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Integ Fall 2024 > Wound management w infection control > Flashcards

Wound management w infection control Flashcards

1
Q

What is the difference between compliance vs adherence?

A

Compliance: 1 way interaction in which the clinician directs the patient to follow instructions

Adherence: patient freely chooses to follow suggested guidelines

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2
Q

What are some reasons for non-adherence?

A

Unintentional:
- misunderstanding
- forgetfulness

Intentional

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3
Q

What are some ways to promote adherence?

A
  • set mutually agreed-upon, low-risk solutions
  • educate the patient on the “why”
  • provide clear instructions and practice “teach back”
  • inform patient of likely consequences if non-adherent
  • encourage caregiver/support system involvement
  • identify and remove barriers
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4
Q

What are some patient characteristics that would warrant a nutritional screening?

A
  • cachexia
  • emaciation
  • transparent skin
  • pallor
  • dull/thinning hair
  • mouth sores
  • missing or poor dentition
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5
Q

What are some recent dietary history notes that would warrant a nutritional screening?

A
  • significant weight loss
  • grossly inadequate intake of vital nutrients
  • poor understanding of proper nutritional guidelines
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6
Q

What are some wound characteristics that would warrant a nutritional screening?

A
  • chronic wounds
  • slow-healing wounds
  • repeat ulcerations
  • pressure ulcers
  • neuropathic ulcers
  • extensive burns
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7
Q

What are some patient comorbidities that would warrant a nutritional screening?

A
  • Diabetes
  • cancer
  • obesity
  • HIV/AIDS
  • GI dysfunction
  • dysphagia
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8
Q

What is the difference between parenteral and enteral nutrition?

A

Parenteral:
- nutrition delivered intravenously

Enteral:
- nutrition delivered via feeding tube (OG, NG, Nasojejunal, gastrostomy)

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9
Q

What are some common conditions for patients to have nutrition delivery devices?

A
  • comatose patients
  • swallowing problems
  • mechanically ventilated patients
  • GI dysfunction
  • cancer, stroke, ALS
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10
Q

What are the adequate nutrients required for homeostasis, repair, and regeneration?

A
  • water
  • protein
  • carbohydrates
  • fats
  • vitamins
  • minerals
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11
Q

How much water is required for an open wound to heal?

A

2.7-3.7 liters per day to help with healing

apart from patients with medical conditions limiting fluid intake

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12
Q

What are some things tested in the laboratory

A
  • Creatinine
  • serum albumin
  • prealbumin
  • BUN (blood urea nitrogen)
  • total lymphocyte count
  • blood glucose
  • A1c
  • Cholesterol
  • CPK
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13
Q

What does testing for creatinine look at and what are normal values?

A

-kidney function
- protein metabolism

  • 30-170 U/L
  • Male: 52-336 U/L
  • Female: 38-176 U/L
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14
Q

What does testing for serum albumin look at?

A
  • measure of protein deficiency and malnutrition
  • Hepatic cirrhosis, heart failure, malnutrition, Crohn’s disease will have lower levels
  • 3.5-5.2 g/dL
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15
Q

What does testing for prealbumin look at?

A
  • measures results of an intervention sooner b/c of shorter half life
  • 19-39 mg/dL
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16
Q

What does testing for BUN look at?

A
  • indicator of kidney function b/c looking at product of protein metabolism
  • 6-25mL

increased BUN = decreased healing

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17
Q

What does testing for total lymphocyte count look at and what are normal values?

A
  • indirect measurement of nutritional status and immune function
  • 5-10 x 10^9/L
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18
Q

What does testing for blood glucose look at and what are normal levels?

A
  • elevated levels increase risk of ulceration, infection, and impaired wound healing
  • 70-100 mg/dL
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19
Q

What does testing for A1c look at?

A
  • average blood glucose over 3 months
  • <5.7%
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20
Q

What does testing for cholsterol look at?

A
  • HDL, LDL, and VLDL levels
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21
Q

What does testing for CPK look at?

A
  • enzyme found in heart, brain, and muscle that is checked when suspected of having a heart attack
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22
Q

What are normal hematocrit and hemoglobin levels?

A

Hematocrit:
- Men: 42-52%
- Women: 37-47%

Hemoglobin:
- Men: 14-17.4 g/dL
- Women: 12-16 g/dL

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23
Q

What are normal platelet levels?

A

140-400 k/uL

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24
Q

What are some infection control guidelines to protect both the clinician and patient?

A
  • hand hygiene
  • use of PPE
  • Respiratory hygiene/cough etiquette
  • sharps safety
  • safe injection practices
  • sterile instruments/devices
  • clean and disinfected environmental surfaces
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25
Q

What are some contact precautions and examples of this?

A

PPE: gloves and gown

EX: VRE, MRSA, scabies, lice, large non-contained draining wounds

26
Q

What are some droplet precautions and examples of this?

A

PPE: gloves, gown, mask

EX: necrotizing fasciitis, certain PNA’s, influenza

27
Q

What are some airborne precautions and examples of this?

A

PPE: gloves, gown, special mask, negative pressure room

EX: Tuberculosis, measles

28
Q

What is the difference between clean and sterile technique?

A

Clean:
- standard technique using boxed gloves
- intended to reduce/prevent transmission from one location to another

Sterile:
- not warranted for most wound care
- used for immunocompromised pts, severe burns, large surface area wounds, packing deep wounds

29
Q

How are different baceria named?

A

Named via:
- shape: cocci (round), spirilla (spillic), or bacilli (rod)
- reproduction: divide in chains (strept) or divide in clusters (staphly)
- staining appearance: gram-positive (crystal violet - BAD) or gram negative (not as damaging exotoxins)
- growth environment: aerobic or anaerobic

30
Q

What is methicillin-resistant staphylococcus aureus?

A

MRSA
- can live hours to days on surfaces
- can cause cellulitis, osteomyelitis, abscess
- common in blood, stool, and wounds
- treated with Mupirocin

31
Q

What is vancomycin-resistant enterococci?

A

VRE
- common in surgical wounds
- treated with ampicillin-amoxicillin

32
Q

What is pseudomonas aeruginosa?

A
  • gram-negative anaerobe
  • sickly sweet odor
  • appears as a greenish blueish color around the rim
33
Q

What are different types of fungus?

A

Tinea: ringworm

Candida: yeast (warm and wet areas)

34
Q

What are biofilms?

A
  • complex communities of bacteria or fungi held together by a self-produced polymer matrix
  • persist on medical devices, surfaces, and tissues causing chronic infection
35
Q

Where are biofilms found and why are they dangerous?

A
  • generally found on devitalized tissues, implanted devices, and within gastric mucosa
  • biofilms can survive in environments where they normally could not
  • hard to kill and redevelop rapidly

present in 6% acute wounds but up to 60% in chronic wounds

36
Q

What is the pH of skin and about how many microflora are on the skin?

A

pH: 5.5

About 10^3 microbes per gram of skin tissue are on our skin

37
Q

What is the difference between contamination and colonization and are these normal?

A

Contamination: microbes non-replicating

Colonization: replicating microbes

YES, these are both normal

38
Q

What is critical colonization?

A
  • bioburden that reaches a critical point and begins to adversely affect host
  • reaches point of damaging tissue
39
Q

What is infection?

A
  • healthy tissue that becomes damaged
  • replicating microbes invade viable body tissue

can cause infection w/ low concentrations but said to happen when >10^5 microbes per gram of tissue accumulate

40
Q

Why do microbes cause problems?

A
  • compete w/ host cells for available O2 and nutrients
  • bacterial exotoxins may be cytotoxic
  • bacterial endotoxins may activate host inflammatory processes
  • wound infections delay and may prevent wound healing
41
Q

What are characteristics of rubor (redness) if a wound is infected?

A
  • poorly defined erythemal boarder
  • disproportionate
  • may possess red streaks leading out from wound
42
Q

What are characteristics of calor (temperature) if a wound is infected?

A
  • patient may be febrile
  • warmer localized tissue temp spreading over a wider surface area
43
Q

What are characteristics of tumor (swelling) if a wound is infected?

A
  • disproportionate to size and extent of wound
  • may be indurated
44
Q

What are characteristics of dolor (pain) if a wound is infected?

A
  • new onset or increased pain
45
Q

What are characteristics of functio laesa if a wound is infected?

A
  • feeling of malaise or illness
46
Q

What are characteristics of drainage if a wound is infected?

A
  • disproportionate amount - may be copious
  • creamy, thick or purulent consistency
  • white, green, yellow, or blue in color
  • may have distinctive odor
47
Q

What are the characteristics of a declining wound that classify it as infected?

A
  • plateau in healing
  • change in granulation tissue (less, friable, change in color)
48
Q

What is an abscess?

A
  • localized collection of pus, that body can contain but not fight completely
49
Q

What are local risk factors for infection?

A
  • ischemia
  • necrotic tissue
  • wound debris
  • chronic wounds
50
Q

What are host risk factors for infection?

A
  • break in skin integrity
  • diabetes
  • malnutrition
  • obesity
  • steroid use
  • immunocompromise
  • increased age
51
Q

What do wound cultures do?

A
  • confirm the presence or absence of infection
  • swap cultures are used to quantify number and type of bacteria

tissue biopsy is gold standard

52
Q

What are antimicrobial agents used for?

A
  • destroy unicellular organisms
53
Q

What are two methods to treat or prevent infection?

A
  • Topically
  • Systemically
54
Q

What are topical ways to treat or prevent infection?

A
  • creams (8-12 hours) and ointments (8-24 hours)
  • antimicrobial dressings
  • iodine or silver containing dressings
  • topical honey
55
Q

What are systemic ways to treat or prevent infection?

A
  • bactericidal (destroy)
  • bacteriostatic (inhibit cell growth)
  • antifungal (yeasts and mold)
56
Q

What are ways to manage wound infections?

A
  • antimicrobials
  • treatment/prevention of infections
  • debridement of dead tissue
57
Q

What are three antifungals?

A
  • nystatin
  • oxiconazole
  • miconazole
58
Q

What is an antiseptic?

A

Antiseptic: antimicrobial that is cytotoxic
- should be used to disinfect inanimate objects or for washes for intact skin

59
Q

What are some common antibiotic misuses?

A
  • prescribed without infection present (50% deemed unnecessary)
  • wrong antimicrobial prescribed
  • taken incorrectly
60
Q

What are some common adverse drug reactions?

A
  • mild skin reactions, hives
  • difficulty breathing, anaphylactic shock
  • photosensitivity
  • hearing loss
  • fever
  • hepatitis, kidney damage
61
Q

What patients tend to have more reactions to topical antimicrobials?

A
  • patients with venous insufficiency
62
Q

What are some keys for infection prevention?

A
  • handwashing
  • standard precautions
  • manage medical conditions known to increase risk of wound formation
  • proper patient positioning
  • proper skin care
  • proper foot care

Integ Fall 2024 (8 decks)

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