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Wound Care Exam 2 > Wound Treatments > Flashcards

Wound Treatments Flashcards

1
Q

methods of debridement

A

selective and non-selective

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2
Q

what are 4 types of selective debridement?

A

sharp, autolytic, enzymatic, and biologic

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3
Q

what are 2 types of non-selective debridement?

A

mechanical and surgical

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4
Q

what is sharps debridement?

A

removal of necrotic tissue by use of sharps instruments (forceps, scissors, scalpel, etc)

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5
Q

Sharps debridements is __________, _________, and ________.

A

selective, aggressive, and painful

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6
Q

What is a precaution for sharps debridement?

A

patient taking blood thinners

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7
Q

When is sharps debridement not appropriate?

A

insufficient vascular supply or nutrition

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8
Q

What is the role of debridement?

A

debridement allowed 54% wound reduction compared to wound that were not debrided

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9
Q

When should debriding start?

A

first 4 weeks

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10
Q

when do you terminate sharps debridement? (6)

A
  1. clinician fatigue, 2. pain is not adequately controlled for patient, 3. decline in patient status/tolerance to technique, 4. extensive bleeding, 5. new fascial plane identified, 6. nothing remaining to debride
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11
Q

what is autolytic debridement?

A

natural degradation of devitalized tissues with enzymes or moisture - dressing to occlude wound so moisture/exudate stay in the wound to help with healing

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12
Q

is autolytic debridement a slow or fast method?

A

slow

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13
Q

when is autolytic debridement not appropriate?

A

infection present or arterial insufficiency

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14
Q

autolytic debridement is _______ and _________.

A

conservation and little pain

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15
Q

what is enzymatic debridement?

A

use of enzymatic ointments to loosen and remove devitalized tissue and proteins; enzymes degrade substrate that is holding the slough to the wound

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16
Q

what enzymes are used for enzymatic debridement?

A
  1. papain-urea (tenderizes tissue from outside in) and

2. collagenase (natural enzyme in our body - works from inside out)

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17
Q

enzymatic debridement is ________, _________, and _______.

A

sometimes slow, nonselective (papain-urea), and may be painful
collagenase is selective

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18
Q

when do you terminate enzymatic debridement?

A

once satisfactory debridement has occurred OR if necrotic tissue fails to decrease in expected amount of time

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19
Q

what is the procedure for enzymatic debridement?

A

patient needs prescription, eschar to be crosshatched PRIOR to application, moist environment, observe for S/S of infection, and prophylactic topical antimicrobial therapy PRN

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20
Q

what is another term for biological debridement?

A

larva therapy

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21
Q

why does biological debridement have limited application?

A

squeamish factor

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22
Q

what do they use during biological debridement?

A

use sterile (don’t reproduce) maggots

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23
Q

what is maggot therapy?

A

larvae release enzymes that degrade necrotic tissue, and larvae digest necrotic tissue/bacteria

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24
Q

when is maggot therapy used?

A

pressure wounds, diabetic wounds, traumatic wounds, and chronic leg ulcers

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25
Q

what is mechanical debridement?

A

use of external forces to non-selectively remove necrotic tissue (gauze, wet-to-dry, whirlpool, pulsed lavage)

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26
Q

what can mechnical debridement cause?

A

bleeding and trauma to wound reducing new cells

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27
Q

is mechanical debridement painful?

A

yes

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28
Q

what is surgical debridement?

A

use of scalpels, scissors, or lasers in sterile environment (basically sharps debridement in sterile environment)

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29
Q

surgical debridement is performed by:

A

physician or podiatrist

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30
Q

what is an advantage of surgical debridement?

A

allows for extensive exploration of wounds bed and debridement of deeper tissues

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31
Q

what are indications for surgical debridement?

A

ascending cellulitis, osteomyelitis, extensive necrotic wounds, undermining, and necrotic tissue near vital organs

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32
Q

what are the contraindications for surgical debridement?

A

patients who are unlike to survive procedure; palliative care plans

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33
Q

What are the procedures for surgical debridement?

A

shaving of eschar, incision and drainage, tissue biopsy, and antimicrobial therapy

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34
Q

What are the goals of wound healing with debridement?

A
  1. promote cleansing to remove debris and necrosis
  2. reduce bacteria and risk of infection
  3. promote optimal environment
  4. promote inflammation to facilitate angiogensis
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35
Q

what are 4 general considerations for debridement?

A
  1. characteristics of wounds, 2. status of patient, 3. existing practice acts, and 4. clinical knowledge/skill level
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36
Q

what are contraindications for debridement?

A
  1. dry gangrene, 2. eschar that is intact (without drainage, erythema or fluctuance on a patient with poor circulation) and 3. unidentified structures in wound bed
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37
Q

what are the benefits of hydrotherapy (whirlpool)?

A

cleanse wound, promote circulation and debridement

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38
Q

what are the precautions of hydrotherapy (whirlpool)?

A

malignancy in area, increases edema, trauma to healthy tissue, promote maceration, and avoid diabetic wounds, also cautious with venous insufficiency wounds

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39
Q

what type of wounds should you avoid with hydrotherapy?

A

diabetic wounds - watch for maceration

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40
Q

what are some precautions/contraindications of hydrotherapy?

A

wounds that are:

  1. clean, macerating, actively bleeding
  2. tunneling, undermining wounds
  3. arterial insufficient wounds
  4. > 50% clean wound
  5. moderate-severe edema (venous insufficiency)
  6. incontinent and confused patients
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41
Q

what are hydrotherapy risks?

A

infection, superhydration (maceration of skin), and changing of skin pH

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42
Q

what are some hydrotherapy considerations?

A

water temperature, position of patient, duration of treatment, and additives/chemicals

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43
Q

what are the 3 water temperatures?

A
  1. non-thermal (80-92 F)
  2. neutral (92-96 F)
  3. thermal (96-104 F)
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44
Q

cross hatching

A

form of sharps debridement of the eschar that lets moist wound dressing or ointment get into the wound

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45
Q

What should you think about when making a decision to use hydrotherapy?

A

positioning, temperature, time, agitation, contamination, and clean up

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46
Q

what does pulsatile lavage promote?

A

LOCALIZED circulation

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47
Q

what does pulsatile lavage reduce?

A

bacteria load

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48
Q

what is pulsatile lavage?

A

debridement using high pressure jet system

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49
Q

For pulsatile lavage with suction, what are some benefits?

A

minimal risk of cross-contamination, eliminates edema issues, more focused cleansing, patient-specific supplies

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50
Q

what are some types of wound irrigation?

A

syringe/gauze, saline, wound cleansers, betadine, hydrogen peroxide, dakin’s solution, acetic acid

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51
Q

when would you use acetic acid?

A

psudomonas infections for about 2 weeks

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52
Q

what are adverse reactions of acetic acid?

A

cytotoxic to human cells

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53
Q

what is Dakin’s solution made from?

A

bleach

54
Q

what are adverse reactions to Dakin’s solution?

A

cytotoxic to human cells

55
Q

what is Dakin’s solution used for?

A

infection and odor

56
Q

When do you use hydrogen peroxide?

A

first 48 hours after injury, infection, inflammatory phase only

57
Q

What are adverse reactions to hydrogen peroxide?

A

cytotoxic to human cells

58
Q

When do you use Betadine?

A

infection and exudate control - effective for large amounts of drainage

59
Q

what is the method for using wound irrigation?

A

use saline/tap water, minimal force, recommended pressure of 4-15 psi

60
Q

irritation after whirlpool removes ____ the bacteria when compared tot he whirlpool alone.

A

4x

61
Q

what are the benefits of electrotherapy?

A

increase capillary perfusion, stimulates fibroblasts, increases wound tensile strength, antibacterial effect, debridement effects, and migration of inflammatory and repair cells

62
Q

“current of injury”

A

electrical potential across the skin

63
Q

Na+ ion pump: surface epidermis __________

A

negative

64
Q

With injury, current flows between _____ and ____ layers; _________ flow of ions with polarity switching

A

outer and inner layers; unidirectional

65
Q

First _____ mm of periwound skin has charge; there is no charge ___ mm from wound edge

A

1-2 mm; 3 mm

66
Q

True or False: current does NOT disappear with regeneration of tissues

A

False; it does disappear

67
Q

_____________ maintains higher electrical potential.

A

moisture

68
Q

what does application of Electrical Stimulation do?

A

enhance movement of cells due to the bioelectrical potentials, leading to healing

69
Q

Contraindications to electrical stimulation

A

ALOT - pg 8 of powerpoint

70
Q

Precautions to electrical stimulation

A

osteomyelitis responding to antibiotics

71
Q

What are the 3 methods of electrical stimulation?

A
  1. direct, 2. periwound, 3. immersion
72
Q

What kind of impregnated gauze do you use with electrical stimulation

A

saline or hydrogel

73
Q

where are the carbon electrodes located?

A

over wound and other is 15-20cm proximal or opposite side of extremity

74
Q

what are the parameters for electrical stimulation? (time, frequency, voltage and pps)

A
  1. time: 45-60 minutes
  2. frequency: 3-7x per week
  3. pps: 50-120 pulses per second
  4. voltage: 80-150 volts
75
Q

is electrical stimulation reimbursed?

A

yes - AFTER no changes in wound for 30 days

76
Q

What does positive polarity do when associated with ES?

A
  1. coagulation of protein, 2. hardening of tissue, 3. coagulation of blood, 4. enhancing congealed scar formation
77
Q

what does negative polarity do when associated with ES?

A
  1. liquefying proteins, 2. softening tissue, 3. bactericidal, 4. debridement
78
Q

When is non-thermal US for wound healing indicated?

A

non-necrotic wounds after documented standard wound care has been used for at least 30 days with no measurable sign of healing

79
Q

What is US NOT used over?

A

malignancy, gonads, eyes, RadRx area, and DVT

80
Q

What are US benefits (3)

A
  1. stimulates release of chemotaxic agents by fibroblasts, mast cells and macrophages = reduce inflammatory phase
  2. stimulate fibroblasts proliferation for collagen deposition, improved granulation, tissue formation, angiogensis and wound contraction
  3. increases wound tensile strength
81
Q

What are US contraindications?

A

osteomyelitis, active bleeding, severe arterial insufficiency, acute DVT, untreated wound infection

82
Q

What are the 3 methods of US?

A

direct, periwound, and immersion

83
Q

What do you use to fill the depth of the wound for US?

A

saline or hydrogel and cover wound with semipermeable filt or sheet hydrogel - then apply US gel

84
Q

With low frequency US, what does cavitation cause?

A

destruction of bacteria, helps with selective dissection and fragmentation of necrosis, and irrigation for cleansing

85
Q

What does VAC/ NPWT help with?

A

increase perfusion to wound (increase oxygen and nutrients) and helps with drainage control

86
Q

when do you change dressings for NPWT?

A

every 48 hours (3 days a week)

87
Q

With NPWT, what does the closed, localized negative pressure promote?

A

healing…. by 1. decreased edema, 2. increased blood flow, 3. decreased bacteria, 4. more granulation tissue, and 5. promotes epithelialization

88
Q

What is NPWT indicated for?

A

arterial, venous, pressure, mixed vascular ulcers, dehisced surgical wounds, wounds with tunneling/undermining, flap graft

89
Q

When is NPWT not indicated?

A

wounds with >20% non-viable tissue present

90
Q

What does intermittent NPWT help with?

A

increase the amount and speed of granulation tissue formation

91
Q

what does continuous NPWT help with?

A

the release of intracellular messengers that mediate growth factor production

92
Q

Contraindications for NPWT

A

malignancy, osteomyelitis, unexplored fistulas, necrotic tissue with eschar, and exposed blood vessels

93
Q

What are the precautions for NPWT

A

active bleeding, anticoagulants, enteric fistula, and close proximity to blood vessels/organs/bony fragments

94
Q

what is monochromatic infrared energy - anodyne?

A

photo energy that produces nitric oxide in hemoglobin to reoxygenate blood and wound bed

95
Q

what does monochromatic infrared energy do?

A

vasodilates blood in the area

96
Q

HBOT administers ____ oxygen at a pressure greater than sea level

A

100%

97
Q

What are the parameters for HBOT treatment?

A

1-2x a day; 90-120 minutes per treatment

98
Q

what does HBOT promote?

A

angiogenesis and improved oxygen perfusion in blood and plasma hypoxic wounds

99
Q

Benefits of HBOT in wound healing

A

hyperoxygenation, helps with oxygen transport, neovascularization, antibacterial effects

100
Q

Hyperoxygenation increases: (3)

A
  1. alveolar pO2, 2. blood oxygen transport, 3. tissue pO2
101
Q

how many HBOT treatments for angiogenesis to occur?

A

10

102
Q

How does HBOT have antibacterial effects?

A

converts anaerobic wounds with low pH to aerobic wounds with a normal pH

103
Q

HBOT provides >30 mmHg which helps with what biochemical reactions in the phases of wound healing? (5)

A
  1. fibroblasts function, 2. leukocyte function, 3. infection control, 4. new capillary growth, 5. epithelial coverage
104
Q

What are some indications for HBOT (what kinds of ulcers can you use this on?)

A

diabetic LE ulcers, skin grafts/flaps, oseoradionecrosis, ST radionecrosis, arterial insufficiency, crush injuries, necrotizing faciitis, gas gangrene, chronic osteomyelitis

105
Q

What do compression bandages do?

A

reduce and control edema

106
Q

How should you wrap compression bandages?

A

distal to proximal; overlap 25-50%

107
Q

what does the ABI have to be for compression bandages?

A

0.6-0.8

108
Q

What is a precaution for compression bandages?

A

CHF

109
Q

what patients should you not use an Ulna boot on?

A

non-ambulatory patients

110
Q

OTC compression therapy is used primarily for?

A

maintenance of edema reduction and wound prevention

111
Q

What is the pressure requirements for class 1 compression?

A

14-18 mmHg

112
Q

What is the pressure requirements for class 2 compression?

A

18-24 mmHg

113
Q

what is the pressure requirement for class 3 compression?

A

25-35 mmHg

114
Q

what is the pressure requirement for class 4 compression?

A

40-45 mmHg

115
Q

What is class 1 compression used for?

A

edema prevention, DVT prophylaxis, and nonambulatory patients

116
Q

what is class 2 compression used for?

A

dependent edema, and failure with class 1

117
Q

what is class 3 compression used for?

A

venous insufficiency, exercising patient, edema -/+ ulcer, >6 mon ulcer, and failed class 1-2

118
Q

what is class 4 compression used for?

A

lymphedema

119
Q

what are the 2 examples of bioengineered skin substitutes?

A

apligraf, and dermagraft

120
Q

what is apligraf made from?

A

newborn foreskin tissue which replaces dermis and epidermis

121
Q

what is dermagraft made from?

A

newborn foreskin tissue which replaces dermis ONLY (human fibroblast- derived dermal substitute)

122
Q

what does apligraf contain?

A

viable dermal and epidermal layers with matrix proteins, active cytokines

123
Q

what does apligraf not contain?

A

melanocytes, macrophages, lymphocytes, or blood vessels, hair follicles or sweat glands

124
Q

when is apligraf indicated?

A

non-infected venous ulcers of >1 mon duration that have not responded to adequately to conventional therapy

125
Q

what is a contraindication to apligraf?

A

bovine collagen allergies (sensitive to the shipping medium)

126
Q

What is OASIS?

A

biosynthetics that are derived from porcine small intestinal submucosa (SIS)

127
Q

Oasis is a temporary dressing for what?

A

partial and full-thickness loss wounds from pressure, vascular, diabetic, thermal, and surgical origins

128
Q

What does Oasis consist of?

A

collagenous, ECM with cytokines and cell adhesion molecultes that support tissue repair

129
Q

What is an example of a topical growth factor?

A

regranex

130
Q

what type of ulcer is Regranex indicated for?

A

LE diabetic neuropathic ulcers

131
Q

what is the regranex protocol?

A

wound bed preparation, apply thin layer of regranex to DFU daily, cover with moist gauze, and change dressing BID

132
Q

Evaluation of Wound Treatment

A

last slide of the “wound treatment” lecture - long list that is a waste of time to memorize.

Wound Care Exam 2 (4 decks)

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