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wound care 2 > wound treatments > Flashcards

wound treatments Flashcards

1
Q

what are the types of selective debridement?

A

sharp, autolytic, enzymatic, biologic

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2
Q

what are the type of non-selective debridements?

A

mechanical and surgical

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3
Q

what is sharps debridement?

A

removal of necrotic tissue by use of sharp instruments

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4
Q

true or false

sharps debridement is non aggressive?

A

false

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5
Q

when is sharp debridement not appropriate?

A

when there is insufficient vascular supply or nutrition

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6
Q

when should precaution be taking with sharp debridement?

A

if taking blood thinners

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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

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8
Q

what is cross hatching?

A

cross pattern used to allow chemical and enzymes to get under eschar

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9
Q

true or false

enzymatic debridement counts as a dressing

A

true

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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
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11
Q

what is autolytic debridement?

A

Natural degradation of devitalized tissues with enzymes or moisture

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12
Q

true or false

autolytic debridement is conservative

A

true

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13
Q

true of false

autolytic debridement is a fast method

A

fasle, its slow

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14
Q

when is autolytic debridement not appropriate?

A

infection or arterial insufficiency

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15
Q

what is enzymatic debridement

A

use of enzymatic ointments to loosen and remove devitalized tissue and proteins

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16
Q

Papain-urea works (outside in/ inside out) while collagenase worse (outside in/inside out)

A

outside in

inside out

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17
Q

true or false

Enzymatic debridement is sometimes slow, nonselective, and may be painful.

A

false

selective

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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

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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
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20
Q

what is biological debridement?

A

larva therapy

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21
Q

how does maggot therapy work?

A

larvae release enzymes that degrade/liquefy necrotic tissue

ingest necrotic tissue and bacteria

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22
Q

what is mechanical debridement?

A

use of external forces to non-selectively remove necrotic tissue

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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

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24
Q

what are types of mechanical debridement?

A

wet-to-dry
gauze
whirlpool
pulsed lavage

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25
Q

what is surgical debridement?

A

use of scalpels, scissors, or lasers in sterile environment and conducted by a physician or podiatrist

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26
Q

what does surgical debridement allow?

A

extensive exploration of wounds bed and debridement of deeper structures.

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27
Q

what are indications of surgical debridement?

A

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

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28
Q

what are contraindications of surgical debridement?

A

pts who are unlikely to survive procedure or pts palliative care plans

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29
Q

what are 4 goals in wound healing debridement?

A

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

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30
Q

what are general considerations for debridement?

A

characteristics of wound
status of pt
existing practice acts
clinician’s knowledge and skill

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31
Q

what should be in documentation for debridement?

A 
physician's orders
selective vs nonselective
location and type
amount of necrotic tissue
amount of necrotic tissue removed
instruments used and setting
CPT codes
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32
Q

what are contraindications for debridement?

A

dry gangrene
eschar that is intact, without drainage, erythema or fluctuance on a patient with poor circulation
unidentified structures in wound bed

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33
Q

what are benefits of hydrotherapy?

A

cleanses wound, promotes circulation, and promotes debridement

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34
Q

what are precautions of hydrotherapy?

A 
malignancy in area
promotes edema
trauma to healthy tissue
may promote maceration
avoid in diabetic wounds
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35
Q

what are precautions/contraindications of whirlpool?

A

clean, macerating, actively bleeding (profuse)
tunneling and undermining
moderate-severe edema (venous insufficiency)
incontinent, confused or combative

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36
Q

when using whirlpool on aterial insufficient wounds, _____ temperatures should be used?

A

lower temps

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37
Q

what are risk of whirlpool?

A

contaminated water and cross contamination
superhydration/maceration of skin
changing of skin pH

38
Q

what are consideration of hydrotherapy?

A 
temp
position
duration of treatment
additives/chemicals
agitation
contamination
clean up
39
Q

non thermal temp =
neutral temp=
thermal temp =

A

80-92 F
92-96 F
96-104F

40
Q

chemical additives added to whirlpool is contraindicated for?

A

chemical wounds, the young, the elderly, and those sensitive to the agents

41
Q

Pulsatile lavave promotes _______ and reduces _________

A

localized circulation

bacterial load

42
Q

how much PSI is pulsatile Lavage

A

5-15 psi

43
Q

what is a reliable, focused alternative to whirlpool for wound cleansing?

A

pulsatile lavage with suction

44
Q

what are positive benefits of pulsatile lavage with suction?

A

minimal risk of cross-contamination
eliminates dependent edema issues
less time needed
pt-specfic

45
Q

when should wounds be irrigated?

A

initial exam and with each dressing

46
Q

irrigation after whirlpool removes _______ times the bacteria when compared to the whirlpool alone and the recommended psi is ____-_____ psi

A

4

4-15

47
Q

what are the benefits of electrotherapy?

A 
increases capillary perfusion
stimulates fibroblast function
increase wound tensile strength
antibacterial effect
debridement effects
migration of inflammatory and repair cells
48
Q

true or false?

application of ES enhanced movement of cells due to bioelectrical potentials, leading to healing

A

true

49
Q

what are contraindications of electrical stimulation?

A 
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
Q

what are three types of electrical stimulation for wound care?

A

direct, periwound, immersion

51
Q

when should positive polarity be used?

A

coagulation of protein
hardening of tissue
coagulation of blood
enhancing congealed scar formation

52
Q

when should negative polarity be used?

A

liquefying protein, softening tissue, bactericidal, debridement

53
Q

what are the parameters of electrical stimulation?

A

45-60 mins
3-7 times per week
50-120 pulses per second
80-150 volts

54
Q

true or false

reimbursement for electrical stimulation as wound care can only be done by a physician

A

fasle, PT can do it also

55
Q

True or false

Ultrasound is effective in all phases of healing?

A

true

56
Q

what are contraindications of ultrasound?

A

over malignancy, over gonads, eyes, over RadRx area, acute DVT, untreated acute wound infection, active bleeding, severe arterial insufficiency, and osteomyelitis

57
Q

what are benefits of ultrasound?

A

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
Q

low frequency ultrasound cavitation causes?

A

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

59
Q

Negative pressure wound therapy (NPWT) works by

A

increasing perfusion to wound thereby increasing oxygen and nutrients to the wound and helps with drainage control

60
Q

When should dressings be changed when using negative pressure therapy?

A

every 48 hours or three times per week

61
Q

What are benefits of NPWT?

A 
decrease edema
increased blood flow
decreased bacterial numbers
fluffier granulation tissue and more of it
promotes epithelialization
62
Q

when is NPWT indicated?

A

arterial, venous, mixed vascular ulcers
dehisced surgical wounds
tunneling or undermining
assisting flap survival

63
Q

when is NPWT not indicated?

A

wounds with more than 20% non-viable tissue present

64
Q

true or false?
Continuous uniform ally applied pull can assist the release of intracellular messengers that mediate growth factor production

A

true

65
Q

contraindications of NPWT

A 
malignancy in wound
untreated osteomyelitits
non-enteric and unexplored fistulas
necrotic tissue with eschar present
exposed blood vessels or organs
66
Q

precautions of NPWT

A

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

67
Q

true or false

NPWT can reduce edema in 3-5 days by half

A

true

68
Q

true or false

NPWT was not effective in securing skin grafts?

A

false

graft take was 40% higher

69
Q

True or false

Traditional wet dry therapy is less effective than NPWT in treating of diabetic foot ulcers?

A

false

60% NPWT closure vs 40% closure in traditional wet dry method

70
Q

what is monochromatic infrared energy?

A

photo energy that produces NO in hemoglobin to deoxygenate blood and wound beds

71
Q

Another name for monochromatic infrared energy?

A

anodyne

72
Q

true or false

Anodyne vasoconstricts blood in the area

A

false

visodilates

73
Q

what is hyperbaric oxygen?

A

machine that administrates 100% oxygen at a pressure greater than sea level

74
Q

what does hyperbaric oxygenation do?

A

promotes angiogenesis and improved oxygen perfusion in blood and plasma hypoxic wounds

75
Q

Benefits of hyperbaric oxygen therapy? (HBOT)

A

hyperoxygenation
neovascularization
increase 02 transport
antibacterial effects

76
Q

how many treatments of HBOT are needed for angiogenesis to occur?

A

10

77
Q

Indications for HBOT?

A 
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
Q

true or false

there are no randomized, controlled trials supporting the use of HBOT to treat neuropathic diabetic foot wounds?

A

true

79
Q

unna boots should not be used for pts who ?

A

cannot ambulate

80
Q

true or false

when applying the Unna boot, apply maximal stretch?

A

false

do not stretch and 1/2 overlap

81
Q 
compression classifications
class 1: 14-18 mmHg
class 2: 18-24 mmHg
class 3: 25-35 mmHg
class 4: 40-50 mmHg
A 
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
Q

what is apligraf?

A

cultured skin substitute made from newborn foreskin tissue which replaces the dermis and epidermis

83
Q

what is a dermagraft?

A

human fibroblast-derived dermal substitute made from newborn foreskin tissue which replaces only dermis

84
Q

what do skin substitutes contain and not contain

A

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
Q

what are indication for apligraf?

A

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

86
Q

what are contraindications of apligraf?

A

bovine collagen allergies or sensitives to the shipping medium

87
Q

Compared to standard compression therapy in ulcers, apligraf therapy was:
8 weeks?
6 months?
at all times?

A

3 times more effective

more than twice as effective

superior to active control for
time to complete wound closure

88
Q

what is Oasis?

A

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
Q

what is Regranex?

A

recombinant human platelet-derived growth factor for topical application

90
Q

what is Regranex indicated for?

A

LE diabetic neuropathic ulcers

91
Q

what is the Regranex protocol?

A

wound bed preparation

apply thin layer of Regranex to DFU daily and cover with moist gauze

Change dressing BID

wound care 2 (2 decks)

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