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Fundamentals of PT > Wounds > Flashcards

Wounds Flashcards

1
Q

What phase is a non-healing wound stuck in?

A

Stuck in the inflammation phase

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2
Q

What is a chronic wound?

A

An injury to the integument that has failed to heal by the generally predictable events that occur through the phases of wound healing

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3
Q

What are common barriers to wound healing (memorize!!)?

A

Inadequate microcirculation
Prolonged pressure from interstitial edema
Bacterial infection
Absence of adequate electrical potential

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4
Q

What are common barriers to wound healing (2)?

A 
Tissue perfusion/oxygenation
Nutrition
Presence/abscence of infection
DM
steriod administration
Immunosupression
Aging
Topical Therapy
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5
Q

What is a pressure ulcer?

A

Localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure (with or without shear and friction)

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6
Q

What are some common sites for pressure ulcers?

A 
Sacrum
Heel
Ischium
Lateral Malleolus
Greater trochanter
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7
Q

What happens when an external load is placed on a tissue?

A

Shear/pressure closes the microcirculation and lymphatic systems when pressure is exceeded

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8
Q

What is tunneling?

A

Not sure yet

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9
Q

What is a stage 1 pressure ulcer?

A

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. color may differ from surrounding area

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10
Q

What is a stage 2 pressure ulcer?

A

A partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister

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11
Q

What is a stage 3 pressure ulcer?

A
  • Full thickness tissue loss.
  • Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.
  • Slough may be present but does not obscure depth of tissue loss
  • May include undermining and tunneling
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12
Q

What is a stage 4 pressure ulcer?

A
  • Full thickness tissue loss with exposed bone, tendon or muscle.
  • Slough or eschar may be present on some parts of the wound bed
  • Often include undermining and tunneling
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13
Q

What is a (suspected) deep tissue injury (DTI)?

A

Purple or maroon localized area of discolored intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/or shear.

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14
Q

What is an unstageable pressure ulcer?

A

A full thickness loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed.

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15
Q

What are the two classifications of Chronic wound?

A

Partial thickness and full thickness

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16
Q

What is a partial thickness wound?

A

Breakdown of the epidermis and possibly penetrating into but not through dermis.

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17
Q

What is a full thickness wound?

A

Breakdown of the dermis into the subcutaneous tissue through fascia, may involve muscle, tendon and/or bone.

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18
Q

What are several causes of venous insufficent ulcers?

A

Muscle pump failure

Pericapillary fibrin deposits

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19
Q

What are some characteristics of venous insufficient ulcers?

A 
Superficial
Highly exudative
minimal pain, relieved with elevation
Irregular edge
Hyperpigmentation
Medial side of ankle
Red wound base
Dermatitis
Hemosiderin staining
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20
Q

What are arterial insufficient Ulcers the result of?

A

Inadequate blood supply

may also have venous insufficiency

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21
Q

Below what ABI are arterial insufficient ulcers not likely to heal?

A

below 0.5

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22
Q

What are some characteristics of Arterial insufficient ulcers?

A 
very painful
Pain decreases with dependency
Associated trophic changes in the skin
Minimal exudate with dry eschar/necrosis
Located on toes, fingers or interdigital spaces
Blanched wound base and periwound tissue
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23
Q

What are some characteristics of post surgical wounds?

A 
Closed by primary intention
Treatment usually uneventful
Healing occurs with protective dressing
Generally well-defined
Straight wound margins
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24
Q

What are some characteristics of traumatic wounds?

A

generally irregular wound margins
Visible inflammatory response margin
indurated wound margin

25
Q

What are the major contributory factors in the pathogenesis of a diabetic foot ulceration?

A

Combination of peripheral neuropathy, peripheral vascular disease and biomechanical abnormalities with PN being the most important complication

26
Q

What are some biomechanical abnormalities that can lead to diabetic foot ulcerations?

A

Foot deformities and limited joint mobility

27
Q

What are different scales for classifying diabetic/neuropathic ulcers?

A

Wagner scale, and University of Texas scale

28
Q

What are the different scales for risk assessment of a diabetic foot ulceration?

A

Norton scale and braden scale

29
Q

What is the range for the Wegner scale and what is it measuring?

A

0-5 (5 being the worst), used for classifying diabetic/neuropathic ulcers

30
Q

What is the range for the University of Texas scale and what is it used for?

A

Stages A-Stage D (measuring the amt of infection present with D being the worst)
Grades 0-3 (Measuring the depth of the wound with 3 being the worst)

31
Q

What different risk factors does the norton scale look at?

A 
Physical Condition
Mental condition
Activity
Mobility
Incontinent
32
Q

What different risk factors does the Braden scale look at?

A 
Sensory perception
Moisture
Activity
Mobility
Nutrition
Friction and Shear
33
Q

What are some preventative skin care methods?

A 
Keeps skin clean and dry
Daily personal hygiene
Clean skin with warm/tepid water
Moisturize skin
Reduce exposure to irritants
34
Q

How can you reduce your exposure to irritants?

A 
Clean immediately after incontinence
Apply skin protectants
Keep linens clean/wrinkle free
Check fit of splints/braces/medical devices
Maintain environmental humidity
35
Q

What should you avoid with incontinent patients?

A

Diapers so the excrement doesn’t pool and create an ulceration. Use incontinence pads/briefs instead

36
Q

Where should you avoid massage with incontinent patients/patients with DM?

A

Red areas, may decrease rather than increase blood flow

37
Q

What does shear do to the skin blood supply?

A

Reduces supply of blood to the skin

38
Q

How can you minimize shear and friction injuries?

A

Use positioning, transferring and turning techniques

39
Q

What layers of skin do friction involve?

A

Superficial skin layers

40
Q

When does friction occur?

A

When the pt is moving across a coarse surface

41
Q

Who is at a high risk for frictional injuries?

A

Agitated pts
spastic pts
When pt’s slide down in bed

42
Q

What are some methods for preventing frictional injuries?

A

Heel protectors, elevation of heels, stockings, skin protectors

43
Q

How often should you reposition bed bound patients?

A

@ least every 2 hours

44
Q

How often should you reposition chair bound individuals?

A

Reposition @ least every hour and encourage weight shift every 15 minutes

45
Q

How many degrees must a person be turned to remove pressure on their sacrum?

A

Must be turned at least 40 degrees

46
Q

What are some positioning devices?

A

Trapeze for self positioning
Lift devices for those who cannot assist
Pillows and wedges for knees and ankles

47
Q

Who should you limit elevating the head of the bed?

A

To reduce friction and shear if the patient slides down the bed

48
Q

Unless medically necessary, what should be the limit of head-of-bed elevation?

A

30 Degrees

49
Q

What bony prominence should you avoid in the side lying position?

A

The greater trochanters

50
Q

What position should you use for side lying?

A

The 30 degree lateral inclined position

51
Q

What should you do to the heels?

A

MUST elevate

52
Q

When elevating the heels, what must you be aware of at the knee?

A

Make sure the knee is not hyperextended

53
Q

What device should you not use for pressure relief?

A

Do not use donuts or plastic rings. They can cause a larger area of tissue injury because of intense pressure along the device

54
Q

What are more effective; standard hospital mattresses or pressure reducing devices?

A

Pressure reducing devices

55
Q

What is a DMERC Category 1?

A

Static overlays and mattresses

-foam, air, gel

56
Q

What is a DMERC Category 2?

A

Alternating pressure and air floatation

57
Q

What is a Category 3 support surface?

A

Air fluidized

Low air loss bed/mattress

58
Q

What should wheelchair bound pt’s use?

A

Pressure reducing cushions

Fundamentals of PT (10 decks)

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