Wound Management Flashcards
List the 8 principles of topical therapy
diwamopi
Debride Identify/Tx Ix Wick dead space Absorb excess exudate Maintain moist wound surface Open or excise closed wound edges Protect healing wound from Ix/trauma Insulate
Explain the rationale for moist wound healing
promotes cell migration
Identify problems associated w/ gauze dressing and identify options for management
x
Describe cleansing guidelines for clean and dirty wounds
Clean Wound (granulating/epitheliazing) - minimize trauma to wound surface flush, nontoxic solution (NS, wound cleanser) Necrotic/Dirty Wound - remove debris w/o increasing trauma, 8-15 psi lavage/mechanical removal, antiseptic solution
Identify indications for a change in topical therapy
no improvement in 2 weeks
increased depth, wound size
Given a hypothetical clinical situation, select an appropriate dressing (general categories only); know contraindication to hydrocolloid dressing
no hydrocolloid drsg for infected wound (anaerobic environment)
Identify indication for wound culture
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Identify indication for aerobic and anaerobic culture
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Describe correct technique for swab culture
Irrigate wound w/ NS
Moisten swab w/ sterile NS (alginate swab recommended)
swab 1 square cm of VIABLE tissue x 5 sec w/ enough force to produce exudate
Identify indications for topical antiseptics such as Dakin’s, use of bactericidal cleansers, and use of sustained release antibacterial dressing such as cadexomer, PHMB, or silver dressings
Dakins bactericidal cleanser SR antibacterial drsg: cadexomer PHMB Ag drsg
Identify indications for systemic antibiotic therapy
Ix involving soft tissues (cellulitis or deep soft tissue) erythema, edema, induration, tenderness, heat, increased exudate,increased pain
Identify indications and contraindications to debridement and advantages/disadvantages to various options for debridement
Necrotic wounds debride if Infected (cellulitis or possible biofilm) OR goal is repair
Surgical Debridement: f/t wound w/ lg necrotic tissue, converts chronic wound to acute wound, need to treat Ix before surgical debridement
instrumental
Noninstrumental approach:
A. autolytic
B. enzymatic (collagenase - Santyl) - nickel thick, no Ag or Iodine/antimicrobial; Hydrofera Blue okay
C. chemical (Dakins) - necrotic infected wounds
D. Hydrotherapy (until wound clean) -loose slough/lg exudate, heavy bacterial counts
E. Mechanical Debridement - nonwoven gauze
F. Larval Therapy (biotherapy)
Identify indications, contraindications, and guidelines for instrumental debridement (CSWD)
CSWD removes avascular tissue
need MD order
appropriate for non-surgical candidate
need visualize line/plane of dissection
Contraindications: clotting disorders, systemic Ix/cellulitus, goal is maintenance (ischemic noninfected dry eschar)
Control bleeding: AgNO3, pressure, calcium alginate, kaltostat, gelfoam, surgicel
Identify/recognize indicators of critical colonization and appropriate management
contamination (nonreplicating organisms)
colonization do not interfere w/ repair/no host response
Critical colonization reproducing bacteria interferes w/ repair (compete w/ fibroblasts, repairing cells for nutrients/O2)
Ix (bacterial adherence & invasion of viable tissue w/ host response
Given a specific wound, write an appropriate dressing order (general categories only)
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