Wound Management

Question 1

Lipodermatosclerosis

Answer 1

Inverted Champagne Bottle Legs

Question 2

70% of Chronic Wound is caused by?

Answer 2

Chronic Venous Insufficiency

Question 3

Signs of Chronic Venous Insufficiency

Answer 3

1. Pitting Oedema2. Haemosiderin Staining3. Venous ulcer - painless, irregular, copious exudate4. Atrophie Blanche5. Lipodermatosclerosis

Question 4

RF of Chronic Venous Insufficiency

Answer 4

Obesity, DVT, Poor mobility

Question 5

Tx of Chronic Venous Insufficiency

Answer 5

1. Graduated compression - toe to knee (ankle 30mmHg)2. Address factors that delay healing3. Must exclude arterial involvement

Question 6

4 Principles of Wound management

Answer 6

1. Define Aetiology - Vascular/Mechanical/Neuropathic/Infective2. Control wound healing factors3. Select appropriate dressing4. Plan for management

Question 7

Signs of lymphoedema

Answer 7

1. Scale and keratin build-up2. Skin thickening3. Hard to pick up skin4. Non-pitting oedema

Question 8

Secondary causes of Lymphoedema?

Answer 8

1. Cancer2. Infection - Filariasis (Elephantiasis)

Question 9

4 Si/Sx of Peripheral Arterial Disease (PAD)

Answer 9

1. Claudication to rest pain2. Lower ABI - nml is 1.03. Weak pulse, poor refill4. Arterial ulcer - regular, punched out, below ankles

Question 10

Tx of Arterial ulcers

Answer 10

1. Improve flow - angioplasty/stent/bypass (essentially angina of leg)2. Amputation of digit or limb

Question 11

Difference between Ischaemic or neuropathic ulcers?

Answer 11

Neuropathic is:1. Painless2. Bony prominence/area of pressure3. Good circulation for healingWhich are all opposite in ischaemic

Question 12

RF and Mx for Pressure ulcer

Answer 12

1. Neuropathy 2. Immobility 3. Malnutrition Mx: manage RF, risk assessment, Foam

Question 13

Friction vs Shear

Answer 13

Friction - epidermis worn away by rubbing external surfaceShear - skin is restrained from sliding while tissue are forced to move

Question 14

4 Stages of Pressure Ulcer

Answer 14

1. Erythema remains after light pressure2. Skin loss involving epidermis/dermis3. Skin loss involving subcutaneous tissue/fascia4. Skin loss with necrosis to underlying structures (muscle/bone/joint etc)

Question 15

Complication of leg ulcers

Answer 15

1. Infection2. Gangrene3. Calcification4. Neoplastic development

Question 16

Risk assessment in pressure ulcers

Answer 16

Norton scale Less than 16/20 is at risk4 marks of each:Physical condition, mental condition, activity, mobility, incontinent

Question 17

Intrinsic Factors affecting healing? (4)

Answer 17

1. Age and build (old or obese?)2. Immune function/DM (immune status)3. Nutrition4. General health status

Question 18

Extrinsic Factors affecting healing? (4)

Answer 18

1. Drugs (NSAIDs, steroids, Bblockers impairs healing)2. Smoking3. Wound factors: Debris, infection, dryness4. Wound location: Mechanical (movement) /Chemical stress

Question 19

Skin Tear Mx Plan (First aid, dressing, FU)

Answer 19

1. Stop bleeding - Alginate2. Cleansing and pat dry(NS/Tap water)3. Steri-strips if skin flap present (mark skin flap direction, avoid tension, max 1cm apart, avoid adhesive tapes)4. Dressing (Hydrogel +/- foam, Mepitel if major skin loss as it is protein and remain in place for 10d)5. Analgesia and tetanus6. RV 24hrs

Question 20

Why does Skin tear occur in old age?

Answer 20

Skin changes with age, thus trauma easily tears skin:Epidermis: less turnover, langerhansDermis: loses 80% thickness, vessels diminish by 40% and fragile, less collagen, skin less elastic

Question 21

Burn conversion

Answer 21

Partial thickness thermal burn convert to full thickness from residual energy

Question 22

Burn first aid

Answer 22

1. Cold (not ice cold) running water for 30min2. Check for hypothermia, wrap pt in towel to keep warm

Question 23

Burn Body surface area estimation

Answer 23

Face/Arms: 9% eachThorax/Abdomen/Legs: 18% each

Question 24

Major burns must obtain the following information (5)

Answer 24

1. Type of burn - thermal/chemical2. Depth and Area%3. Presence of inhalation injury4. Associate injuries5. Medical status of the patient

Question 25

Burn Depth

Answer 25

1. Partial Thickness - Superficial2. Partial Thickness - Deep (dermis)3. Full thickness (thru subcutenous)

Question 26

Blister management

Answer 26

1. Remain intact unless large or over joint2. If not: Antiseptic cleansing -> Drain with sterile needle

Question 27

Burn dressing of choice

Answer 27

Hydrogels - absorbs exudate, prevent infection, keep moist, cost effective

Question 28

Mepilex use and product type

Answer 28

Silicone Foam Dressing; Exudate Management Product1. Absorbs ooze + Pad protects wound from friction2. For ulcers (mepiLegs)C.f. Mepitel - protein dressing, protection only no absorption

Question 29

Name a wound rehydration product, use and require additional what

Answer 29

Hydrogel. Insect bite, shingles or superficial burn. Requires secondary dressing (Non-adherent pad or Foam)

Question 30

Name a haemostatic absorbent dressing (aka stops bleeding)

Answer 30

Alginate

Question 31

Moisture retentive dressing is aka?

Answer 31

Films (Tegaderm3M), for simple superficial wounds, not for fragile skin

Question 32

Hydrocolloid dressings are contraindicated in

Answer 32

Ulcer in DM or PAD, produces anaerobic infection environment

Question 33

Name a Wound protection product, use

Answer 33

Mepitel foam. For burns, tears. But no absorption. (MepiTear, proTein)

Question 34

Diabetic wound dressing of choice

Answer 34

Iodosorb sheet (0.9% Iodine). Debriding/Antimicrobial dressing

Question 35

Very infected/dirty wound dressing of choice

Answer 35

Silver containing dressing

Question 36

Bandages types and use (4)

Answer 36

Compression - venous compression, NOT for arterialTubular - for compression in older patients/cannot tolerate compressionRetention - to hold dressings Crepe - support joint, no pressure