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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
benefits of gauze dressings
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
26
limitations of gauze
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
27
common uses for gauze
infected wounds wounds requiring packing / requiring frequent dressing changes highly exudative wounds
28
what can mesh be impregnated with
petrolatum bismuth zinc hydrogel saline
29
what do impregnated gauze dressings do
create a nonadherent contact layer increase occlusive nature of gauze dressing
30
explain what wound type a petrolatum-impregnated gauze can be used on
contact layer on granulating wound beds - with a secondary gauze and +/- topical agent typically burn wounds
31
what would petrolatum impregnated gauze help with
inhibit dehydration of deep structures within wound bed
32
dressings with bismuth are considered to be? what may the be used as?
cytotoxic to inflammatory cells - may be used as a sensitizing agent or to increase inflammatory response
33
iodine impregnated gauzes are
cytotoxic and only mildly antimicrobial
34
benefits of impregnated gauze dressings
decrease trauma to wound bed decrease pain or trauma during dressing changes increase occlusive nature of dressings
35
limitations of impregnated gauze
more costly require secondary gauze present a barrier to cell migration minimal absorptive qualities
36
common uses of impregnated gauzes
burns granulating epithelizing wounds with exposed deep tissue bloody wounds painful wounds
37
what are semipermeable film dressings
thin sheets of transparent polyurethane with adhesive backing
38
semipermeable dressings are permeable to _______ but impermeable to
water vapor, oxygen, carbon dioxide bacteria and water
39
precautions to application of semipermeable film dressings
secure a 1-2 cm border of intact periwound skin apply without tension or wrinkles in skin
40
how to prevent maceration using semipermeable film dressings
skin sealant
41
how to prevent bacteria using semipermeable film dressings
maintain good edge seal
42
contraindications of semipermeable dressings
infected wounds moderate-heavy exudate fragile skin/skin sensitivities
43
semipermeable dressing benefits
moisture retentive autolytic debridement reduce friction visualization of wound bed waterproof cost less over time
44
limitations of semipermeable dressings
skin trauma during changes certain exudative wounds difficulty in application non-infected wounds only
45
common uses of semipermeable dressings
skin tears donor sites areas of friction abrasions IV catheters wounds for US treatments
46
what are sheet hydrogels permeable to
gas and water - will be less effective to bacteria compared to semipermeable
47
common use of sheet hydrogel
minimal - mod draining wounds diabetic foot ulcers total contact casts / splints dry wounds
48
how are sheet hydrogels used in total contact casts
padding pressure and sheer force decrease
49
contraindications of sheet hydrogels
heavy draining wounds bleeding wounds infected wounds
50
what is a precaution of sheet hydrogels? what is the solution?
propylene glycol is a common irritant - skin sealant
51
benefits of hydrogel dressings
moisture retentive autolytic debridement pressure reduction minimally adherent
52
limitations of hydrogels
may dehydrate not on highly exudative or infected wounds skin irritation typically require a secondary dressing
53
common uses of hydrogels
pressure ulcers blisters abrasions/tears burns (thermal/radiation) donor sites total contact casts
54
what can amorphous hydrogels be used for
softening eschar
55
semipermeable foams are described as
polyurethane foam with a hydrophilic wound side and a hydrophobic outside
56
what are semipermeable foams permable to
gas not bacteria
57
what are semipermeable foams used for
donor sites ostomy sites minor burns diabetic ulcers VI ulcers
58
what wound characteristics indicate semipermeable foams
minimal-heavy exudate granulating or slough covered partial and full thickness wounds
59
contraindications of semipermeable foams
dry/eschar covered wounds arterial ulcers heel ulcers in bed bound pt fragile skin integrity known skin sensitivities
60
benefits of semipermeable foams
moisture retention autolytic debridement thermal insulation cushioning absorptive
61
limitations of semipermeable foams
adhesives / skin trauma non infected wounds only
62
hydrocolloids are made of
colloidal particles with strong film or foam adhesive backing
63
hydrocolloids absorb
exudate slowly swelling into gel like mass
64
hydrocolloids are impermeable to
water oxygen bacteria
65
contraindications of hydrocolloids
bleeding / heavy drainage wounds infected wounds dry wounds (AI, 3rd degree) exposed deep tissue wounds poor skin integrity
66
benefits of hydrocolloid
moisture retentive autolytic debridement impermeable
67
limitations of hydrocolloid
periwound damage residue in wound bed hypergranulation roll in areas of frictionc
68
common uses of hydrocolloid
pressure ulcers burns VI wounds
69
what do alginates do
react with serum / wound exudate to form hydrophilic gel
70
how do alginates prevent infection
moist wound environment can trap bacteria can get cleaned out during dressing changes
71
indications of alginates
moderate-high drainage partial to full thickness packing cavities granular/slough covered
72
can alginates be used on infected wounds?
yes, requires daily change
73
contraindications of alginates
full-thickness burns (3rd) exposed deep tissue wounds neonates <38 weeks at birth
74
benefits of alginates
autolytic debridement highly absorbant infected and uninfected biocompatible non adherent
75
limitations of alginates
secondary dressing
76
common uses of alginates
highly exudative wounds VI uclers tunneling
77
composite dressings have ____ layers
3 inner contact middle outer
78
inner contact layer of composite dressings - characteristic - goal
non adherent prevent wound bed truama
79
middle layer of composite dressing - characteristic / types - goal
hydrogel, semipermeable foam, hydrocolloid, alginate absorbs moisture / maintains moist wound bed
80
outer layer of composite dressings - characteristic - goal
semipermeable film bacteria barrier
81
common antiseptic agents
silver cadexomer iodine
82
silver antimicrobial dressings are best at
reducing wound bioburden
83
what wounds does the FDA approve silver dressings for
partial to full thickness
84
timeline of silver antimicrobial dressings
in short term - assist with infection control
85
contraindications of silver antimicrobial
neonates with estim moisten dressing with saline patients sensitive to sulfa drugs MRI
86
benefits of silver dressings
broad spectrum antimicrobial
87
limitations of silver
lack of research high cost potential toxicity and limitations of other interventions
88
common uses of silver antimicrobial dressings
burns donor sites neuropathic ulcer pressure ulcer traumatic wound VI ulcer
89
charcoal dressings are used to control
odor
90
honey can be used to ____ in wound care? what is the example
control bioburden wound odor leptospermum
91
how do honey-impregnated dressings work
high osmolality draws fluid into wound surface acidic environment promotes protease and growth factor
92
what do hony impregnated dressings enhance during healing
angiogenesis fibroblast proliferation decrease prostaglandin synthesis
93
common use of honey-impregnated dressings
infected/colonized wounds stage 2 or 3 pressure ulcers diabetic foot ulcer VI ulcer
94
collagen dressings are used for
nonhealing category 3/4 pressure ulcers partial to full thickness wounds various ulcers/surgical wounds
95
what do moisture barriers do
prevent perineal rashes/skin breakdown prevent adhesives from sticking
96
benefits of skin sealants
protection from maceration minimal protection from adhesives
97
growth factors are described as
growth promoting substances that enhance cell size, proliferation or activity
98
what cells do growth factors directly affect
cytokines interleukins colony stimulating factors
99
types of growth factors
becaplermin gel small intestinal submucosa
100
what is becaplermin gel used for
recalcitrant stage 3 and 4 injuries
101
what wounds are small intestinal submucosa indicated on
partial thickness ulcers
102
grafts can help
retain skin's natural barrier properties encourage autolytic debridement healthy granular wound bed
103
what wounds can skin grafts be indicated
extensive surface area large full-thickness burns chronic wound
104
skin substitutes are used in what types of wounds
nonhealing uninfected partial to full-thickness VI / neuropathic ulcers burns / truama
105
thought process with a draining wound
need to absorb moisture protect from maceration
106
thought process with a non-draining wound
provide moisture prevent evaporative loss skin sealant to protect periwound
107
if a warm wound environment is present, what needs to be done
cover with dressing
108
what to think about if presented with dead space in a wound
fill the cavities ;) prevent premature wound closure and abscess formation depending on drainage, alginates or gauzes
109
something to always remember when packing dead space
leave a wick to take out next dressing change

Integ (13 decks)

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