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delivering pharmaceutical care > wound management > Flashcards

wound management Flashcards

1
Q

what are the Number of skin layers affected by the types of wounds?

A 
Superficial (epidermis - only)
Partial thickness (epidermis + dermal tissue)
Full thickness (epidermis + dermal tissue + subcutaneous and fat below)
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2
Q

what are the different ways that wounds are classified?

A

Number of skin layers affected

clean

contaminated + non-infected

contaminated + infected

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3
Q

what are the two different process of wound healing?

A

Cellular, physiological, biochemical and molecular processes:
Healing by Primary intention e.g. a cut.
Place edges together (? Stitches) will reattach from internal parts outward

Secondary intention –e.g. injury,
need to re-grow skin from bottom of wound up
Contraction of wound

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4
Q

what are the three stages of wound healing?

A

Inflammation:
Clotting first, then…
pain heat redness swelling.

Repair:
Proliferation – collagen,
Organisation - epithelial tissue, angiogenisis

Maturation
Keratin, increased layer thickness, contraction.

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5
Q

what are the Factors Altering Effectiveness of healing

A 
Diet:
Many building blocks required, including:
Protein
Vitamin A
Vitamin C (ascorbic acid)
Zinc
Copper

Drugs:
Steroids
Prostaglandin inhibitors
Immune modulators

Clinical conditions:
Diabetes
Anaemia
Others??

Local factors:
Microenvironment
Tissue temperature
Secondary trauma from dressing adherence

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6
Q

what make an ideal dressing?

A 
Optimum environment
Moist environment
Allows gaseous exchange
Impermeable to bugs
Free of particles
Safe to use
Non-adherent
Acceptable to patient
High absorption
Cost effective
Standardised
Constant properties
Non-inflammable
Sterilisable
Mechanical protection
Comfortable
Infrequent changes
Availability
Allows monitoring
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7
Q

list types of dressing? 11

A 
Low adherent
VP dressings
Alginate
Hydrocolloid
Hydrogel
Foam
Polysaccharides
Polysaccharides
Enzymatic
Capillary
Silicone
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8
Q

place these dressing types in order of their Ability to absorb Exudate

A

Low adherent/VP dressings > Hydrocolloid/Hydrogels > Foam/Polysaccharides > Alginate

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9
Q

state facts about Low adherent dressing

A

Modern alternative to ‘dry dressings’

Lightly exuding, superficial wounds

Plastic film, knitted viscose or with fluid repellent backing

Plastic film (with/without Ad. Border):
Cutilin			Cosmopor E		
Melolin			Mepore
Release			Neosafe
Skintact			Primapore
Solvaline N
Knitted Viscose:
Impregnated or not
Iodine, chlorhexidine even honey! (Activon Tulle)
Most commonly see Jelonet (paraffin), Inadine (iodine)
Non-impregnated dressings
NA Ultra
NA Dressing
Paratex
Setoprime
Tricotex
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10
Q

state facts about Vapour Permeable wound dressing

A

Sterile, thin, hypoallergenic

Prophylactic for pressure sores

Clean skin around wound prior to application

Skill needed for application

Many available on DT, e.g.
Bioclusive
C-View
Mefilm
OpSite Flexigrid
Tegaderm

Also available with absorbent pad:
Alldress, Mepore Ultra, Opsite Plus

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11
Q

when is Vapour Permeable wound dressing suitable

A

Only suitable for relatively shallow wounds
Often used as a secondary dressing over alginate, hydrocolloids etc.
Can get adhesive trauma on removal

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12
Q

when is dry dressing used?

A

This is used for heavily exuding wounds as has a fluid repellant backing

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13
Q

Adhesive edging = ____________

A

mepore and primapore, cosmopore E

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14
Q

knitted viscose type [Tricotex and NA dressings] the open structure allows ______________________

A

free passage of exudate through to the secondary dressing

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15
Q

state facts about alginate dressing?

A

Physical properties of dressings depend upon Ca and Na ions and ratio of mannuronic/guluronic monomers:
Sorbsan-gel like
Kaltostat-firmer, less gel like

Method of removal therefore will vary

Used primarily on medium to heavy exuding wounds

Used in cavity wounds

Again many available-12 listed just in DT:
E.g. Algisite M, Curasorb, Tegagen

Also combined with absorbent backing:
Sorbsan Plus

Or combined with a hydrocolloid:
Seasorb Soft, urgosorb pad

firmer products lifted directly out from wound [Tegagel and Kaltostat]

gels can be irrigated with saline [sorbsan, kaltogel]

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16
Q

______________is Produced from calcium and sodium salts of alginic acid, a polymer obtained from seaweed that is composed of mannuronic and guluronic acid residues

A

alginates

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17
Q

__________________require moisture to function correctly, therefore not used on dry sloughy wounds or those covered with necrotic tissue.

A

alginate dressing

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18
Q

_______________guluronic acid gel less readily and form firmer less mobile gels

A

alginate

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19
Q

______ is used to describe a family of wound management products containing gel-forming agents such as sodium carboxymethylcellulose and gelatin

A

Hydrocolloid

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20
Q

in _______________ is the removal-due to nature tends to be virtually pain free

A

alginate

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21
Q

______ is used to describe a family of wound management products containing gel-forming agents such as sodium carboxymethylcellulose and gelatin

A

Hydrocolloid

22
Q

________________Often combined with adhesives and applied to a carrier to form an absorbent, self adhesive waterproof dressing

A

Hydrocolloid

23
Q

state facts about Hydrocolloid dressing?

A

natural or synthetic polymers
NaCMC or pectin in an adhesive matrix

interactive-exudate changes dressing to gel
used as primary dressings for many different wound types
leg ulcers, burns, pressure sores

NOT on heavily or infected exuding wounds

Products available look similar but do behave differently

24
Q

why is Hydrocolloid dressing a Wide choice?

A

standard’, thin, with or without borders, different shapes, impregnated or as paste!
standard, e.g. Comfeel, Granuflex
thin, e.g. Tegasorb thin, Askina Biofilm (most say thin after name-helpful)
Shaped-sacral or heel
Impregnated, e.g. Contreet (silver)
Paste, e.g. Comfeel paste

25
Q

___________Require secondary dressing

A

hydrogels

26
Q

_____________Change every 1 to 3 days

A

hydrogels

27
Q

_____________-has been reported that on application cools surface of wound and said to cause a reduction in pain

A

hydrogels

28
Q

On very dry wounds it is usual to change the dressing at least once a day for _______

A

hydrogels

29
Q

_____________-has been reported that on application cools surface of wound and said to cause a reduction in pain

A

hydrogels

30
Q

state facts about hydrogels?

A

Composed of;
water [95%]

Carboxymethylcellulose polymer [1-2%]

interact with Aq solutions & has ability to absorb or donate water

Primary indication for cleansing of sloughy or necrotic wounds

Not for v heavily exuding wounds

As a ‘paste’ or in a sheet form

Paste type
ActivHeal, Granugel, Intrasite etc

Sheet form
Curagel Island, Hydrosorb Comfort (Ad)
ActiformCool, Curagel etc (No Ad. Bdr.)

31
Q

state facts about foams?

A

All DT foam dressings have very different performance characteristics

Can influence type of wound used on
Tielle Lite cf Tielle

Also construction differs between manufacturers:
Lyofoam-wound exudate by capillarity
Allevyn-foam sandwich
Spyrosorb-foam coated with adhesive
Tielle-foam located in centre of an adhesive moisture vapour permeable membrane

32
Q

___________________ transmits absorbed fluid laterally rather than front to back. Size of _____________-should always be selected which overlaps the edges of the wounds by about 2-3cm

A

Lyofoam

33
Q

_____________has limited absorbency but highlt permeable to moisture vapour. Used on lightly exuding wounds or wounds in final stages of healing

A

Spyrosorb-

34
Q

____________is suitable for moderatley exuding wounds despite its limited absorbent capacity

A

Tielle

35
Q

state 3 types of foam dressing?

A

Tielle

Spyrosorb

Lyofoam

36
Q

state facts about Enzymatic dressing?

A

Varidase

Streptokinase/streptodornase

For necrotic [eschar] or sloughy tissue

Vial, kept in fridge. If shaken enzymes denatured

37
Q

with regards to enzymatic dressing:

____________ is often cross hatched with a sterile scalpel to facilitate action or sometimes injected under the ___________

A

Eschar

38
Q

with regards to enzymatic dressing:

____________-brings about dissolution of blood clots and_____________ breaks down nucleoprotein, a DNA-protein complex emanating from dead cells or pus

A

Streptokinase

streptodornsase

39
Q

state facts about Biosurgery in wound healing?

A

Maggotts: are being used for necrotic tissue, larvae of blowfly Lucilia sericata]

considerable success in wounds which are in awkward positions

Debridement of necrotic and sloughy tissue

left in situ for 3 days

usage becoming more widespread

burns, pressure sores, diabetic foot ulcers,
necrotising fascititis

40
Q

state wound types

and try to imagine what they look like, browse it or check it out on the lecture slide

A 
Discoloured, unbroken skin
Superficial wounds
Maladorous wounds
Oedamatous wounds
xuding wounds
Necrotic or sloughy
Infected
Granulating
41
Q

dry skin can be treated with_______________

A

emoillents

42
Q

preventative measures can be taken such as_____________ for pressure areas in discoloured unbroken skin

A

VPM

43
Q

state facts about Superficial wounds?

A

Most likely to be dealt with by community pharmacists

Many dressings available
Choice depends on many factors
cost, availability, acceptability, ease of application, exudate formation

Dressing options include:
low adherent
VP
Hydrocolloids

44
Q

what are the signs of Malodorous wounds infection

A

Signs of infection
pyrexial
pus formation
cellulitis

45
Q

what to consider with Malodorous wounds?

A

Patient distress

Generally implies infection
Signs of infection other than odour?

Occlusive dressing[s] discontinued
Infection must be removed
Systemic Abs preferred
Pseudomonas isolated-Flamazine BUT
Topical Abs or antiseptics best avoided
Toxicity
Rapidly deactivated
Allergic contact dermatitis
Increasing resistance
46
Q

what are the treatment options for Malodorous wounds?

A 
Treatment Options
Activated charcoal dressings
E.G., Carboflex, Lyofoam C
Silver
Acticoat
Or Both (Actisorb Silver 220)

Metronidazole gel
anabact [0.75%] bd-fungating tumours
metrotop [0.8%] od/bd
both require secondary dressing

Sugar paste
Prevents bacterial growth due to high osmolarity

47
Q

state things to consider with Exuding wounds?

A

Initial healing produces large volume of exudate

Heavy exudation
Associated with extensive pressure sores or leg ulcers, burns, skin graft donor sites

Strike through-skin maceration, discomfort, prone to infection

Skin protection? Secondary dressings?

48
Q

state things to consider with Necrotic/sloughy Wounds

A

Removed before healing can commence

Yellow, green or grey slough-once dehydrated -brown or black tissue

Debridement: Txt choices include
hydrogels, hydrocolloids, Varidase, Maggots

Multifactorial on choice
E.g. location, extent, time, location, user skill, patient choice

49
Q

state things to consider with Oedamatous Wounds

A

Healing will not occur until oedema removed

Generally leg ulcers

Drugs

Elevation/compression

Sloughy!!!!

Could surgically debride.

Could try Varidase

Maggots would work

I would try intrasite gel with secondary pad on top. Chang every other day,
?could try hydrogel as well.

50
Q

state thins to consider with Granulating Wounds?

A

Granulation is good!

Deep granulating wounds-packing
potential abscess formation Pink and healthy looking

Hypergranulation

delivering pharmaceutical care (44 decks)

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