wound treatments Flashcards
1
Q
what are the types of selective debridement?
A
sharp, autolytic, enzymatic, biologic
2
Q
what are the type of non-selective debridements?
A
mechanical and surgical
3
Q
what is sharps debridement?
A
removal of necrotic tissue by use of sharp instruments
4
Q
true or false
sharps debridement is non aggressive?
A
false
5
Q
when is sharp debridement not appropriate?
A
when there is insufficient vascular supply or nutrition
6
Q
when should precaution be taking with sharp debridement?
A
if taking blood thinners
7
Q
wounds that are debrided within the first four weeks have a median wound reduction of _____% higher than wounds that were not debrided.
A
54
8
Q
what is cross hatching?
A
cross pattern used to allow chemical and enzymes to get under eschar
9
Q
true or false
enzymatic debridement counts as a dressing
A
true
10
Q
termination of sharp debridement should occur when?
A
clinician fatigues pain is not controlled decline in pt status or tolerance extensive bleeding new fascial plane is identified nothing remaining to debride
11
Q
what is autolytic debridement?
A
Natural degradation of devitalized tissues with enzymes or moisture
12
Q
true or false
autolytic debridement is conservative
A
true
13
Q
true of false
autolytic debridement is a fast method
A
fasle, its slow
14
Q
when is autolytic debridement not appropriate?
A
infection or arterial insufficiency
15
Q
what is enzymatic debridement
A
use of enzymatic ointments to loosen and remove devitalized tissue and proteins
16
Q
Papain-urea works (outside in/ inside out) while collagenase worse (outside in/inside out)
A
outside in
inside out
17
Q
true or false
Enzymatic debridement is sometimes slow, nonselective, and may be painful.
A
false
selective
18
Q
when should termination of enzymatic debridement occur?
A
once satisfactory debridement has occurred
when necrotic tissue fails to decrease in expected amount of time
19
Q
what is the procedure of enzymatic debridement?
A
- Follow manufacturer’s guidelines
- Physician’s prescription
- Eschar to be crosshatched prior to application
- Moist environment
- Observe for signs and symptoms of infection
- Prophylactic topical antimicrobial therapy prn
20
Q
what is biological debridement?
A
larva therapy
21
Q
how does maggot therapy work?
A
larvae release enzymes that degrade/liquefy necrotic tissue
ingest necrotic tissue and bacteria
22
Q
what is mechanical debridement?
A
use of external forces to non-selectively remove necrotic tissue
23
Q
true or false?
Mechanical debridement is painful, selective, and can cause bleeding and trauma to wound reducing the new cells?
A
false
nonselective
24
Q
what are types of mechanical debridement?
A
wet-to-dry
gauze
whirlpool
pulsed lavage
25
what is surgical debridement?
use of scalpels, scissors, or lasers in sterile environment and conducted by a physician or podiatrist
26
what does surgical debridement allow?
extensive exploration of wounds bed and debridement of deeper structures.
27
what are indications of surgical debridement?
ascending cellulitis, osteomyelitis, extensive necrotic wounds, undermining, necrotic tissue near vital organs/structure
28
what are contraindications of surgical debridement?
pts who are unlikely to survive procedure or pts palliative care plans
29
what are 4 goals in wound healing debridement?
promote wound cleansing to remove debridement and necrosis
reduce bacterial bioburden and reduce risk of infection
promote optimal environment for wound healing
promote inflammation to facilitate angiogenesis
30
what are general considerations for debridement?
characteristics of wound
status of pt
existing practice acts
clinician's knowledge and skill
31
what should be in documentation for debridement?
```
physician's orders
selective vs nonselective
location and type
amount of necrotic tissue
amount of necrotic tissue removed
instruments used and setting
CPT codes
```
32
what are contraindications for debridement?
dry gangrene
eschar that is intact, without drainage, erythema or fluctuance on a patient with poor circulation
unidentified structures in wound bed
33
what are benefits of hydrotherapy?
cleanses wound, promotes circulation, and promotes debridement
34
what are precautions of hydrotherapy?
```
malignancy in area
promotes edema
trauma to healthy tissue
may promote maceration
avoid in diabetic wounds
```
35
what are precautions/contraindications of whirlpool?
clean, macerating, actively bleeding (profuse)
tunneling and undermining
moderate-severe edema (venous insufficiency)
incontinent, confused or combative
36
when using whirlpool on aterial insufficient wounds, _____ temperatures should be used?
lower temps
37
what are risk of whirlpool?
contaminated water and cross contamination
superhydration/maceration of skin
changing of skin pH
38
what are consideration of hydrotherapy?
```
temp
position
duration of treatment
additives/chemicals
agitation
contamination
clean up
```
39
non thermal temp =
neutral temp=
thermal temp =
80-92 F
92-96 F
96-104F
40
chemical additives added to whirlpool is contraindicated for?
chemical wounds, the young, the elderly, and those sensitive to the agents
41
Pulsatile lavave promotes _______ and reduces _________
localized circulation
| bacterial load
42
how much PSI is pulsatile Lavage
5-15 psi
43
what is a reliable, focused alternative to whirlpool for wound cleansing?
pulsatile lavage with suction
44
what are positive benefits of pulsatile lavage with suction?
minimal risk of cross-contamination
eliminates dependent edema issues
less time needed
pt-specfic
45
when should wounds be irrigated?
initial exam and with each dressing
46
irrigation after whirlpool removes _______ times the bacteria when compared to the whirlpool alone and the recommended psi is ____-_____ psi
4
| 4-15
47
what are the benefits of electrotherapy?
```
increases capillary perfusion
stimulates fibroblast function
increase wound tensile strength
antibacterial effect
debridement effects
migration of inflammatory and repair cells
```
48
true or false?
| application of ES enhanced movement of cells due to bioelectrical potentials, leading to healing
true
49
what are contraindications of electrical stimulation?
```
basal or squamous carcinoma
active osteomyelitits
residue of silver, iodine, or beta dine
pacemaker
wound over heart region, carotid sinus, or larynx
acute arterial occlusive disease
local radiation
DVT or thrombosis
metal implants
pregnancy
A fib
ventricular arrhythmia
```
50
what are three types of electrical stimulation for wound care?
direct, periwound, immersion
51
when should positive polarity be used?
coagulation of protein
hardening of tissue
coagulation of blood
enhancing congealed scar formation
52
when should negative polarity be used?
liquefying protein, softening tissue, bactericidal, debridement
53
what are the parameters of electrical stimulation?
45-60 mins
3-7 times per week
50-120 pulses per second
80-150 volts
54
true or false
| reimbursement for electrical stimulation as wound care can only be done by a physician
fasle, PT can do it also
55
True or false
| Ultrasound is effective in all phases of healing?
true
56
what are contraindications of ultrasound?
over malignancy, over gonads, eyes, over RadRx area, acute DVT, untreated acute wound infection, active bleeding, severe arterial insufficiency, and osteomyelitis
57
what are benefits of ultrasound?
stimulates release of chemoattractants by fibroblast, mast cells and macrophages to reduce inflammatory phase
may stimulate fibroblast proliferation for collagen deposition, improved granulation tissue formation, angiogenesis and wound contraction
increases wound tensile strength
58
low frequency ultrasound cavitation causes?
destruction of bacteria, helps with selective dissection and fragmentation of necrosis, and irrigation for cleansing
59
Negative pressure wound therapy (NPWT) works by
increasing perfusion to wound thereby increasing oxygen and nutrients to the wound and helps with drainage control
60
When should dressings be changed when using negative pressure therapy?
every 48 hours or three times per week
61
What are benefits of NPWT?
```
decrease edema
increased blood flow
decreased bacterial numbers
fluffier granulation tissue and more of it
promotes epithelialization
```
62
when is NPWT indicated?
arterial, venous, mixed vascular ulcers
dehisced surgical wounds
tunneling or undermining
assisting flap survival
63
when is NPWT not indicated?
wounds with more than 20% non-viable tissue present
64
true or false?
Continuous uniform ally applied pull can assist the release of intracellular messengers that mediate growth factor production
true
65
contraindications of NPWT
```
malignancy in wound
untreated osteomyelitits
non-enteric and unexplored fistulas
necrotic tissue with eschar present
exposed blood vessels or organs
```
66
precautions of NPWT
active bleeding
anticoagulants
close proximity to blood vessels, organs or bony fragments
enteric fistula
67
true or false
| NPWT can reduce edema in 3-5 days by half
true
68
true or false
| NPWT was not effective in securing skin grafts?
false
| graft take was 40% higher
69
True or false
| Traditional wet dry therapy is less effective than NPWT in treating of diabetic foot ulcers?
false
| 60% NPWT closure vs 40% closure in traditional wet dry method
70
what is monochromatic infrared energy?
photo energy that produces NO in hemoglobin to deoxygenate blood and wound beds
71
Another name for monochromatic infrared energy?
anodyne
72
true or false
| Anodyne vasoconstricts blood in the area
false
| visodilates
73
what is hyperbaric oxygen?
machine that administrates 100% oxygen at a pressure greater than sea level
74
what does hyperbaric oxygenation do?
promotes angiogenesis and improved oxygen perfusion in blood and plasma hypoxic wounds
75
Benefits of hyperbaric oxygen therapy? (HBOT)
hyperoxygenation
neovascularization
increase 02 transport
antibacterial effects
76
how many treatments of HBOT are needed for angiogenesis to occur?
10
77
Indications for HBOT?
```
diabetic LE wounds Grade 3 or higher or not responding to conservative treatment after 30 days
compromised skin grafts
osteoradionecrosis
soft tissue radio necrosis
acute arterial insufficiency
crush injuries
necrotizing fasciitis
gas gangrene
chronic osteomyelitits
```
78
true or false
| there are no randomized, controlled trials supporting the use of HBOT to treat neuropathic diabetic foot wounds?
true
79
unna boots should not be used for pts who ?
cannot ambulate
80
true or false
| when applying the Unna boot, apply maximal stretch?
false
| do not stretch and 1/2 overlap
81
```
compression classifications
class 1: 14-18 mmHg
class 2: 18-24 mmHg
class 3: 25-35 mmHg
class 4: 40-50 mmHg
```
```
class 1:
edema prevention
DVT prophylaxis
nonambulatory pts
Class 2:
dependent edema
failure with class 1
Class 3:
venous insufficiency
exercising pt
edema ulcer
ulcer greater than 6 months
failed class 1 and 2
Class 4:
lymphedema
```
82
what is apligraf?
cultured skin substitute made from newborn foreskin tissue which replaces the dermis and epidermis
83
what is a dermagraft?
human fibroblast-derived dermal substitute made from newborn foreskin tissue which replaces only dermis
84
what do skin substitutes contain and not contain
contain viable dermal and epidermal layers with matrix proteins, active cytokines
do not dontain melanocytes, macrophages, lymphocytes, or blood vessels, hair follicles or sweat glands
85
what are indication for apligraf?
non-infected venous ulcers of >1 month duration that have not responded adequately to conventional therapy
86
what are contraindications of apligraf?
bovine collagen allergies or sensitives to the shipping medium
87
Compared to standard compression therapy in ulcers, apligraf therapy was:
8 weeks?
6 months?
at all times?
3 times more effective
more than twice as effective
superior to active control for
time to complete wound closure
88
what is Oasis?
derived from porcine small intestine submucosa
collegenous, extracellular matrix with cytokines and cell adhesion molecules that support tissue repair
temporary dressing for partial and full thickness loss wounds from pressure, vascular, diabetic, thermal, and surgical origins
89
what is Regranex?
recombinant human platelet-derived growth factor for topical application
90
what is Regranex indicated for?
LE diabetic neuropathic ulcers
91
what is the Regranex protocol?
wound bed preparation
apply thin layer of Regranex to DFU daily and cover with moist gauze
Change dressing BID
