Wounds and their management 2

Question 1

What is a chronic wound?

Answer 1

A wound that fails to progress through an orderly and timely sequence of repair

e. g. chronic wound or ulcer
- associated with delayed healing and reoccurrence

Question 2

Describe a chronic wound

Answer 2

Considered stuck in between inflammatory and proliferation stages of healing
A range of causes
- extrinsic
- intrinsic
Usually very weepy - exudate management and odour control are important in chronic wound care

Question 3

What are MMPs?

Answer 3

Matrix Metalloproteinases

Question 4

What do chronic wounds contain?

Answer 4

Increased levels of inflammatory cells and elevated levels of proteases that degenerate the extracellular matrix

Question 5

What are MMPs important for?

Answer 5

Breaking down proteins so that new tissue forms

Question 6

What happens if the levels of MMPs are too high for too long in the wrong place?

Answer 6

Can delay healing

Question 7

What are pressure ulcers also known as?

Answer 7

Bed sores

Pressure sores

Question 8

Who usually suffers from pressure sores?

Answer 8

Mainly affect people with mobility issues and aging/weakened skin

• bed ridden
• elderly

Question 9

What are the ranges of pressure sores?

Answer 9

Patches of discoloured skin to open wounds that expose the underlying bone or muscle

Question 10

What is decubitus?

Answer 10

Simultaneous compression, friction and shear forces causing breakdown of local microcirculation

Question 11

What causes ulcer formation?

Answer 11

Without a blood supply, the affected tissue becomes starved of oxygen and nutrients and begins to break down, leading to ulcer formation

Question 12

Where are common pressure points for ulcer formation?

Answer 12

Heel
Buttocks
Sacrum

Question 13

What is a venous ulcer?

Answer 13

Painful wound that occurs due to improper functioning of a weakened venous valve

Question 14

Where do venous ulcers occur?

Answer 14

Lower leg

- leg ulcers

Question 15

Why do venous ulcers occur?

Answer 15

Returning blood flow against gravity compromised

Question 16

What is the major cause of chronic wounds?

Answer 16

Venous ulcers - occurring in 70% of chronic wound casesWhat is the common treatment for venous ulcers?

Question 17

What is the common treatment for venous ulcers?

Answer 17

Topical treatment
Dressing
Compression bandage

Question 18

Which disorder impedes the normal steps of the wound healing process?

Answer 18

Diabetes mellitus

Question 19

What is a major complication of diabetes mellitus?

Answer 19

Diabetic foot ulcer

Question 20

For diabetics, what can seemingly superficial cuts turn into?

Answer 20

Chronic wounds, infection and gangrene

Question 21

What are the two major concerns with wounds and microbes?

Answer 21

Commensal pathogens

Pathogens on penetrating objects

Question 22

Why do pathogens in a wound proliferate?

Answer 22

Nutrient rich environment

- some microflora unavoidable in wounds (unless surgical)

Question 23

What are planktonic bacteria?

Answer 23

Free floating single bacteria

Question 24

What can planktonic bacteria that have successfully colonised a wound do?

Answer 24

Rapidly evolve into a biofilm

Question 25

What is a biofilm?

Answer 25

A shiny and slimy material covering the wound bed

Question 26

Which species of bacteria in a wound produces a green/yellow colour with a putrid smell?

Answer 26

Pseudomonas

Question 27

What problems can the presence of bacteria in the biofilm cause?

Answer 27

Cause or problem inflammation

Strain the body’s ability to fight infection

Question 28

What percentage of chronic wounds have a biofilm?

Answer 28

Up to 90%

Question 29

What percentage of acute wounds have a biofilm?

Answer 29

6%

Question 30

What is debridement?

Answer 30

Removal of biofilm and dead tissue

- counteracts impeding factors

Question 31

How is debridement carried out?

Answer 31

• surgical
• mechanical
• chemical
• autolytic
• larvae

Question 32

How do larvae (maggots) gently remove necrotic tissue?

Answer 32

Proteolytic enzymes in saliva gently remove necrotic tissue, ingest and kill bacteria and inhibit inflammation

Question 33

What is larvae debridement an effective treatment for?

Answer 33

Leg ulcers and other chronic wounds

Question 34

How can you tell if a wound is infected?

Answer 34

A wound infection arises when microorganism colonies invade surrounding tissues, provoking an immune response
- risk of systemic infections or sepsis