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Advanced EVPC Yr2 > Wound healing + management > Flashcards

Wound healing + management Flashcards

1
Q

Name the 5 layers of the skin
(In order)

A

Stratum..
1. Corneum
2. Lucideum
3. Granulosum
4. Spinosum
5. Basale

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2
Q

How many types of cells does the Epidermis have
+
What are they?

A
  1. 3
  2. Squamous, Basal, Melanocytes
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3
Q

What do Melanocytes create?

A

Melanin

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4
Q

Where is the Dermis located?

A

Beneath the Epidermis

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5
Q

How many layers are in the Dermis?
+
What are they?

A
  1. 2
  2. Papillary (upper) + Therectiular (lower)
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6
Q

What 2 things does the Dermis provide?

A
  1. Flexibility
  2. Strength
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7
Q

List 5 structures that lie within the Dermis

A
  1. Connective tissue
  2. Hair follicles
  3. Blood vessels
  4. Lymphative vessels
  5. Sweat glands
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8
Q

What are the 5 structures of the Dermis held together by?

A

Collagen

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9
Q

What 2 types of receptors are located within the Dermis?

A
  1. Pain receptors
  2. Touch receptors
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10
Q

What is the lowest layer of the dermis called?

A

The Hypodermis

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11
Q

What 2 things does the Hypodermis do for the body?

A
  1. Protects the body from Injury
  2. Acts as a shock absorber
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12
Q

What 3 things does the Hypodermis consist of?

A
  1. Fat
  2. Connective tissue
  3. Collagen
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13
Q

Identify the 3 layers of this diagram.

Starting from top to bottom

A
  • Top = Epidermis
  • Middle = Dermis
  • Bottom = Hypodermis
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14
Q

Name the 7 functions of the skin

A
  1. Protection
  2. Sensation
  3. Mobility
  4. Endocrine activity
  5. Exocrine activity
  6. Immunity
  7. Temperature regulation
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15
Q

How does the skin provide Protection?

A

Protects against:
1. Microorganisms
2. Dehydration
3. Ultraviolet light
4. Mechanical damage

First physical barrier against external environment

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16
Q

How does the skin provide Sensation?

A

Provides sensation of:
* Pain
* Temperature
* Touch
* Deep pressure

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17
Q

How does the skin provide Mobility?

A

Allows smooth movement of the body, particularly over Joints

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18
Q

How does the skin provide Endocrine activity?

A
  • Skin intiates biochemical processes involved with VItamin D production
  • Essential for Calcium absorption + normal bone metabolism
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19
Q

How does the skin provide Exocrine activity?

A

Occurs by the release of:
1. Water
1. Urea
1. Ammonia

Secretes:
1. Sebum
2. Sweat
3. Pheromones

Exerts:
1. Important immunologic functions by secreting bioactive substances, such as Cytokines

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20
Q

How does the skin provide Immunity?

A

Prevents development against pathogens

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21
Q

How does the skin provide Temperature regulation?

A
  1. Conserves or prevents release of heat
  2. Helps maintain body’s water + homeostatic balance
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22
Q

Define the 2 classifications of wounds

A
  1. Open
  2. Closed
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23
Q

What 3 ways are wounds classified by?

A
  1. Type of wound
  2. Duration of wound
  3. Degree of contamination
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24
Q

What type of wound is this?

A

Incision

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25
Q

What type of wound is this?

A

Laceration

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26
Q

What type of wound is this?

A

Abrasion

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27
Q

What type of wound is this?

A

Puncture

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28
Q

What type of wound is this?

A

Penetration

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29
Q

What type of wound is this?

A

Contusion

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30
Q

What type of wound is this?

A

Haematoma

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31
Q

Identify the 5 types of Open of wounds

A
  1. Incision
  2. Abrasion
  3. Avulsion
  4. Laceration
  5. Puncture
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32
Q

Identify the 2 types of Closed of wounds

A
  1. Contusion
  2. Crushing
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33
Q

Describe what is meant by a Incision wound

A
  • An open wound
  • Created by sharp tool (Scalpel, w/minimal tissue trauma)
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34
Q

Describe what is meant by a Abrasion wound

A
  • An open wound
  • Damage with the loss of Epidermis + Portion of Dermis
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35
Q

Describe what is meant by a Avulsion wound

A
  • Open wound
  • Tearing of tissues, away from attachments, underlying tissue + surroundsing strutures
  • Can be caused by a Cat bitee
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36
Q

Describe what is meant by a Laceration wound

A
  • Open wound
  • Irregular in shape
  • Causes damge to the superficial + underlying tissues
  • Caused by objects like Barbed wire
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37
Q

Describe what is meant by a Puncture wound

A
  • Open wound
  • Penetrating wound
  • Can introduce contaminants deep into tissue
  • Resulting in high-risk infection
  • Typically created by a sharp object
  • Caused by metal oject, cat or dog bite
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38
Q

Describe what is meant by a Contusion wound

A
  • Closed wound
  • Otherwise known as a bruise
  • Caused by blunt force trauma
  • Doesn’t break skin
  • Causes damage to skin + underlying tissue
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39
Q

Describe what is meant by a Contusion wound

A
  • Closed wound
  • Force applied to the tissue for a long period of time
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40
Q

What is meant by the ‘Duration of Contamination’

A

The time between the wound being inflicted + treatment

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41
Q

What is important to ascertain from a client when communicating about a wound?

A

When it was inflicted + how long it has been like that for

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42
Q

Can a new wound have a high degree of contamination?

A

Yes

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43
Q

How many degrees of contamination are there, when it comes to wounds?

A

3

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44
Q

What are the 3 degrees of contamination, when it comes to wounds?
+
What are there durations?

A
  1. Class 1 = Clean wound w/minimal contamination, from 0 - 6hrs
  2. Class 2 = Significant contamination, from 6 - 12hrs
  3. Class 3 = Gross contamination, for 12+hrs
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45
Q

What are the 4 classifications of Surgical wounds?

A
  1. Clean
  2. Clean-Contaminated
  3. Contaminated
  4. Dirty
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46
Q

Give the 2 characteristics of a Clean wound

A
  1. No break in surgical asepsis
  2. Not entered a body cavity (Resp, GI, Urogential etc)
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47
Q

Give the 2 characteristics of a Clean-Contaminated wound

A
  1. Minor break in surgical asepsis
  2. Elective opening of body cavities - w/minimal leak
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48
Q

Give the 2 characteristics of a Contaminated wound

A
  1. Major break in asepsis
  2. Spillage from body cavities, in presence of infection
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49
Q

Give the 2 characteristics of a Dirty wound

A
  1. Purulent inflammation of body cavities
  2. Presence of gross foreign material +. necrotic tissue
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50
Q

What is wound healing?

A

The normal physiological function that restores the continuity of tissues after injury

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51
Q

What is a complex process that is characterised by Macroscopic, Microscopic + Biochemical event?

A

Wound healing

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52
Q

They describe the microscopic changes that occur at that time.,.

What are the 4 phases of wound healing?

A
  1. Haemostasis
  2. Inflammation
  3. Proliferative (Repair)
  4. Maturation (Remodeling)
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53
Q

When does Haemostasis occur, in wound healing?

A
  • 1st stage
  • Occurs immediately after the injury
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54
Q

When does Inflammation occur, in wound healing?

A
  • 2nd stage
  • Occurs within 6hrs of the injury
  • Lasts 3-5 days
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55
Q

How long does the Inflammation stage last in wound healing?

A

3 - 5 days

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56
Q

When does Proliferation occur, in wound healing?

A
  • 3rd stage
  • Known as the Repair stage
  • Occurs 3 - 7 days post-injury
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57
Q

How long does the Proliferative/Repair stage last for in wound healing?

A

3 - 7 days

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58
Q

When does Maturation occur, in wound healing?

A
  • 4th stage (Last)
  • Known as the Remodelling stage
  • Occurs 5 - 7 days post injury
  • Can last as long as 2 years
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59
Q

How long can the Maturation/Remodelling phase last for in wound healing?

A

Up to 2 years

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60
Q

When does the Maturation/Remodelling phase occur in wound healing?

A

5 - 7 days post-injury

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61
Q

True or False.

Each of the phases of healing occurs at completely seperate times + as a seperate process.

A

False

They can occur all at similar times + can overlap

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62
Q

If the phases of healing overlap, what can this influence?

A

The development + duration of the next phase of healing

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63
Q

Why is the phases of healing important to identify + treat accordingly?

A

Because if the the healing phases overlap, they can influence the development + duration of the next phase of healing, becoming critical to reaching the final result

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64
Q

What do the numbers at the bottom of this graph indicate?
+
What does this graph demonstate?

A
  1. The ‘Days after Injury’
  2. Demonstrating the cross-over of the wound healing phases
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65
Q

What is Phagocytosis?

A

Process of cells using it’s plasma membrane to engluf large particles, surrounding + destroying foreign substances

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66
Q

What are Macrophages?

A
  • Type of WBC
  • Helps eliminate foreign substances
  • Initates immune response from other immune system cells
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67
Q

What are Neutrophils?

A
  • Type of WBC
  • Function - to phagocytose, to kill bacteria
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68
Q

What is a platelet?

A
  • Disc-shaped cell
  • No nucleus
  • Found in blood
  • Plays an important role in clotting
69
Q

What is a Fibroblast?

A
  • A cell that contributes to the formation of connective tissue
  • By secreting collagen proteins
70
Q

What is Vasoconstriction?

A
  • Constriction of BVs
  • Making them narrower
  • Aided by muscle of vessel wall
71
Q

What is Vasodilation?

A
  • Dilation of BVs
  • Making them wider
  • Aided by muscle of vessel wall
72
Q

What is Exudate?

A
  • Fluid that leaks out of BVs
  • Into surrounding tissues
  • Contains:
    1. Cells
    1. Proteins
    1. Solid materials
73
Q

What 3 components make up Exudate?

A
  1. Cells
  2. Protein
  3. Solid materials
74
Q

What is this process called?

A

Haemostasis

75
Q

How long does vasoconstriction last for in haemostasis?

A

5 - 10 minutes

76
Q

What is an Eschar?

A

Scab

77
Q

What does the inital bleeding do to the wound in Haemostasis?

A

Flushes the wound

78
Q

What is the 1st thing that occurs in Haemostasis?

A
  • Blood + Lymph flows from damaged vessel
  • Initial blood flushes wound
79
Q

List the 8 basic step process of Haemostasis

A
  1. Blood + Lymph flows from damaged BV
  2. Bleeding flushes wound
  3. Vasconstriction
  4. Vasodilation
  5. Intravascular cells + fluid pass into extravascular space
  6. Platelet plus forms
  7. Fibrin plug + Eschar formation
  8. Injured cells release thromboplastin
80
Q

What is the function of Vasoconstriction in Haemostasis?

A

Preserves blood

81
Q

What triggers platelet plug formation?

A

Damaged BV wall

82
Q

When the injured cells release thromboplastin, what does this activate?

A

The Extrinsic Coagulation Process
(ECP)

83
Q

What characteristic makes platelets good for Platelet plug formation?

A

They’re sticky!

84
Q

Name the 4 characteristics of Inflammation

A
  1. Redness
  2. Swelling
  3. Heat
  4. Pain
85
Q

What is the Inflammation stage otherwise known as in healing?

A

The Debridement Phase

86
Q

What does Transudates mean?

A
  • Fluids that pass through a membrane or squeeze through tissue or into the Exracellular space of the tissues.
  • Thin and watery and contain few cells or PROTEINS
87
Q

How long does the Inflammation or Debridement stage last for in healing?

A

3 - 5 days
Post-injury

88
Q

What are the 5 basic steps of the Inflammation stage in healing?

A
  1. BVs dilate, inc blood flow + bring transudates into the wound - causing heat, redness + swelling
  2. WBCs in exudate initiate debridement
  3. Neutrophils help break down bactreia, debris + stimulates monocytes
  4. Monocytes convert to macrophages = continuing to phagocytoize debris
  5. Macrophages release growth factors that aid in tissue repair
89
Q

What is the Proliferation stage otherwise known as?

A

The Repair phase

90
Q

When does the Proliferation or Repair phase occur in healing?

A

From 4 - 12 days

91
Q

What is the Proliferation stage characterized by?

A

Replacement of lost tissue with normal, functioning cells of the same type

92
Q

What 3 types of tissue or organs are capable of undergoing mitosis, to heal damaged cells in Proliferation stage of healing?

A
  1. Epithelia
  2. Bone
  3. Liver
93
Q

What are the 6 basic steps of the Proliferation stage of healing?

A
  1. Angiogenesis begins (formation of new BVs), capillaries grow into the wound
  2. Growth factors allow migration of fibroblasts, leading to creation of collagen + myofibroblasts
  3. Granulation tissue begins to form 4-7 days followed by epithelialization + wound contraction
  4. Epithelialisation takes weeks > months to fully stratify
  5. Wound contraction occurs 5-7 days after, wound area reduces + surrounding skin stretches
94
Q

What is Angiogenesis?

A

The formation of new BVs

95
Q

What does epithelialization do during the Proliferation stage in healing?

A

Provides structure or scaffolding to the wound

96
Q

What stage of healing is this?

A

Inflammation/Debridement phase

97
Q

What stage of healing is this?

A

Proliferation phase

98
Q

What stage of healing is this?

A

Maturation phase

99
Q

What is name given to the final stage of healing?

A

Maturation phase

100
Q

What is the Maturation stage otherwise known as?

A

The Remodelling stage!

101
Q

At what stage does scar tissue form?

A

The Maturation stage

102
Q

What are the 5 basic steps of the Maturation stage of healing?

A
  1. Begins when collagen fibres begin to orient along lines of stress
  2. Wound edges meet (Epitheliasation completed)
  3. Redness reduces
  4. Skin strength grows (10% @ 14 dyas, 25% @ 4 weeks + 80% @ several months)
103
Q

How long can the Maturation stage of healing last for?

A

Years!

104
Q

During the Maturation phase of healing, how many days does it take for 10% strength to form?

A

14 days

105
Q

During the Maturation phase of healing, how many weeks does it take for 25% strength to form?

A

4 weeks

106
Q

During the Maturation phase of healing, how many months does it take for 10% strength to form?

A

Several months

107
Q

What is the approx day after injury for picture one?

A

Day 7

108
Q

What is the approx day after injury for picture one?

A

Day 11

109
Q

What is the approx week after injury for picture one?

A

Week 6

110
Q

What is occuring during this stage of healing?

A

Day 7
* Necrotic tissue + aschar remains after a large section of skin + sloughes
* Microscopically, the WBCs are selectivel debriding the diseased tissue

111
Q

What 2 interventions should be performed at this stage?

A
  1. Surgical debridement
  2. Lavage
112
Q

Why should you wait a few days during this stage before intervening?
(especially if it is caused by trauma)

A
  • Allow it to declare itself!
  • This allows the VS to determine what skin is viable or not

Flush, pain relief etc..

113
Q

What is occuring during this stage of healing?

A

Day 11
* Granulation tissue is moving from periphery of wound
* Central area is undergoing debridement of WBCs still

114
Q

What is occuring during this stage of healing?

A

Week 6
* Granulation tissue is filling the wound
* Rim of pink epithelial cells are migrating inward, across the granulation tissue + building new skin
* Contraction is occuring, pulling pre-eexisting skin inward, thus diminishing the size of the wound

115
Q

List the 7 factors that promote wound healing

A
  1. Moist wound environment
  2. Good nutrition
  3. Tissue oxygenation
  4. Limited oxygenatoin
  5. Limited movement of wound edges
  6. Clean wound
  7. Good immune system
116
Q

What will a dry wound environment predipose the wound to?

A

Scarring

117
Q

What 3 nutrients help aid wound healing?

A
  1. Minerals
  2. Vitamins
  3. Carbohydrates
118
Q

Why are wounds that are over joints usually harder to heal?

A

Because movement cannot be limited, to give the wound a chance to heal or reform new skin

119
Q

With grande wounds, when it comes to movement, what might the VS prescribe - tx wise?

A

Cage rest!

120
Q

List 9 potential factors that delay wound healing

A
  1. Excessively dry wound
  2. Exudating wound
  3. Poor circulation (Shock, concurrent conditions, age or recumbency)
  4. Lack of essential nutrients (anorexia, poor perfusion, malnourished)
  5. Lack of oxygen delivery (poor perfusion, resp problems, lack of mobility)
  6. Excessive wound edge tension
  7. Patient interference
  8. Damage during dressing changes
  9. Infection
121
Q

What does poor perfusion predispose a healing wound to delay?

A

Because there are a lack of deoxgenated RBCs

122
Q

When might excessive wound edge tension occur, that may delay wound healing?

A
  1. Applying dressings
  2. VS closing wound surgically
123
Q

What might a lot of exduate tell you about a wound?

A

That its infected

124
Q

What are the 2 classifications of wounds?

A
  1. Open
  2. Closed
125
Q

Is this wound open or closed?

A

Open

126
Q

What type of wound is this?

A

Laceration - as has irregular edges!

Looks quite fresh ..
But ..
Most likely, contaminated!

127
Q

Is this wound open or closed?

A

Closed

128
Q

What type of wound is this?

A

Contusion

129
Q

Why might this closed, contusion wound worry you?

A
  • Because you don’t know whether this it superfical or deep!
  • If deep, it can be bleeding into the abdominal cavity..!
130
Q

Is this wound open or closed?

A

Open

131
Q

What type of wound is this?

A

Puncture

132
Q

What can you do to explore this puncture wound + when?

A
  • When the px is under GA
  • Explore wound site with a sterile surgical instrument
  • To identify the depth of the wound + if any foregin bodies present or other abnormalities
133
Q

Is this wound open or closed?

A

Open

134
Q

What type of wound is this?

A

Degloved +/or Laceration

135
Q

Is this wound open or closed?

A

Open

136
Q

What type of wound is this?

A

Abrasion

Nasty abrasion…

Probably been dragged…

137
Q

Is this wound open or closed?

A

Open

138
Q

What type of wound is this?

A

Laceration +/or Wound breakdown

139
Q

What type of surgery could potentially cause this wound?

A

Dew-claw removal

140
Q

Is this an open or closed wound?

A

Open

141
Q

What type of wound is this?

A

Penetration (full)

142
Q

What does the dark red colour in this wound possibly indicate?

A

Contamination

143
Q

What are the 4 aims of wound management?

A
  1. To produce a functional + cosmetic repair
  2. Relief of pain + distress to px
  3. To be economic + time efficient
  4. To make prompt decision making in the event of signs of delayed healing
144
Q

What does it mean when we say we aim for a functional repair, in wound managment?

A

The area that the wound is located, remains functional

145
Q

What is the primary aim of wound management?

A

To close the wound, restoring px to normal function

146
Q

What are the 4 things that wound management plan should aim for?

A
  1. Wound closure should aim to return px to normal function
  2. VS + RVN disucss as team to plan method for wound/s closure (Primary or Secondary)
  3. Should be revised regularly on reassessment of wound condition
  4. Provide indication of tx + costs to owner
147
Q

How often should a wound re-assessment occur?

A

Q3 days

148
Q

What are the 9 things you should establish during a wound assessment?

Think questions..

A
  1. Assess the patient as a whole + are they stable?
  2. Time since injury?
  3. What caused the wound?
  4. What is the degree of contamination? *
  5. What is the degree of trauma?
  6. Is there any necrosis?
  7. Is there any concurrent disease present?
  8. Are they on medication?
  9. Is tx or cost a viable option for the owner? Or will euthanasia have to be considered?

  • = Degrees of contamination:
  • Clean
  • Clean-contaminated
  • Contaminated
  • Dirty
149
Q

What are the 4 wound closure options?

A
  1. Primary
  2. Delayed primary
  3. Secondary
  4. Second Intention
150
Q

What class of wound(s) should be closed using primary wound closure?

A

Clean

151
Q

What class of wound(s) should be closed using delayed primary wound closure?

A
  • Clean-contaminated
  • Contaminated
  • Wounds with questionable tissue viability
152
Q

What class of wound(s) should be closed using Secondary wound closure?

A
  • Contaminated
  • Dirty
153
Q

What class of wound(s) should be closed using Second intention wound closure?

A
  • Extensive contamination
  • Devitalisation
154
Q

2 instances…

What class of wound(s) should NOT be closed using Second intention wound closure?

A
  • Surgical closure
  • Wounds over joints (will restrict blood flow)
155
Q

How are primary wound closures managed?

A
  • Immediate closure if there is enough skin with surgical sutures
  • Closure in the first couple of hours
  • No tension applied
156
Q

How are delayed primary wound closures managed?

A
  • Lavage + debridement until healthy (under sedation)
  • Use appropriate dressing
  • Closure after 2-3 days
157
Q

How are Secondary wound closures managed?

A
  • Lavage + debridement until healthy (under sedation)
  • Use appropriate dressing
  • Closure after 5-7 days
  • Once granulation bed has begun to form
158
Q

How are Second intention wound closures managed?

A
  • Open wound management
  • Constant lavage + debridement until healthy
  • Use appropriate dressing
  • Allowed to heal
159
Q

Why should contaminated wounds never be closed using primary intention?

A

Because that would be surgically closing the bacteria in the wound!

160
Q

Why is it important to not manage an open wound for an excessive period of time?

A

Because open wound management is to create an environmnt that will allow wound closure + return to normal function

161
Q

What is the most important thing to ensure you do during wound preparation?

A

Wear STERILE gloves + apron!!

162
Q

List the 7 basic steps for wound preparation

A
  1. Apply sterile gloves + apron
  2. Ensure adequate analgesia takes effect at time of procedure (often GA)
  3. Keep covered with sterile, non-linting dressing prior to prep
  4. Swab wound bed for culture + sensitivty test
  5. Insert sterile water soluble jelly into wound
  6. Clip around wound - total injury should be visable! (clip past unviable tissue + provide 2cm margin MINIMUM)
  7. Debride
163
Q

When clipping a wound for preparation, what are the 3 most vital things to remember?

A
  1. Clip around wound - until whole injury site is visable
  2. Clip past unviable tissue
  3. Provide a 2cm margin MINIMUM
164
Q

What type of swabs should you use for swabbing a wound for a culture + sensitivity test?

A

Lint-free guaze swabs

165
Q

What do sterile water soluble jelly often come in?

A

Sachets

166
Q

How much saline is too much?

A

No such thing!
(Unless hypothermic)

167
Q

Where should you store a culture + sensitivity test after use?

A

In the fridge

168
Q

Why do you use sterile water soluble jelly?

A

To:
1. Protect wound
2. Clumps all clipped hair together + away from the wound

169
Q
A

Advanced EVPC Yr2 (28 decks)

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