Wounds and Oral Care

Question 1

Intrinsic risk factors for ulcer development

Answer 1

-age
-cachexia
-limited mobility
-conditions that reduce tissue oxygenation
-cachexia

Question 2

Extrinsic factors for ulcer development

Answer 2

-shear force
-moisture
-friction

Question 3

List preventative strategies for pressure ulcers

Answer 3

-pressure-reducing surface
-regular turning
-protect from shear, moisture, friction
-hydrocolloid dressing to high risk areas

Question 4

List and define pressure ulcer stages

Answer 4

Stage I - non-blanchable erythema.

Stage II. Partial-thickness skin loss involving epidermis, dermis, or both.

Stage III. Full thickness skin loss involving subcutaneous tissue. Down to, but not through fascia.

Stage IV. The ulcer is deep enough to include necrosis and damage to underlying
muscle, bone, and/or other supporting structures such as tendon or joint capsule. Undermining of adjacent skin and sinus tracts may also be present.

Question 5

List the 4 complications of malignant wounds

Answer 5

-exudates
-infection
-odor
-bleeding

Question 6

List strategies to manage wound exudates

Answer 6

-absorbent foams
-alginate dressings

Question 7

List 3 properties of alginate dressings

Answer 7

-absorptive
-hemostatic
-?bacteriostatic

Question 8

List strategies to manage malignant wound infections

Answer 8

Superficial infection:
-topical metronidazole
-silver sulfdiazine

Deeper tissue infection
-systemic metronidazole

Other:
-povidone (cytotoxic to bacterial cells and granulation tissue - for non-healing wound only)

Question 9

List strategies to manage wound odor

Answer 9

Odor absorbers:
-kitty litter
-activated charcoal
-charcoal dressings

Other:
-burning flame (candle) - combusting
-competing odor (coffee, vanilla, vinegar)
-avoid fragrances

Question 10

List strategies to manage wound bleeding

Answer 10

-avoid dressings that adhere (use mesh synthetic polymer, non-stick, non-absorptive)
-alginate dressings
-topical tromboplastin (100U/ml)
-topical TXA
-silver nitrate
-cautery

Question 11

Describe mucositis and it’s pathophysiology

Answer 11

-inflammatory response of oral-pharyngeal mucosa, often related to chemo or RT
-results form destruction of rapidly dividing epithelial cells, and secondary release of inflammatory mediators (TNF-alpha and interleukins)

Question 12

List and define the 5 grades of mucositis

Answer 12

Grade 1 - injection only. Mild pain without need for analgesia.
Grade 2 - Patchy mucositis which may produce serosang. discharge. Mod. pain requiring analgesia.
Grade 3 - Confluent fibrinous mucositis. Severe pain requiring opioid.
Grade 4 - Ulceration, hemorrhage, or necrosis
Grade 5 - Death resulting from mucositis

Question 13

List patient-related risk factors for mucositis

Answer 13

-xerostomia
-collagen vascular disorders
-nutritional status
-development of neutropenia

Question 14

List treatment-related risk factors for mucositis

Answer 14

-combination of radiation and chemo
-radiation dose, fraction size, field
-type of chemotherapy

Question 15

cytotoxic topical agent for fungating malignant wounds

Answer 15

miltefostine 6%

Question 16

wound assessment tool

Answer 16

TSAS-w (toronto wound assessment scale)

Question 17

DIME approach to wounds

Answer 17

D - debride / download
I - inflection / inflammation
M - moisture balance
E - edges

Question 18

What is a kennedy ulcer

Answer 18

Skin ulcer that develops despite best preventative care
Underlying skin failure associated with dying process

Question 19

How do you differentiate between a Kennedy ulcer and pressure ulcer?

Answer 19

timing - KTU develops over hours not days
shape - usually irregular