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Integ > wound management > Flashcards

wound management Flashcards

1
Q

explain moist wound healing and timeline of healing

A

3-5x faster
facilitates all 3 phases

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2
Q

explain what moist wound healing does specifically

A

traps endogenous enzymes to facilitate autolytic debridement

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3
Q

benefits of moist wound healing

A

preserves endogenous growth factors
reduced patient pain
more cosmetically appealing scars

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4
Q

negatives associated with too dry wound healing

A

crust formation
lack enzymes / growth factors

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5
Q

explain the negatives of too moist wound healing

A

maceration
additional skin damage
increased chance of infections

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6
Q

functions of wound dressings

A

moist environment
thermal insulation
barrier for microorganisms
hemostasis
edema control
eliminate dead space in wound bed

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7
Q

if dead space is not taken up, what can happen

A

abscess formation

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8
Q

what is the contact layer

A

primary dressing that comes in direct contact with wound

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9
Q

what can the secondary dressing provide

A

protection
cushion
absorption
occlusion

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10
Q

why are composite dressings called such?

A

combine primary and secondary dressing in one

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11
Q

explain which types of wounds moisture retentive dressings can be used on

A

superficial, partial or full thickness
granular or necrotic

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12
Q

explain infection rates in relation to occlusive or nonocclusive dressings

A

occlusive = lower infection rates

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13
Q

how do moisture retentive dressings negate infection

A

bacterial barrier
lower risk of cross-contamination
retains macrophages/neutrophils
endogenous enzymes can remove necrotic tissue / debris

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14
Q

guidelines for moisture retentive dressings to reduce chance of infection

A

change dressing if barriers are compromised

do not use if infection is present

removed after 5-7 days

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15
Q

if a wound is infected, what dressing can be used

A

semipermeable foams / alginates
antimicrobial dressing

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16
Q

relationship between moisture-retentive dressings and wound

A

interaction of dressing with wound fluid prevents the dressing from adhering to the wound bed

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17
Q

how to reduce risk of maceration with moisture-retentive dressings

A

maintain moist, not wet environment

topical skin protectants should be applied to all intact skin covered by dressings

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18
Q

how do wrinkles in dressings compromise healing

A

wound fluid can escape
microbes can enter

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19
Q

how is the continuum of wound dressing scale measured

A

least to most occlusive

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20
Q

of the moisture retentive dressings, tell me a list of the least to most absorptive dressings

A

semipermeable films

hydrogels

hydrocolloids

semipermeable foams

alginates

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21
Q

gauze dressings are described as

A

highly permeable
relatively nonocclusive

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22
Q

compare absorption of woven and nonwoven gauze

A

non woven = more absorptive

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23
Q

common use of gauze dressings

A

infected and uninfected wounds of any size, shape, depth, or etiology

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24
Q

woven gauze precautions

A

may require more force of removal
may leave residue leading to granulomas
dehydrated gauze can adhere to the wound bed

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25
Q

benefits of gauze dressings

A

available
low cost
can be used on all types of wounds
- can be used alone or with other treatments
absorptive
cushioning
can keep adhesives from direct skin contact

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26
Q

limitations of gauze

A

costly over time
can adhere to wound be d
can leave particulate matter in the wound bed
highly permeable / can be more likely for infection

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27
Q

common uses for gauze

A

infected wounds
wounds requiring packing / requiring frequent dressing changes
highly exudative wounds

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28
Q

what can mesh be impregnated with

A

petrolatum
bismuth
zinc
hydrogel
saline

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29
Q

what do impregnated gauze dressings do

A

create a nonadherent contact layer
increase occlusive nature of gauze dressing

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30
Q

explain what wound type a petrolatum-impregnated gauze can be used on

A

contact layer on granulating wound beds
- with a secondary gauze and +/- topical agent

typically burn wounds

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31
Q

what would petrolatum impregnated gauze help with

A

inhibit dehydration of deep structures within wound bed

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32
Q

dressings with bismuth are considered to be? what may the be used as?

A

cytotoxic to inflammatory cells
- may be used as a sensitizing agent or to increase inflammatory response

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33
Q

iodine impregnated gauzes are

A

cytotoxic and only mildly antimicrobial

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34
Q

benefits of impregnated gauze dressings

A

decrease trauma to wound bed

decrease pain or trauma during dressing changes

increase occlusive nature of dressings

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35
Q

limitations of impregnated gauze

A

more costly
require secondary gauze
present a barrier to cell migration
minimal absorptive qualities

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36
Q

common uses of impregnated gauzes

A

burns
granulating
epithelizing
wounds with exposed deep tissue
bloody wounds
painful wounds

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37
Q

what are semipermeable film dressings

A

thin sheets of transparent polyurethane with adhesive backing

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38
Q

semipermeable dressings are permeable to _______ but impermeable to

A

water vapor, oxygen, carbon dioxide

bacteria and water

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39
Q

precautions to application of semipermeable film dressings

A

secure a 1-2 cm border of intact periwound skin

apply without tension or wrinkles in skin

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40
Q

how to prevent maceration using semipermeable film dressings

A

skin sealant

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41
Q

how to prevent bacteria using semipermeable film dressings

A

maintain good edge seal

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42
Q

contraindications of semipermeable dressings

A

infected wounds
moderate-heavy exudate
fragile skin/skin sensitivities

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43
Q

semipermeable dressing benefits

A

moisture retentive
autolytic debridement
reduce friction
visualization of wound bed
waterproof
cost less over time

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44
Q

limitations of semipermeable dressings

A

skin trauma during changes
certain exudative wounds
difficulty in application
non-infected wounds only

45
Q

common uses of semipermeable dressings

A

skin tears
donor sites
areas of friction
abrasions
IV catheters
wounds for US treatments

46
Q

what are sheet hydrogels permeable to

A

gas and water
- will be less effective to bacteria compared to semipermeable

47
Q

common use of sheet hydrogel

A

minimal - mod draining wounds
diabetic foot ulcers
total contact casts / splints
dry wounds

48
Q

how are sheet hydrogels used in total contact casts

A

padding
pressure and sheer force decrease

49
Q

contraindications of sheet hydrogels

A

heavy draining wounds
bleeding wounds
infected wounds

50
Q

what is a precaution of sheet hydrogels? what is the solution?

A

propylene glycol is a common irritant

  • skin sealant
51
Q

benefits of hydrogel dressings

A

moisture retentive
autolytic debridement
pressure reduction
minimally adherent

52
Q

limitations of hydrogels

A

may dehydrate
not on highly exudative or infected wounds
skin irritation
typically require a secondary dressing

53
Q

common uses of hydrogels

A

pressure ulcers
blisters
abrasions/tears
burns (thermal/radiation)
donor sites
total contact casts

54
Q

what can amorphous hydrogels be used for

A

softening eschar

55
Q

semipermeable foams are described as

A

polyurethane foam with a hydrophilic wound side and a hydrophobic outside

56
Q

what are semipermeable foams permable to

A

gas not bacteria

57
Q

what are semipermeable foams used for

A

donor sites
ostomy sites
minor burns
diabetic ulcers
VI ulcers

58
Q

what wound characteristics indicate semipermeable foams

A

minimal-heavy exudate
granulating or slough covered
partial and full thickness wounds

59
Q

contraindications of semipermeable foams

A

dry/eschar covered wounds
arterial ulcers
heel ulcers in bed bound pt
fragile skin integrity
known skin sensitivities

60
Q

benefits of semipermeable foams

A

moisture retention
autolytic debridement
thermal insulation
cushioning
absorptive

61
Q

limitations of semipermeable foams

A

adhesives / skin trauma
non infected wounds only

62
Q

hydrocolloids are made of

A

colloidal particles with strong film or foam adhesive backing

63
Q

hydrocolloids absorb

A

exudate slowly
swelling into gel like mass

64
Q

hydrocolloids are impermeable to

A

water
oxygen
bacteria

65
Q

contraindications of hydrocolloids

A

bleeding / heavy drainage wounds
infected wounds
dry wounds (AI, 3rd degree)
exposed deep tissue wounds
poor skin integrity

66
Q

benefits of hydrocolloid

A

moisture retentive
autolytic debridement
impermeable

67
Q

limitations of hydrocolloid

A

periwound damage
residue in wound bed
hypergranulation
roll in areas of frictionc

68
Q

common uses of hydrocolloid

A

pressure ulcers
burns
VI wounds

69
Q

what do alginates do

A

react with serum / wound exudate to form hydrophilic gel

70
Q

how do alginates prevent infection

A

moist wound environment can trap bacteria
can get cleaned out during dressing changes

71
Q

indications of alginates

A

moderate-high drainage
partial to full thickness
packing cavities
granular/slough covered

72
Q

can alginates be used on infected wounds?

A

yes, requires daily change

73
Q

contraindications of alginates

A

full-thickness burns (3rd)
exposed deep tissue wounds
neonates <38 weeks at birth

74
Q

benefits of alginates

A

autolytic debridement
highly absorbant
infected and uninfected
biocompatible
non adherent

75
Q

limitations of alginates

A

secondary dressing

76
Q

common uses of alginates

A

highly exudative wounds
VI uclers
tunneling

77
Q

composite dressings have ____ layers

A

3
inner contact
middle
outer

78
Q

inner contact layer of composite dressings
- characteristic
- goal

A

non adherent

prevent wound bed truama

79
Q

middle layer of composite dressing
- characteristic / types
- goal

A

hydrogel, semipermeable foam, hydrocolloid, alginate

absorbs moisture / maintains moist wound bed

80
Q

outer layer of composite dressings
- characteristic
- goal

A

semipermeable film

bacteria barrier

81
Q

common antiseptic agents

A

silver
cadexomer iodine

82
Q

silver antimicrobial dressings are best at

A

reducing wound bioburden

83
Q

what wounds does the FDA approve silver dressings for

A

partial to full thickness

84
Q

timeline of silver antimicrobial dressings

A

in short term
- assist with infection control

85
Q

contraindications of silver antimicrobial

A

neonates
with estim
moisten dressing with saline
patients sensitive to sulfa drugs
MRI

86
Q

benefits of silver dressings

A

broad spectrum antimicrobial

87
Q

limitations of silver

A

lack of research
high cost
potential toxicity and limitations of other interventions

88
Q

common uses of silver antimicrobial dressings

A

burns
donor sites
neuropathic ulcer
pressure ulcer
traumatic wound
VI ulcer

89
Q

charcoal dressings are used to control

A

odor

90
Q

honey can be used to ____ in wound care? what is the example

A

control bioburden
wound odor

leptospermum

91
Q

how do honey-impregnated dressings work

A

high osmolality draws fluid into wound surface

acidic environment promotes protease and growth factor

92
Q

what do hony impregnated dressings enhance during healing

A

angiogenesis
fibroblast proliferation
decrease prostaglandin synthesis

93
Q

common use of honey-impregnated dressings

A

infected/colonized wounds
stage 2 or 3 pressure ulcers
diabetic foot ulcer
VI ulcer

94
Q

collagen dressings are used for

A

nonhealing category 3/4 pressure ulcers

partial to full thickness wounds
various ulcers/surgical wounds

95
Q

what do moisture barriers do

A

prevent perineal rashes/skin breakdown

prevent adhesives from sticking

96
Q

benefits of skin sealants

A

protection from maceration
minimal protection from adhesives

97
Q

growth factors are described as

A

growth promoting substances that enhance cell size, proliferation or activity

98
Q

what cells do growth factors directly affect

A

cytokines
interleukins
colony stimulating factors

99
Q

types of growth factors

A

becaplermin gel
small intestinal submucosa

100
Q

what is becaplermin gel used for

A

recalcitrant stage 3 and 4 injuries

101
Q

what wounds are small intestinal submucosa indicated on

A

partial thickness ulcers

102
Q

grafts can help

A

retain skin’s natural barrier properties

encourage autolytic debridement

healthy granular wound bed

103
Q

what wounds can skin grafts be indicated

A

extensive surface area
large full-thickness burns
chronic wound

104
Q

skin substitutes are used in what types of wounds

A

nonhealing
uninfected
partial to full-thickness
VI / neuropathic ulcers
burns / truama

105
Q

thought process with a draining wound

A

need to absorb moisture
protect from maceration

106
Q

thought process with a non-draining wound

A

provide moisture
prevent evaporative loss
skin sealant to protect periwound

107
Q

if a warm wound environment is present, what needs to be done

A

cover with dressing

108
Q

what to think about if presented with dead space in a wound

A

fill the cavities ;)
prevent premature wound closure and abscess formation

depending on drainage, alginates or gauzes

109
Q

something to always remember when packing dead space

A

leave a wick to take out next dressing change

Integ (13 decks)

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