Wounds- Schoenwald Flashcards
What is the word for when a wound looks wet and soggy?
Macerated
Result from pressure or repetitive pressure at same anatomical location
Pressure ulcers (also called bedsores or decubitus ulcers)
Where do pressure ulcers typically occur on the body?
Develop at areas of bony prominences.
Ankles, elbows, tailbone
What stage ulcer is this?
Nonblanchable erythema of intact skin
Stage 1
What stage ulcer is this?
Partial thickness skin loss with exposed dermis
Stage 2
What stage ulcer is this?
Full thickness skin loss
Stage 3
What stage ulcer is this?
Full thickness skin and tissue loss
Stage 4
What stage ulcer is this?
Obscured full thickness skin and tissue loss
Unstageable
Could be obscured by esgar (scab)
What stage ulcer is this?
Persistent, non-blanchable deep red, maroon, purple
Deep tissue pressure injury
lesion that isn’t open but you know deep tissue injury from color
What is the treatment for a pressure ulcer?
Relieve/remove pressure
Air beds, padded seat covers, sheep skin boots
This type of dressing is good for exudate absorption
Alginates (made from seaweed)
This type of dressing is good at retaining moisture, absorption
Foams
This type of dressing is good at retaining moisture, debride
Gauzes
This type of dressing is good at occlusion (keeping an IV in place)
Hydrocolloids
This type of dressing is good for obliterate dead space, absorb
Wound fillers
_________ delays wound healing
SMOKING
What organism is responsible for an ulcer that is macerated because of soaking feet? (Think diabetic foot ulcer)
Pseudomonas
What two organisms are responsible for cellulitis without an open skin wound?
B hemolytic strep and Staph aureus
This type of organism category STINKS because it produces sulfide gas
Anaerobes
How much protein should a patient be taking for wound healing?
1.25 to 1.5 grams/kg in a healthy patient
What supplements can be helpful in wound healing?
Zinc and vitamin D
Risk factors for venous ulcerations (stasis)?
- varicose veins
- DVT
- chronic venous insufficiency
- poor calf muscle function
- obesity
Where is a common place for venous ulceration to occur?
gaiter area of the leg (calf from below knee to above ankle)
What are common signs of venous ulcers?
- Edema often present
- Hemosiderin staining
- Hair loss of extremity
- Weeping and itching of skin often present
What is a huge part of treatment for venous stasis ulcers to control edema?
Compression therapy- compression stockings
You should AVOID compression stockings when __________ flow is compromised
arterial
How much compression pressure should you wrap a venous ulcer in?
40-60 mmHg
You have a wet wound… what type of dressing should you use?
Alginate and foam
This type of ulcer is due to decrease in arterial blood supply to lower extremity
Arterial ulcer
Who are at risk for arterial ulcers?
PVD, diabetes, sickle cell
Arterial ulcers result in tissue ________ and damage/ulcer formation
hypoxemia
Arterial ulcers have a ___________ capillary refill time
Reduced
Arterial ulcer may also have reduced __________ _____
palpable pulses
What are some characteristics of an arterial ulcer?
- Painful
- Ulcer appears punched out with well demarcated edges
- Pale, often necrotic base
- Surrounding skin dusky or shiny, hairless
You should not decide if an ulcer is venous or arterial based on what?
the appearance of hair whether hairless or not
Is a venous or arterial ulcer more painful?
Arterial
Are medications used to treat arterial ulcers?
No but could get relief from meds like Plavix to keep blood flowing
How do you treat an arterial ulcer?
Try to restore arterial function if possible with surgery usually
This type of ulcer has a “punched out” appearance
arterial
This type of ulcer is usually associated with limb edema and has a high level of exudate
Venous
Mainstay treatment for venous ulcer?
Compresison
This test is helpful in determining extent of peripheral vascular disease?
ABI
How is an ABI performed?
Performed by measuring systolic blood pressure in both brachial arteries and
both dorsal arteries
During an ABI, a patient should be at ________ and _______ for how many minutes?
At rest and supine for 10 min
What is the acceptable range for an ABI?
0.9-1.4
An ABI greater than _____ means a noncompressable calcification of vessels
1.4
An ABI below what number would need a referral to a vascular specialist?
ABI below 0.8
What ABI is indicative of severe arterial disease?
Less than 0.5
What ABI value is considered diagnostic of PAD?
below 0.9
How does a negative pressure wound therapy- wound vac enhance wound healing?
- Reducing edema
- Increasing rate of granulation tissue formation
- stimulation of circulation
What are contraindications for a wound vac placement? Meaning when would you NOT use a wound vac?
- Malignancy of wound
- Untreated osteomyelitis
- Placement of dressings in contact with exposed blood vessels, organs or nerves
- Nonenteric or unexplored fistulas
What are two growth factors in artifical skin grafting?
- Apligraft (using skin from circumsized foreskin)
- Dermagraft
Treatment of wounds?
- Enzymatic- chemical agents but taken off the market
- Mechanical- wet to dry dressings, gauze (peroxide debridement controversial)
- Sharp- surgical removal
