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Woundcare Flashcards

1
Q

specific measures that set payments/penalties in healthcare

A

quality measures

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2
Q

3 parts of healthcare triple aim

A
  1. improved pt outcome
  2. improved pt satisfaction
  3. lower, efficient cost of care
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3
Q

IMPACT quality measure domains are all related to _______________

A

therapy

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4
Q

4 risk factors for pressure ulcers

A
  1. loss of continence
  2. immobility
  3. poor nutrition
  4. impaired mental awareness
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5
Q

3 primary prevention guidelines for diabetics

A
  1. education
  2. physical activity
  3. lifetime wellness
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6
Q

best treatment for wound care

A

prevention

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7
Q

term to use instead of education

A

health literacy

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8
Q

goal of healing a wound

A

create an ideal wound environment

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9
Q

4 parts of an ideal wound environment

A
  1. moist not wet
  2. clean not sterile
  3. free from stress
  4. healing needs to occur from base up
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10
Q

cellular migration is dependent on __________ for transportation

A

water

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11
Q

wounds are not a ______ environment

A

sterile

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12
Q

describe the difference between internal and external forces that cause trauma to tissue

A

internal: edema
external: shearing, pressure

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13
Q

fluid that is stagnant in body

A

abcess

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14
Q

infection vs colonization

A

infection: active destructive process
colonization: infection present but no longer causing damage

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15
Q

9 types of wounds

A
  1. pressure ulcers
  2. venous stasis/arterial ulcers
  3. diabetic ulcers
  4. surgical sites
  5. burns
  6. traumatic wounds
  7. skin tears
  8. kennedy terminal ulcer
  9. deep tissue injury
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16
Q

6 causes of wounds

A
  1. pressure
  2. shearing
  3. circulation probs
  4. infection
  5. trauma
  6. disease process
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17
Q

pressure ulcers are not ____________

A

age-dependent

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18
Q

how are pressure ulcers staged?

A

numbers

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19
Q

pressure ulcers are usually located in these two places:

A
  1. bony prominences

2. between contracture sites

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20
Q

non blanchable erythema is seen in…

A

stage I pressure ulcer

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21
Q

in stage I of a pressure ulcer, the skin is usually _____

A

intact

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22
Q

what layer of skin are stage II pressure ulcers primarily found in?

A

epidermis

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23
Q

main diff between stage I vs II

A

skin breaks in stage II

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24
Q

stage II often presents as a ______

A

blister

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25
Q

what stage of pressure ulcer would a skin tear fall under?

A

II

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26
Q

3 modalities used on stage II pressure ulcers

A

whirlpool, periwound, ultrasound

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27
Q

stage III ulcer = _________ skin loss

A

full thickness

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28
Q

stage III: damage or necrosis to ______ tissue

A

subcutaneous

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29
Q

depth of the wound in stage III commonly describe as a _____

A

crater

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30
Q

for stage III treatment, focus on cleaning the ______ of the wound

A

base

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31
Q

stage III modalities (3)

A
  1. high volt pulse current aka stim
  2. pulsed lavage
  3. whirlpool
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32
Q

stage IV pressure ulcer presents with extensive _______ to bone, muscle or other underlying structures

A

destruction

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33
Q

is stage IV painful?

A

no

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34
Q

stage IV at high risk for _________

A

infection

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35
Q

stage IV may need this for treatment

A

graft to close wound

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36
Q

when you can’t see the base of a pressure ulcer, what stage is it?

A

unstageable

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37
Q

a wound is deemed unstageable due to covering of _____________

A

necrotic tissue

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38
Q

name of wound that occurs in pts who are imminently dying

A

kennedy terminal ulcer

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39
Q

shape/characteristics of kennedy terminal ulcer

A

butterfly or pear

transitions from red –> black very rapidly

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40
Q

location of kennedy terminal ulcer

A

sacrum

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41
Q

time span between kennedy terminal ulcer development and death of pt

A

8-24 hr

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42
Q

pressure-related injury to subcutaneous tissues under intact skin

A

deep tissue injury (DTI)

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43
Q

appearance of DTI

A

deep bruise

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44
Q

DTIs may cause development of a stage ________ pressure ulcer even with optimal treatment

A

III-IV

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45
Q

80-90% of LE ulcers

A

venous stasis ulcers

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46
Q

up to 1/3 of treated venous stasis pts experience…

A

4+ episodes of recurrence

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47
Q

cause of venous stasis

A

dec venous return from legs due to one-way valve failure

48
Q

venous stasis ulcers are staged by….

A

description

partial thickness vs full thickness

49
Q

skin characteristics in pts with venous stasis

A

shiny, hairless, flaky skin

50
Q

what increases venous stasis ulcer pts pain?

51
Q

what decreases venous stasis ulcer pts pain?

52
Q

hallmark sign of longterm VS problems

A

hemosiderin deposits aka permanent black marks

53
Q

cause of hemosiderin deposits

A

holes in arteries and veins that cause leakage of blood and permanent discoloration

54
Q

contraindication to venous stasis ulcers

55
Q

main VS treatment

A

edema reduction, mobility increase

56
Q

arterial ulcers have what affect on the pedal pulse?

A

dec or diminished

57
Q

what causes increased pain in arterial ulcer pts?

A

gait and elevation

decreased w rest

58
Q

where are arterial ulcers normally located?

A

lower 1/3 of leg, toes, interdigital spaces

59
Q

true arterial ulcers are _____

60
Q

what position would you not put an arterial ulcer pt in?

A

LE elevated - we want to position them in a dependent position

61
Q

where are DPN ulcers found?

A

plantar aspect of feet

62
Q

hugely important DPN ulcer treatment

A

education on skin inspection, disease process, and proper footwear

63
Q

3 characteristics of DPN ulcers

A

callouses, thick toenails, hair loss

64
Q

primary vs secondary intention closure

A

primary: wound completely closed up
secondary: wound left open to heal naturally

65
Q

skin grafts have a ________ potential to heal

66
Q

_______ required for treating burns

A

special training

67
Q

skin tears are common in geriatric pts with _________

A

“onion skin”

68
Q

8 factors of wound eval

A
  1. size (lengthxwidth)
  2. depth
  3. undermining/tunneling
  4. necrotic tissue
  5. exudate (type/amt)
  6. periwound integrity
  7. granulation tissue
  8. epithelialization
69
Q

allows for early detection and prevention of pressure ulcers

A

ultrasound scanning

70
Q

uses computerized pad that measures surface and deep pressures in sitting/lying pts

A

pressure mapping

71
Q

without _______, the would will not heal

A

inflammation

72
Q

length of inflammatory phase

73
Q

purpose of vasoconstriction/vasodilation in inflammatory phase

A

VC: clotting

VD: migration of neutrophils, macrophages, GFs

74
Q

neovascularization occurs during which phase of healing?

A

inflammation

75
Q

4 parts of proliferation

A
  1. GFs for collagen synthesis
  2. wound contraction
  3. granulation
  4. epithelialization
76
Q

proliferation length

A

5 days to 2-3 weeks

77
Q

3 parts of maturation

A
  1. collagen fiber reorination/remodeling
  2. inc in tensile strength
  3. scar reduction
78
Q

how long does it take to regain 80% of original strength?

79
Q

5 types of debridement

A
  1. surgical
  2. sharp
  3. mechanical
  4. enzymatic
  5. autolytic
80
Q

surgical debridement is necessary for which stages of wounds?

A

III and IV

81
Q

how does surgical debridement accelerate healing?

A

restarting inflammatory phase of healing

82
Q

surgical debridement usually requires:

A

anesthesia in OR

83
Q

sharp debridement does not require:

A

anesthesia

84
Q

sharp debridement is not recommended for these two populations

A

diabetics and pts on blood thinners - may cause bleeding

85
Q

nonselective removal of tissue with wet to dry dressing, whirlpool

A

mechanical debridement

86
Q

2 cons to mechanical debridement

A
  1. significant time and delayed healing

2. painful to some pts

87
Q

selective debridement using chemicals

88
Q

is enzymatic debridement painful?

89
Q

selective debridement by endogenous enzymes

90
Q

downside of autolytic debridement

A

v time consuming

91
Q

dry wounds prevent _____________

A

migration of granulating tissue

92
Q

alcohol ____ the skin and can cause _____

A

dries; breaking

93
Q

rubbing a reddened area causes more ________________

A

ischemia and tissue destruction

94
Q

colonization wounds will heal by…..

A

secondary intention

95
Q

all open wounds are colonized by ______

96
Q

infection causes ____ but ______ cellular destruction

A

local; extensive

97
Q

4 colonization wound characteristics

A
  1. inflammation
  2. periwound erythema
  3. odor present before cleaning
  4. exudate
98
Q

4 steps to cleaning a wound

A
  1. saline or sterile water
  2. clean technique
  3. hand washing technique
  4. infection control procedures
99
Q

4 things to not clean a wound with

A
  1. Dakin’s solution
  2. povidone-iodine
  3. acetic acid
  4. hydrogen peroxide
100
Q

name the modality:

application of electrical current through electrodes applied directly to the skin in close proximity to ulcer

A

high volt pulsed current

HVPC

101
Q

5 indications to use HVPC

A
  1. III/IV ulcers
  2. arterial ulcers
  3. diabetic ulcers
  4. venous stasis ulcers
  5. wound sizes 1cmx1cm>
102
Q

2 contraindications to HVPC

A

active cancers

osteomyelitis

103
Q

pulsed lavage is an example of which type of debridement?

A

mechanical

104
Q

4 types of wounds that pulsed lavage can be used on

A
  1. tunneling wounds
  2. infected surgical sites
  3. pressure sores
  4. diabetic and venous stasis ulcers
105
Q

what are the contraindications to pulsed lavage?

A

there are none

~trick question~

106
Q

what phase of healing is whirlpool believed to affect?

A

inflammation phase

107
Q

name dat modality:

use of high changing frequency electromagnetic fields to affect the polarized water molecules and enhance circulation to a small area

A

electromagnetic/diathermy

108
Q

name dat modality:

mechanical vibration delivered at a frequency above the range of human hearing

A

ultrasound

109
Q

effect of ultrasound on inflammatory phase

A

release of histamine –> attracts neutrophils and monocytes to injured site

110
Q

effect of ultrasound on proliferative phase

A

stimulate collagen secretion from fibroblasts - increase tensile strength of tissue

111
Q

ABI

A

ankle brachial index

112
Q

ABI equation

A

systolic BP LE/systolic BP UE

113
Q

if ABI <1…

A

ischemia - not a candidate for wraps

114
Q

modality that removes interstitial fluid from wound bed and allows migration of granulation tissue

A

VAC

vacuum assisted closure

115
Q

pattern for edema wrapping

A

circumferential

116
Q

during wrapping, every time you cross over, what does it do to the pressure?

E&I (13 decks)

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