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243 > Wounds (treating P ulcers, types of drsgs, dressing wounds) > Flashcards

Wounds (treating P ulcers, types of drsgs, dressing wounds) Flashcards

1
Q

what is most serious complication of P ulcer

A

infection

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2
Q 
The RYB Colour Code of p ulcers
	Universal classification of wounds by colours = red, yellow, black (RYB) 
	Red = what kind of tissue 
	Yellow =? 
	Black = ?

which colour do you Want to:
cleanse
protect
debride

what if there is a mixd wound with all 3 colours, what do you treat first?

A

red=granulation
yellow=slough
black=necrosis
protect (cover) red, cleanse yellow, and debrideblack

tx aimed at black first, then yellow, then red

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3
Q

what do you want to do to red P ulcer?
how can you do this?
what stage of healing is it likely in?

A

 Need to cover + keep moist
o Gentle cleansing
o Protect periwound skin w alcohol-free barrier cream
o Filling dead space w hydrogel or alginate
o Cover w approp dressing
o ∆ drsg as infrequently as possible

 Pale pink to beefy red – indicates depth of granulation tissue
 Can be in inflammatory or proliferative stage of healing

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4
Q

you have a yellow p ulcer and the slough isnt being removed by cleansing. do you leave it or do you debride?

A

debride

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5
Q

what colours indiate slough

what is slough

A

 Pale ivory to shaes of yellow, green, and brown – indicate presence of slough (dead but moist tissue)

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6
Q

how do you treat yellow P ulcer

A

 Need to be debrided to remove slough + reduce bacteria

 Methods of cleansing: wet-to-damp drsg, irrigation, absorbent drsgs
 Consult dr about need for topical antimicrobial
 Slough not removed by cleansing needs debridement

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7
Q

you have black wound with eschar is this viable tissue?

what should be done and what is the exception to this rule?

A

 Black/brown or tan – indicates dead tissue that is dehydrated to some degree
Covered with eschar (thick, hard, leathery necrotic tissue) – when present, cannot assess depth of wound
 Eschar = breeding ground for bacteria, devitalized tissue that impairs wound healing
 If DM with inadequate blood supply, dry eschar kept intact until thorough vascular exam done

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8
Q

when is sharp debridement used and who can do this

A

only specially trained can perform sharp debridement. It can be used when there is urgent need of debridement (advancing cellulitis and sepsis)

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9
Q

what are the risks of sharp debridement

what tools are used

A

serious risk of bleeding + damage to underlying nerves and tissue

scalpel or scissors

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10
Q

what is mechanical debridement

what is it used for

and what are its disadvantages

A

Mechanical debridement: uses physical forces to remove foreign material and contaminated tissue

Use whirlpool baths, dextranomers, and wound irrigations; may be used as prep for sharp debride;

is slow + painful. pain mgmt is key!!

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11
Q

what is chemical debridement?
aka
who is it used for

A

 Chemical or enzymatic debridement: topical application of proteolytic substances (enzymes); collagenase enzymes such as papain-urea often used;

relatively slow;

is good for those not able to use sharp, in long term facilities, and when infection not present

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12
Q

what is the most selective method of debridement

A

autolytic (it causes the least damage to surrounding and healing tissues

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13
Q

what is the slowest method of debridement

A

autolytic

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14
Q

what is autolytic debridement

A

synthetic drsg used to cover wound + allow eschar to self digest by enzymes in wound fluids; slowest but most selective so doesn’t harm surrounding tissues

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15
Q

should an occlusive drsg be used in pt with infection

A

 Occlusive drsg not be used with infection (b/c create anaerobic enviro)

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16
Q

why are maggot larvae used for wounds

A

 Maggots received inc attention lately as option as they sevrete Es that break down necrotic tissue hile leaving the remaining tissue untouched, ingest bacteria and dec bact growth d/t them causing inc in pH

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17
Q

which colour wounds need to be kept moist

A

black and yellow

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18
Q

what is the drawback of the RYB system

A

it doesnt address the underlying pathology and tx of certain wounds like venous or art ulcers (compression for V and revascularization for art)

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19
Q

what is the preferred wound cleanser

A

NS

20
Q 
transparent drsg is...
what kind of wounds is it used for?
not used for?
how long can it stay on?
benefits?
A

it is nonporous and self adhesive
what kind of wounds is it used for?–Applied to superficial wounds and skin breaks to maintain healing environment

not used for? Not to be used if evidence of yeast infection (will make it worse)

how long can it stay on? Left in place up to 7 days

benefits?  Elastic so do not disrupt mobility
 Do not adhere to wound itself, only skin around it (because wound kept moist)
 Can shower
can assess through
Semiocclusive

21
Q

because a transparent drsg is semiocclusive what benefit does this have

A

 Semiocclusive so wound remains moist + retains serous exudate, which supports epithelial growth, autolytic debridement, reduces risk of infection

22
Q

not putting much on applying removing transparent type of drsg..
why houldnt you stretch it as you put it on
why and how clean the skin first

A

stretching it as applied dec pt mobiity

if drsg adherence is concern then clean area adjacent to wound with alcohol or acteon to defat the kin

23
Q

what kind of drsg is good for wounds with moderate-minimal drainage and those requiring debridement

what are the benefits of this drsg type

A

hydrocolloid

 Provide wound hydration
 Can cut to size of wound (ensure 1-2inch beyond wound margins)
 Do not need cover dressing and H2O resistant so pt can bathe
 3-7 days (depends on drainage)
 Act as temporary skin + effective bacterial barrier
 Dec pain, thus dec need for analgesics

24
Q

hydrocolloid is it good for infection?

is it good for assessment?

what body image consideration is there

A

o Occlusive + opaque (no visibility)

o Should NOT be used if infect suspected as facilitate anaerobic growth

o Characteristic odour often confused for infection

25
Q

t or f hydrocolloids are difficult to remove

they are absorbnt

A

o Difficult to remove, leave residue on skin

o Limited absorption capacity

26
Q

which type of drsg is kept airtight with plastic film like plastic wrap.
what is the underlying drsg made of?

how long can this wrap be on

A

occlusive drsg

  • May be commercial or prepared from gauze squares or wrap
  • Cover topical meds applied to skin lesion
  • Plastic surgical tape impregnated with corticosteroid can be cut to size + applied to lesions

• Don’t use plastic wrap for more than 12 hrs/day

27
Q

which type of drsg used for acute weeping inflm lesion isnt used much anymore

A

wet drsgs

28
Q

moisture retentive drsg

used instead of….
what are they good for?
are they impregnated?

A
  • Used in place of wet dressings now
  • More efficient at removing exudate b/c higher moisture-vapour transmission rate
  • Some have reservoirs to hold excessive exudate
  • Impregnated with NS, petrolatum, zinc-saline soln, hydrogel, antimicrobial agents – eliminates need to coat skin + therefore avoids maceration
29
Q

how long can you use moisture retentive drsg

probly not imp why theyre used more than wet drsg

A
  • Most remain 12-24hrs, some up to 1 wk
  • Better than wet dressings b/c: improved fibrinolysis, accelerated epidermal resurfacing, less pain, fewer infections, dec scar tissue, gentle autolytic debridement + dec freq of dressing ∆
30
Q

egs of moisture retentive drsg

A

hydrogels
hydrocolloids
foam drsg
calcium alginates

31
Q 
which type of drsg is good for
 autolyti debridement
semi transparent (good for assessing)
needs another secondary drsg because its not adhesive
comfy
A

hydro gel

o Polymers with 90-95% H2O content
o Impregnated sheets or gel in tube
o High moisture makes ideal for autolytic debridement
o Semi-transparent so can view w/o dressing removal
o Comfortable + soothing
o Not adhesive – need secondary dressing

32
Q

which kinds of wounds is hydrogel good for

A

o Good for: superficial w high serous output (ex: abrasions, skin graft sites, draining ven ulcers)

33
Q

hydrocolloid benefits

what is made of
fx
can you assess through it?
remove for bathing?

A

o Made of H20-impermeable, polyurethane outer covering separated from wound by hydrocolloid material
o Adherent, non-perm to water vapour + oxygen
o As H2O evaporates from wound, goes into dressing  dressing softens + discolours w inc H2O

o Easy to use, comfortable, promote debridement + formation of granulation tissue

o Most opaque so require removal to inspect wound

o Do not have to removed for bathing; left in place for up to 7 days

34
Q

hydrocolloid covred wound has foul smelling yellow stuff on it. significance

A

o Causes form of foul-smelling yellowish covering over wound – is normal, d/t chemical interaction between dressing + wound exudate (do NOT confuse with purulent exudate)

35
Q

what kind of wound is hydrocolloid good for

A

o Good for: exudative + acute wounds

36
Q

what is foam drsg made of?
adheres to skin?
assess through it?

A

o Microporouspolyrethene w absorptive hydrophilic surface that covers wound + hydrophobic backing to block leakage
o Non-adherent (req secondary drsg to keep in place)
o Opaque (must remove for inspection)

37
Q

benefits of foam drsg?

what kind of wound is it for

A

o Moisture absorbed into foam – prevents maceration
o Moist enviro maintained, removal doesn’t damage wound

o Good for exudate wounds esp good over bony prominences b/c provide cushioning

38
Q

which kind of drsg is good for iritated tissue or macrated tissue? what is it made of?

what other kind of wound is it good for?

A

o Derived from seaweed – tremendously absorbent Ca alginate fibres

also good packed into deep cvity, wound, sinus tract with heavy drainage

39
Q

how does calcium alginate work
is it adherent
drawback

A

o Derived from seaweed – tremendously absorbent Ca alginate fibres
o As exudate absorbed, turns into fiscoushydrogel
o Forms moist pocket over wound while keeping surrounding tissue dry

o Reacts w wound to cause foul-smelling coating

40
Q

which 2 drsgs cause foul odour

A

calcium alginate and hydrocolloid

41
Q

which drsgs are nonaherent and need second drsg to hold in place

A

foam drsg

hydrogel

42
Q

which drsgs are good for absorption

A

Alginates, composite dressings, foams, gauze, hydrogels

43
Q

which drsgs can provide autolytic debridement

A

)Absorption beads, pastes, powders, alginates, composite dressings, goams, hydrate gauze hydrogels, hydrocolloids, transparent dressings, wound care systems

44
Q

what is diathermy

A

Produces electrical current to promote warmth + new tissue growth

45
Q

how can you add moisture to wound/hydrate

A

Gazue (sat with NS), hydrogels, wound care systems, fibrous fleece dressings

46
Q

what to use to main mosit env

not putting anything on how to protect and covr wound/periwound skin becase it includes basically everything

A

Composites, contact layers, foams, gauze (impregnated or sat), hydrogels, hydrocolloids, transparent films, wound care systems

47
Q

what can be used to provide therapeutic compression for those with venous stasis disease

A

compression bandages and wraps

243 (14 decks)

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