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Advanced Patient Care > Wound Management > Flashcards

Wound Management Flashcards

1
Q

What’s the first thing to do if patient comes in with a wound?

A

Assess the whole patient

Check for shock etc - wounds aren’t life threatening

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2
Q

What are the types of wound closure?

A
  1. Primary
    - clean, non-traumatic wound
    - immediate closure without tension
  2. Delayed Primary
    - Clean-contaminated/ contaminated
    - lavage and debride until healthy, use appropriate dressing and close after 2-5d
  3. Secondary
    - Contaminated/Dirty
    - Lavage and debride and use appropriate dressing
    - Close after 5-7days when granulation bed has begun forming
  4. Secondary Intention
    - Wound unsuitable for surgical closure - extensive contamination
    - Open wound management
    - Lavage and debride
    - Appropriate dressing
    - Allow to heal by granulation
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3
Q

When is early closure implied?

A

If the wound is over vital tissues or organs, if it is over joints or an orofacial wound.
NOT if contaminated

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4
Q

Name closure techniques

A
  • Sutures
  • Staples
  • Reconstruction (flaps and grafts)
    +/- Surgical drain
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5
Q

What is the purpose of lavage?

A

Rehydrates necrotic tissue, removes debris and bacteria, dilutes the bacteria

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6
Q

What is the purpose of debridement?

A

Creates a viable tissue edge and removes contaminated and necrotic tissue from the wound

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7
Q

How would you carry out lavage?

A

Non-toxic solution. Can use a dilute anti-septic solution if contaminated. Apply with pressure at large volumes

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8
Q

What is the difference between a passive, interactive and bioactive dressing?

A

Passive - has no action on wound
Interactive - responds to wound environment in some way
Bioactive - has a biological effect on the wound

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9
Q

What is the aim of laser therapy?

A

Enhance wound healing and reduce or prevent infection, by:

  • increasing blood flow and oxygenation
  • reducing inflammation and pain
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10
Q

What is vacuum assisted closure?

A

Using a vacuum pump to create negative pressure encouraging epithelialisation and contraction of the wound

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11
Q

What is devitalised tissue?

A

Problem with a wound where the tissue is now an optimum growth conditions for bacteria. It delays the inflammatory phase and reduces the viability of the wound bed.
It requires debridement

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12
Q

What is an exudating wound?

A

A wound secreting exudate- which is an inflammatory fluid containing WBCs and protein debris

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13
Q

Is exudate normal?

A

Yes, but not if prolonged or excessive, infected or bleeding

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14
Q

What is maceration of a wound?

A

Prolonged contact with moisture has caused it to become soggy

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15
Q

What is excoriation of a wound?

A

Contact with toxins from the wound has damaged the top layers of skin

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16
Q

How can we protect the periwound tissue?

A

Using a barrier cream. Ensuring the bandages/dressing are appropriate and being changed regualrly

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17
Q

What are the 4 stages of infection?

A

Contamination
Colonisation
Critical colonisation
Infection

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18
Q

What is a biofilm?

A

A protective film produced by bacteria causing folding in of the skin edges

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19
Q

What should you do if a wound is infected?

A
  • ensure adequate debridement and cleaning
  • manage extudate level
    Use antimicrobial dressings
    May also want to use systemic antimicrobials
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20
Q

What is the function of a foam dressing e.g. Allevyn?

What type of wounds are they for?

A

To absorb exudate and provide a moist environment. For granulating wounds.

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21
Q

What is the function of a non/low-adherent dressing e.g. melonin/primapore?
What type of wounds are they for?

A

Protects wound from environment, and absorbs some exudate. Doesn’t interfere with any healing.
For low extudating, closed wounds, burns or grazes.

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22
Q

What is the function of a hydrogel dressing e.g. intrasite gel?
What type of wounds are they for?

A

Interacts with the wound to increase healing and gentle debridement. Provide a moist environment and absorbs fluid.
For dry, sloughing or necrotic granulating wounds

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23
Q

What is the function of a hydrocolloid dressing?

What type of wounds are they for?

A

Interact with wound to create a barrier to microorganisms and maintain hydration. They also stimulate the inflammatory response and have anti-oxidants. For moderately extudating wounds, necrotic wounds, non-infected wounds.

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24
Q

What is the function of a Alginates dressing?

What type of wounds are they for?

A

Absorbs exudate and maintains moist environment

- for mod-high extudating wounds, infected, haemorrhaging, slow-granulated or irradiated wounds

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25
Q

What is the function of a Film dressing e.g. opsite?

What type of wounds are they for?

A

Secondary dressing to protect newly epilethialised wounds. Waterproof but allows wound to breathe.
For superficial wounds e.g. clipped skin, IV, lick granuloma, pressure sores

26
Q

What is the function of an anti-microbial dressing e.g. manuka honey?
What type of wounds are they for?

A

Protects wound from bacteria with an anti-microbial action. For infected wounds that need debriding.

27
Q

What are the 5 freedoms?

A
  • freedom from hunger or thirst
  • freedom from discomfort
  • freedom from pain, injury or disease
  • freedom to express normal behaviour
  • freedom from fear and distress
28
Q

What are the advantages and disadvantages of closing wounds using staples?

A

Speed of use
Ease of use

Cost
Single use
removal can be difficult if temperament bad

29
Q

What are the advantages and disadvantages of using tissue adhesives to close wounds?

A
  • good for cutaneous/ incision wounds, oral surgery and internal use
  • easy to use/ quick
  • good for rabbit’s thin skin
  • tissue toxicity
  • granuloma formation
  • infection/delayed healing
30
Q

Why would you use non-absorbable stiches as opposed to absorbable?

A

Cause less tissue reaction - removed 7-10 days post-Sx

31
Q

What’s the reasons for use of 1. Natural and 2. Synthetic suture material?

A

Natural has less inflammatory response but can have a variable and unpredictable breakdown time

Synthetic has a more predictable breakdown

32
Q

What characteristics of suture material are important when selecting?

A
  • Pliable for easy handling
  • Low tissue drag
  • Tissue reactivity
  • Memory
  • Uniform diameter
  • High tensile strength
  • predictable performance
33
Q

What are the 3 main needle shapes?

A
  • Straight - for skin and tendon repair
  • Half-curved - straight shaft, curved cutting tip
  • Curved - arc shaped
34
Q

Describe the classifications of suture patterns

A

Interrupted or continuous

  • apposing - sutures in direct opposition
  • everting - turn edges slightly out to give flexibility and drainage
  • inverting - turns inward to prevent leakage e.g. in bowels
35
Q

What 3 components make up the surgical knot?

A
  • The loop (inside tissue)
  • The knot
  • Ears (leave long enough to just see)
36
Q

Why would subcutaneous (on epidermal layer) sutures be used instead of skin sutures?

A

Prevent removal and reduce patient interference
Don’t have to remove them
More comfortable generally
No loop for chewing

37
Q

Why would you use subcuticular sutures?

A

Dermis layer

  • allows skin sutures to be less tight, eliminate dead space and provide less tension on skin
  • Less wound breakdown
  • Don’t have to remove them
  • more comfortable generally
  • no loop for chewing
38
Q

What can be done to make removal of stitches easier?

A

Use coloured suture material

Count and record stitches when placing

39
Q

What are the positives and negatives of simple interrupted skin sutures?

A 
\+ okay to lose one
\+ even tension 
\+ no rotation 
- time consuming
- more foreign material 
- more knots
40
Q

What are the positives and negatives of horizontal mattress skin sutures?

A

+ good for high tension areas
+ fast to place
+ relieves pressure (good for aural haematoma)

41
Q

What are the positives and negatives of vertical mattress skin sutures?

A

+ stronger than horizontal mattress sutures
+ results in less tissue eversion
- more time consuming

42
Q

What are the positives and negatives of simple continuous skin sutures?

A

+ quick

- lose one, lose the entire thing

43
Q

What are the positives and negatives of ford interlocking skin sutures? (a modification of simple continuous)

A

+ brings tissues together well - good for internal!!!
+ good for FB removal from intestines
- uses a lot of suture material
- difficult to remove so avoid on skin

44
Q

How do you choose the direction of wound closure?

A

The long axis of the would is aligned parallel to the line of tension in that area ( to reduce tension)

45
Q

What techniques are used to relieve tension on a wound?

A
  • Subcuticular sutures
  • Walking sutures (first stitch where skin still joined)
  • Relaxing incisions (creating incision on one or both sides of wound to stretch skin)
46
Q

Why might you be careful with relaxing incisions?

A

Can cause vascular compromise, necrosis and cosmetic issues

47
Q

What is the difference between a skin graft and a skin flap?

A

Graft - skin is removed and put elsewhere

Flap - pulled from one point over another

48
Q

What is the benefit of a skin flap?

A

Helps the reconstruction of large areas of skin deficit

- Uses the nerve and blood supply from another area to help heal the wound

49
Q

What are cautions with skin flaps?

A
  • self trauma due to discomfort
  • seroma (large wound with dead space - can use a drain )
  • discharge if skin is rejected
  • deniscence (separation)
  • necrosis (usually due to incorrect prep of wound bed)
50
Q

How many days does a skin graft have to ‘take’ before its likely to fail?

A

3-4 days to develop a good blood supply

51
Q

When is a skin graft usually used?

A

For limbs where a flap wouldn’t work

52
Q

What types of skin graft can you get?

A

Pinch, punch, strip or stamp. Have slots to allow drainage

53
Q

What nursing care does a patient with a skin graft on a limb need?

A

Need to immobilise the limb - Robert-Jones (leave toes out to monitor blood supply)
Minimal bandage change for first 7 days to minimise disruption, then may need daily changes due to massive amount of fluid!
Need a dressing that wont pull off the new skin - use non-adherent paraffin gauze or silicon mesh

54
Q

When would a drain be required?

A
  • for repeated lavage of an area
  • for repeated aspiration of air or fluid from an area
  • prevention of seromas
55
Q

What is the difference between an active and passive drain?

A

Passive drains rely on gravity and capillary action whereas active have suction apparatus at one end that creates a constant gentle negative pressure

56
Q

What is a Penrose drain ?

A

A passive drain. A latex tube with one end inside wound and one end out. Allows fluid to drain along surface.

57
Q

What nursing care is required for a passive drain?

A

Must have a dressing applied - primapore.

Changes every 2-4 hours or as soon as see any strike through

58
Q

When would an active chest drain be removed?

A

When fluid production decreases to less than 2-4mls/kg/hr

59
Q

What nursing care is required for an active drain?

A
  • Buster collar
  • Body stocking
  • Pain management
  • Fluid intake and output recording
60
Q

What are the positives and negatives of using a passive drain?

A

+ Low cost
+ Can use more drains over the surface area
+ Soft and more comfortable for patient
- Not ideal for large wounds
- gravity
- avoid in air spaces e.g. thorax
- less accurate (harder to assess when to remove)

61
Q

What are the positives and negatives of using an active drain?

A 
\+ More effective 
\+ low infection risk 
\+ portable
\+ no dressings
\+ Monitored/ accurate
\+ Works with the wound (suction will change with amount of fluid being produced)
  • placement
  • clots risk
  • patient interference (less comfortable)
62
Q

What planning should the nurse do when a large skin repair surgery is planned?

A
  • plan wound care in advance
  • schedule as last or only Sx of day
  • Plan home care
  • Good wound management prior to op (elimination of necrotic tissue or infection to increase success)
  • Pre-op diagnostics - is blood results stable?
  • Long GA - prep patient and consider warming asap, also consider dehydration/blood loss
  • Large area skin prep (check clippers)
  • Gentle handling of skin as will affect healing
  • prepare post op bedding and analgesia
  • prepare collars, stocking to prevent interference
  • give some drain dressings away with owner and information sheets

Advanced Patient Care (16 decks)

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