wound management

Question 1

abrasion

Answer 1

wound caused by friction ex, scrape, blister

Question 2

hematoma

Answer 2

a large blood clot under the skin caused by trauma, swelling is present

Question 3

contusion

Answer 3

damage to the tissue without laceration to the skin ex. bruise, bowed tendon

Question 4

puncture wound

Answer 4

wound caused by a foreign object (ex. nail), generally little to no bleeding which may cause infection, small hole on the skin surface

Question 5

incision

Answer 5

cleaner than laceration, generally caused by a sharp object, edges of wound will come back together easily

Question 6

laceration

Answer 6

complicated injury with turns and torn edges of the skin

Question 7

complicated wound

Answer 7

difficult to heal, torn edges, necrotic tissue, infection may be involved. will take a long time to heal

Question 8

3 phases of healing

Answer 8

1. inflammation 2. granulation 3. contraction and epitheliazation

Question 9

inflammation

Answer 9

clot provides scaffolding for new matrix and migration of cells, phagocytic cells will debride wound

Question 10

granulation

Answer 10

cannot proceed until blood clots, necrotic tissue, debris, and infection have been eliminated. angiogenesis for blood supply, granulation tissue made of loose ECM develops 3-6 days after injury and continues until epitheliazation occurs. begins closing wound and protects against additional bacteria

Question 11

construction and epithelialization

Answer 11

very slow, but starts within hours of wounding. cells migrate centripetally. healing epithelium is fragile and poorly adherent to underlying tissues. the wound contracts and a scar is formed

Question 12

purpose of granulation tissue

Answer 12

1. provides surface for epitheliazation (attachment of skin cells)
2. resistant to infection
3. necessary for wound contraction

Question 13

factors that delay healing

Answer 13

location, infection, movement, wound dimensions, involvement of deep structures, poor blood and/or oxygen supply, foreign bodies, nutritional factor, previous treatment, age of wound, economic factor

Question 14

how does location delay wound healing

Answer 14

wounds on limbs heal slower and are more problematic than other parts of the body due to decreased vascular supply, bone prominences, no supporting deep musculature, highly mobile joints, higher degree of contamination. wounds closer to the heart heal faster.

Question 15

initial wound cleaning

Answer 15

wash wound with saline or water, cover the wound with hydrogel (water soluble gel) before clipping (remember hair becomes a foreign body and impedes healing). clean wound with 0.5% chlorohexidine. flaps of skin should be lifted and flushed underneath. do not wipe wound after it has been flushed. always clean wounds from the inside to outside

Question 16

wound assessment

Answer 16

use sterile gloves to prevent contamination, may need to use anesthesia for safety

Question 17

wound debridement

Answer 17

convert an accidental wound into a surgical wound by cutting along the edges. a scalpel should be used instead of scissors

Question 18

provisions of a moist environment

Answer 18

use water soluble gels instead of petroleum

Question 19

types of wound closure

Answer 19

primary closure, delayed primary closure, second intension. TETANUS VACCINE OR ANTISERUM SHOULD BE GIVEN

Question 20

primary closure

Answer 20

wounds should not be completely closed unless the deeper tissues are sterile. suture dehiscence is a result of infection, skin loss, tension in suture line or marked swelling

Question 21

when to use antibiotics

Answer 21

infection will delay healing, use for known or suspected infections and as prophylaxis, important to choose effacious drug, convenient route and dose with minimal side effects, it is important to give the full course to prevent bacterial resistance

Question 22

parenteral antibiotic

Answer 22

used only initially unless the wound becomes complicated

Question 23

wound lavage or flushing

Answer 23

removes dead tissue, bacteria, foreign matter without compromising the physiological status of the new forming tissues. the two main factors are the type of fluid and pressure