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JJ > Wound Management > Flashcards

Wound Management Flashcards

1
Q

why is classification of a wound important?

A

enables you to ensure correct management of the wound and patient

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2
Q

how should a wound be classified?

A

when did the wound occur
how contaminated is the wound
how did the wound occur
what type of wound is it

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3
Q

why is it important to know when the wound occurred?

A

in order to classify level of bacterial multiplication (longer time = more bacteria)

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4
Q

what are the classes of wound based on bacterial multiplication?

A 
class 1
class 2
class 3
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5
Q

how old is a class 1 laceration (bacterial classification)?

A

0-6 hours old

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6
Q

how old is a class 2 laceration (bacterial classification)?

A

6-12 hours old

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7
Q

how old is a class 3 laceration (bacterial classification)?

A

older than 12 hours (or unknown time of wound occurance)

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8
Q

describe the contamination level of a class 1 (bacterial multiplication) wound

A

minimal contamination

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9
Q

describe the contamination level of a class 2 (bacterial multiplication) wound

A

significant contamination

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10
Q

describe the contamination level of a class 3 (bacterial multiplication) wound

A

gross contamination

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11
Q

describe the type of wound of a class 1 (bacterial multiplication) wound

A

clean laceration

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12
Q

what are the levels of wound contamination?

A

clean
clean contaminated
contaminated
dirty / infected

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13
Q

when are clean wounds created?

A

under sterile conditions

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14
Q

describe the level of contamination of clean contaminated wounds

A

minimal contamination - easily removed

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15
Q

when are clean contaminated wounds produced?

A

during surgery if a tract is perforated with minimal spillage

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16
Q

when can clean contaminated wounds be closed?

A

after appropriate treatment

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17
Q

describe contaminated wounds

A

gross contamination with foreign debris

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18
Q

what could cause a contaminated wound?

A

dog fight
RTA
gunshot

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19
Q

when can a contaminated wound be closed?

A

after appropriate treatment

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20
Q

describe a dirty / infected wound

A

infection (>10^5 organisms per gram) already exists

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21
Q

at how many organisms per gram is there said to be an infection?

A

> 10^5 organisms per gram

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22
Q

should dirty / infected wounds be closed primarily?

A

no

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23
Q

how can a wound be tested for infection?

A

flushed and then swabbed for culture and sensitivity tests

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24
Q

what are the 5 types of wound?

A 
incision
abrasion
avulsion
laceration
puncture
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25
Q

what creates and incision wound?

A

sharp objects

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26
Q

describe an incision wound

A

smooth edges
minimal surrounding trauma
surgical wound

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27
Q

what creates an abrasion wound?

A

blunt trauma or shearing force

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28
Q

describe an abrasion wound

A

damage to skin including epidermis

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29
Q

what happens during an avulsion wound?

A

tearing of tissue from attachment (e.g. degloving)

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30
Q

what is a laceration wound created by?

A

tearing

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31
Q

describe a laceration wound

A

variable damage to tissues

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32
Q

describe a puncture wound

A

penetrating wound

minimal superficial damage but substantial deeper damage

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33
Q

what can cause a puncture wound?

A

sharp object / missile

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34
Q

what must be considered about the anatomy near to / within a wound?

A

deterioration or progression of the wound and how this may affect the patient (long and short term)
side effects / results of tissue breakdown due to associated anatomy

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35
Q

how may a wound affect mobility in the long term?

A

if near to a joint scar tissue may form which alters range of movement

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36
Q

what are the 3 phases of wound healing?

A

inflammatory
proliferative
maturation

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37
Q

what is the aim in the inflammatory phase?

A

debridement

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38
Q

when does the inflammatory stage of wound healing occur?

A

within the first 72 hours post injury

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39
Q

when does haemorrhage occur post injury?

A

within minutes

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40
Q

what is the role of vasoconstriction during the inflammatory phase of wound healing?

A

reduces haemorrhage and allows clot to form

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41
Q

what is the role of vasodilation in the inflammatory stage of wound healing?

A

releases clotting elements into the wound and triggers the healing process

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42
Q

what process in the inflammatory stage of wound healing initiates the debridement phase?

A

white blood cells leak from the blood vessels into the wound - ‘clean up’

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43
Q

when does the early proliferative stage begin?

A

3-5 days post injury

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44
Q

what happens during the early proliferative stage of wound healing?

A

granulation tissue fills the wound
fibroblasts lay a network of collagen in the wound bed which gives strength to tissue
epithelial cells from the wound margins migrate to cover the wound

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45
Q

what is the aim during the early proliferative stage of wound healing?

A

maintain moist wound environment

prevent damage to cells

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46
Q

what happens during the late proliferative stage of wound healing?

A

wound contracts

epithelialisation

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47
Q

what are the aims during the late proliferative stage of wound healing?

A

exudate reduced

maintain moist environment

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48
Q

when does the maturation stage of wound healing begin?

A

2-4 weeks post injury when the wound has filled in and resurfaced

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49
Q

what happens during the maturation stage of wound healing?

A

remodelling phase

collagen fibres reorganise, remodel and mature to give wound tensile strength forming scar tissue

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50
Q

what are the 4 key goals of wound healing?

A

full epithelialisation with minimal / no scar formation
in as minimal time as possible
without recurrence or risk of breakdown
as cost effectively as possible

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51
Q

what are the 6 goals of wound management?

A 
prevent further wound contamination
remove foreign debris and contamination
debride dead and dying tissue
promote viable vascular bed
provide drainage where possible
select appropriate method of closure
52
Q

how can the viability of tissue be assessed?

A

colour
warmth
pain sensation
bleeding

53
Q

why must tissue viability continue to be assessed after repair / dressing?

A

skin circulation can continue to deteriorate because of oedema and other factors

54
Q

what are the 4 types of wound closure?

A

primary
delayed primary
secondary
secondary intention

55
Q

when is primary wound closure indicated?

A

minimal tissue contamination, loss or trauma

56
Q

when is the golden period for primary closure?

A

6-8 hours - if time of injury unsure assume this has passed

57
Q

what should happen to wounds prior to primary closure?

A

explored, cleaned by lavage and surgically debrided

58
Q

when does the fibrin seal form on a wound that is closed by primary closure?

A

within 4-6 hours

59
Q

what is the role of a fibrin seal on a wound?

A

protects the wound against invasion of microorganisms and prevents fluid leakage from the wound

60
Q

when does epithelialisation of the wound surface occur?

A

48 hours after formation of fibrin seal

61
Q

when does wound tensile strength increase?

A

once sealed in the next 7-14 days

62
Q

when are sutures usually removed?

A

at day 10 following primary closure

63
Q

when is delayed primary closure indicated?

A

wounds that have gone beyond the golden period or require further debridement

64
Q

what should happen to the wound in delayed primary closure?

A

wound explored, cleaned by lavage and debrided

65
Q

what does debridement involve?

A

removal of dead or damaged tissues, foreign bodies and micororganisms

66
Q

what will be caused by inadequate debridement?

A

delay in wound healing

67
Q

what wounds indicate the need for secondary closure?

A

heavily contaminated or dirty wounds

68
Q

how are secondary closure wounds managed?

A

as open until granulation bed is established

69
Q

when are wounds closed during secondary closure?

A

debrided and closed once granulation bed is established (if possible)

70
Q

what type of wound indicates secondary intention wound healing?

A

wounds that have significant tissue loss, contamination or infection

71
Q

how are secondary intention healing wounds managed?

A

as open wounds that are allowed to granulate and epithelialise

72
Q

when should wounds only be allowed to close?

A

if there is sufficient tissue to allow reconstruction without dehiscence
if there is no devitalised tissue or foreign material
if functional structures will be affected by contraction or delayed closure
no signs of infection or contamination
if adjacent skin is healthy

73
Q

what are difficult areas to dress?

A

ears
bottom / back
some extremities

74
Q

how can dressings be encouraged to stay on?

A

tie over dressings
bandages
vac pac

75
Q

what does a vac pac do?

A

suctions debris away from wound

applies constant negative pressure to help with closure

76
Q

what can be caused by using the wrong dressing?

A

delay in healing

77
Q

what dressing should be used?

A

the one most appropriate for the stage of wound healing - should be assessed at each dressing change

78
Q

what are the 2 main types of dressing options available?

A

non adherent / passive / absorbent

non adherent / mildly absorbent / passive

79
Q

describe non adherent / passive / absorbent dressings

A 
foam dressings
absorb fluid (exudate)
semi permeable (allow air to get to wound)
delivers moist environment
80
Q

what are non adherent / passive / absorbent dressings made from?

A

hydrophilic polyurethane

81
Q

what are non adherent / passive / mildly absorbent dressings made from?

A

perforated PET film on a backing of cellulose fabirc

82
Q

what is allowed by non adherent / passive / mildly absorbent dressings?

A

epithelialisation and absorption of exudate

83
Q

when are non adherent / passive / mildly absorbent dressings indicated?

A

lightly exuding lesions
sutured wounds
superficial cuts and abrasions
light burns

84
Q

what does frequency of dressing change depend on?

A

type of wound
volume of exudate
type of dressing in place
stage of wound healing

85
Q

when should wet to dry or dry to dry dressings be changed?

A

daily or twice daily

86
Q

when should dressings on granulating wounds be changed?

A

every 2-3 days

87
Q

what are the limitations of wound treatment?

A

cost
infection / MRSA risk
patient tolerance of nursing
owners patience

88
Q

what must be made clear about dressing changes?

A

when they were done and how the wound appeared at this stage

89
Q

what is important to consider when triaging a patient with a large wound?

A

that you must look at the whole patient. The wound may look alarming but other injuries or problems could be more immediately life threatening
hydration status is also key

90
Q

what are the key issues to check for with polytrauma patients aside from obvious fractures and wounds?

A

pneumothorax
diaphragmatic hernias
ruptured bladder
head injuries

91
Q

what is involved in patient triage?

A

brief history from client and then ensure that further full history is gained when patient is stable
clinical exam
note obvious wounds haemorrhage and detail severity

92
Q

what is included in the triage clinical exam?

A 
TPR
MM
check of limbs
demenour
resp effort / pulse quality
hydration status
93
Q

once patient is triaged what must be done to ensure the wound can be safely managed / treated?

A

patient must be suitably restrained via sedation or GA

ensure adequate analgesia

94
Q

why must PPE be used when cleaning a wound?

A

to prevent further contamination of the wound

95
Q

what equipment is required for wound flush?

A 
large bag of warm fluids (Hartmanns or saline)
giving set
3 way tap
18 or 19 gauge needle
20-30 ml syringe
incontinence pads
96
Q

what is the recommended pressure that a wound should be flushed at?

A

8-12 psi

97
Q

what can be done once the wound has been cleaned?

A

bacteriology swab

98
Q

what drugs should a wound patient be managed with?

A

correct pain relief

antibiotic treatment indicated by swab

99
Q

what must all wound patients wear to protect the wound?

A

buster collar

100
Q

what must be considered when caring for the wound patient outside of medical care?

A

enrichment
grooming
play
owner visits

101
Q

who should carry out each dressing change?

A

where possible the same staff should carry out each dressing change

102
Q

what can be useful if the same staff cannot carry out dressing changes?

A

photographs of the wound at each change

103
Q

where do equine injuries often occur?

A

lower limbs

104
Q

why are most equine wounds considered dirty / infected?

A

due to the environment

105
Q

why is there more concern with tension on equine wounds?

A

location of wounds and inability to restrict movement in the same way as with cats / dogs

106
Q

what are sometimes used to relieve pressure on wounds in horse?

A

quills - using horizontal mattress suture pattern

107
Q

why is the aim for minimal scar tissue formation in equine wounds?

A

scar tissue is 15-20% weaker than original tissue

108
Q

what is the problem with topical antiseptics?

A

will not reduce bacterial load in deeper / necrotic tissue

109
Q

what topical treatment is often used in treatment of equine wounds?

A

manuka honey - reduces bacterial colonisation, increases healing rates and achieves superior debridement to hydrogels

110
Q

what types of surgical drain are available?

A

passive and active

111
Q

what does the choice of surgical drain depend on?

A

location, requirement and patient considerations

112
Q

name 2 types of active drains

A

blake - wound explorations

jackson pratt - abdomens, post ex lap

113
Q

how should drains be managed?

A

with aseptic technique (PPE)

114
Q

what can be used to aid communication with client?

A

photographs can show development and help with owner patience as long as they are ok with seeing photos

115
Q

what must owner visits be fitted in around?

A

starvation, dressing changes and recovery time - can be difficult but should be accommodated

116
Q

when should the wound patient be sent home?

A

as soon as suitable and when owner is prepared to care for the patient

117
Q

when is staff communication about a wound patient crucial?

A

ensure patient is starved when required
dressing changes are carried out when expected
ensure any issues / concerns with dressings are addressed immediately

118
Q

what can be done to show when a dressing change is required?

A

write the date / time of application of dressing onto the bandage itself using permanent marker
ensure this is written clearly on the hospital sheet

119
Q

what can be difficult to maintain when patients are having multiple dressing changes?

A

weight - due to starvation and sedation associated with dressing changes

120
Q

how are calorie requirements calculated?

A

RER = (BWx30)+70

121
Q

what additional care do wound patients need due to the often long length of hospitalisation?

A 
time without buster collar
grooming
supervised play
longer walks on lead
hand feeding
sitting with them
mini training sessions
122
Q

what must be done to protect the bandage?

A

ensure patient cannot interfere

stop dressing from getting wet

123
Q

how can you prevent the bandage from getting wet?

A

cover with plastic cover to go outside for walks

remove water bowls from the kennel

124
Q

what should the dressing be checked for every 4-6 hours?

A 
damp or wet
slipping
patient interference
tightening (swelling above or below)
checking toes for moisture and temperature
patients tolerance of dressing
125
Q

when are wound patients normally discharged?

A

when dressings are being changed every 2-3 days

126
Q

what should clients be given when the patient is sent home?

A

clear instructions on dressing management
point of contact
cover for dressing
buster collar

127
Q

what parameter must be managed very carefully in long term wound patients?

A

weight loss

JJ (33 decks)

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