
30
Q

What are the 4 types of dressing types and describe them?

A
  • Adherent: used for debridement, wet to dry, dry to dry
  • Non-adherent: absorbent, provides moist and aids wound healing
  • Can be passive (have no action)
  • Can be active (have action on the wound)
31
Q

What are passive dressings?

A
  • Dressings that act as a barrier for the wound and aid moist healing
  • Adherent, wet to dry, dry to dry, non-adherent and absorbent dressings
32
Q

What are the 5 types of active dressings?

A
  • Hydrocolloids
  • Hydrogel dressings
  • Alginates
  • Collagens
  • Silver
33
Q

What are hydrocolloids?

A
  • Adhere to wound edges, provide a moist environment and absorbs exudate
  • Aid rapid epithelialisation
  • Waterproof
34
Q

What are hydrogel dressings?

A

Placed directly onto the wound bed under gauze swabs or absorptive non-adherent dressings

35
Q

What are alginates?

A

Forms a soft flexible gel in the wound, encourages granulation tissue, moist healing and absorbs exudate

36
Q

What are collagens?

A

Promotes formation of granulation tissue and epithelialisation; may reduce wound contraction and improve deposition of collagen fibres

37
Q

What is a silver dressing?

A
  • Active release of silver ions into the wound bed, which has antimicrobial effect
  • Can lead to the Argyria effect (Blackening of tissue)
  • Requires moisture
38
Q

What are the 5 topical applications?

A
  • Cleansing solutions: debriding agents
  • Antiseptics
  • Antibiotics
  • Poultices: induce vasodilation and softening of tissue to produce fluid exudate
  • Aloe vera: promotes wound healing by accelerating formation of granulation tissue
39
Q

What are the 3 layers of bandages?

A

Primary layer: debridement, protection and absorption
Secondary layer: padding to absorb exudate and compress
Tertiary layer: protection from teh environment

40
Q

What are surgical drains?

A
  • Placed in wounds to evacuate fluid that can cause inflammation, infection or necrosis
  • Passive: Penrose drain
  • Activde: Jackson-pratt

EVNS (10 decks)

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