Wound Management Flashcards
4 stages of the Inflammatory phase
Hemorrhage and vasoconstriction
Vasodilation
Fibrin clot
Scab
5 stages of the Debridement phase
Platelets- FIRST to arrive
Neutrophils- white blood cells that eat bacteria
Monocytes- become macrophages
Lymphocytes- immune response
Exude pus- wound fluid
Repair phase includes
Granulation tissue: fibroblasts make Scar tissue out of collagen. Capillaries bring blood for repair. Macrophages ward off infection. Results in a scab. No nerve in granulation tissue. Then wound contraction and epithelialization
What occurs during the Maturation phase
Type 3 collagen to type 1 collagen. Regains 80 to 85 percent of original strength.
Factors affecting wound healing
Specific infectious agents
Immunodeficiency
Concurrent disease
Chemotherapeutic agent, radiation therapy
Neoplasm
Malnutrition
Foreign body, necrotic tissue, dead space
Age
Healing of a wound requires three things
Proper treatment
Cooperation
Budget
4 types of Wound classification
Clean
Clean contaminated
Contaminated
Dirt and infected
Fundamentals of wound management
Cover the wound
Assess and stabilize
Culture
Clip and aseptically prepare the area around the wound
Debride dead tissue and remove foreign debris
Lavage
Drainage
Stabilize and protect
Appropriate wound closure
What is an important aspect of lavaging the wound
Flush to clean
35cc syringe and 18g needle- enough to clean without pushing bacteria in further.
What should you keep in mind about proper surgical debridement
Copious lavage
Closure of dead space
Gentle tissue handling
Proper suture selection
Adequate and judicious hemostasis
What are the 2 types of adherent dressings
Wet to dry
Dry to dry
Describe a wet to dry bandage
Soak first layer of bandage then wrap. When it dries, it sucks up the pus attached to the tissue. Changing it may be painful. Dead necrotic tissue comes up with the bandage.
When to use sugar bandage
Thermal burns with skin sloughing
Deep tissue infections
Contaminated wounds after mechanical debridement
Degloving injuries
Wound bed preparation for skin grafting
Wounds with questionable viability
Advantage of sugar bandage
Enhance epithelialiation and granulation tissue formation which accelerates wound healing. Reduces edema. Reduces inflammation, available and inexpensive. Nutrients for cells. Deodorizing. Antibacterial action.
T or F: for a honey bandage you can use any kind
F: Manuka honey only
Name 2 types of nonadherent dressings
Semiocclusive
Occlusive
Semiocclusive dressings
Protect the wound, prevent infection. Primary layer
Role of the bandage
Protect wound
Absorb drainage
Reduce dead space
Increase epitheliation and wound contraction
Control hemorrhage
Increase local temp
Protect from self mutilation
Modulate pain
Immobilize stabilize and support underlying structures
Describe the three layers of a bandage
Contact/Primary- in direct contact with the wound
Intermediate/Secondary- hold primary in place
Outer/Tertiary- hold entire bandage and establish the sub-bandage pressure
Describe the primary bandage layer
Establishes wound environment that supports healing
Keeps wound bed moist and periwound skin dry
Should be STERILE
Describe the secondary layer of bandaging
Holds primary dressing in place
Often has inner absorbent layer and an outer stabilizing layer.
Absorbs the excess exudate
Describe the Tertiary layer of bandaging
Establishes appropriate pressure
Controls hemorrhage
Limits edema, dead space, and the spread of microflora
Supports underlying tissue and holds other bandages in place
4 things in granulation tissue
- Fibroblasts proliferation
- Capillaries proliferation
- Collagen
- Macrophages
How does sugar help a wound
Sugar causes migration of water and lymph out of the tissue. You need 1 cm.
Closure of a wound 4 types
Primary closure-close
Delay primary closure- clean with wet to dry then close
Secondary closure- wet to dry, sugar bandage, remove granulation tissue, close
Second intention healing
Basic surgical technique of Halstead
Gentle tissue handling
Hemostasis
Preserve blood supply
Adequate deplbridement
Aseptic technique
Wound drainage
Closure without tension
How to decide where to suture
Follow tension lines
Diff between human and animal vascularizarion
Animals have panniculus muscle.
When is a Plasty used
For wounds with too much tension to close. Cut skin to release tension then close
Describe the Axial pattern flap
Leave artery intact, cut under to be able to lift skin and move.
Purpose of a drain
Prevents fluid filling empty space
Define Skin graft
Take skin from elsewhere on the body and put over wound. No drain. Mesh the graft. Fluid comes out of mesh.
Second intention healing
Granulation tissue
Epithelialization
Contraction
Treat the wound until it closes by itself
Factors affecting contraction
Dead space
Bandage
Corticosteroids
Movement
Exposed bone
Infection
Vac system
Vacuum assisted closure. Cut sponge size of wound. Absorbs fluid and necrotic tissue. Sealing over the top with a drain. Machine continuously, gently sucks fluid. Debrides. Pulls the skin over.
T or F: wounds heal from the edges to the center
True
Why would you make a circle wound into a square shape
Wounds close from edges to the center. A square shape will close faster and more neatly
Omentum has these qualities
Fibrinolysis
What are the four stages of wound management
- Inflammatory phase
- Debridement phase
- Repair phase
- Maturation phase
T or F: To retain proper environment, sugar must be present in the wound at all times
True
Describe a thermal burn
Extreme temperature that causes cellular damage
Describe a chemical burn
Exposure to chemicals that cause tissue necrosis
Describe an electrical burn
Electrical current causing cellular necrosis along its path
Describe a radiation burn
Exposure to ionizing radiation at levels that cause acute
cell death
Differentiate between the 1st and 2nd degree of burns
First degree- only epidermis is affected
Second degree- Full-thickness epidermal necrosis that extends into the underlying dermis
Differentiate between the 3rd and 4th degree of burns
Third degree- Extend completely through the dermis to the underlying SQ tissue
Fourth degree- Extend to underlying muscle or fascia
Describe a fifth degree burn
Extension to the bone
What is the difference between a partial and a full thickness burn
Partial involves the epidermis only. Full thickness involves the epidermis and the underlying dermis.
True or False: Epidermal necrosis occurs if the skin temperature reaches 60C (140F) for 1 sec
True
What temperature does the skin have to reach for a full thickness burn to occur and for how long
Full-thickness burn in less than 1 sec if temperature reaches 70C (158F)
How to treat a thermal burn
Aggressive fluid resuscitation
Early/intensive management of inhalation injury
Early/complete removal of the burn eschar, with sepsis prevention
Improved analgesia
Nutritional support and metabolic intervention
Initial first aid for a thermal burn
Cool to cold running water to burn area (no ice)
Cover with a sterile, occlusive, nonadherent dressing reduces pain and protects it from
contamination and further trauma.
What is one of the most important things to do when treating a thermal burn
Fluid resuscitation- vital amounts of fluid are lost from the body when a burn occurs
What is the primary goal of fluid resuscitation
Restoration of volume and perfusion
Treatment of an inhalation injury
Bronchial hygiene therapy
Oxygen therapy
Pharmacologic interventions
Steps of bronchial hygiene therapy for thermal burns
Remove accumulated secretions
Remove necrotic material
Remove foreign debris
Remove bacteria from the airways
Define physiotherapy (coupage)
hitting either side of the chest to induce coughing
What is oxygen therapy and what is its effect on the body
Removal of carbon monoxide from the blood
Decreases the respiratory effort which decreases stress
What is the benefit of applying talapia skin to a thermal burn
Adheres to the wound
Avoids retention of exudates and loss of fluids, rich in collagen type I
Promotes a barrier to bacterial invasion, accelerates healing
Provides pain relief
Peels away easily at bandage change, does not need frequent changes
What are the effects of frostbite
Extremities are most often affected (pinnae and digits)
Tissue freezing, hypoxia, and release of inflammatory mediators.
Treatment of frostbite
Gentle rewarming in lukewarm water
Wait until the extend of necrosis is known
Pain management, NSAID, wound management
First aid of a chemical burn
Dilute. Continue until the chemical is either neutralized or is washed off
What are some qualities of an electrical burn
Heat generated from the resistance of the tissues to the electrical current flow. Often deeper tissues vs skin
In general, how should you treat a wound/burn
Prevention of further wound contamination
Good debridement
Practice aseptic technique
Adequate drainage and obliteration of dead space
Promotion of a viable vascular bed
Radiographs
Culture and sensitivity
Biopsy
Selection of appropriate wound closure
