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Wound Care 3
| Question | Answer |
|---|---|
| Factors of wound healing that DO NOT change with age | Number of epidermal layers/thickness, stratum cornea prevention of water loss, Collagen IV gene expression, Lamin B1/B2 expression, Production of collagen VII from TGF-Beta, total hyaluronan, collagen deposition and cellular infiltrates |
| Factors of wound healing that DO change with age | Smaller Corneocyte (stratum corneum), Regression of capillaries, 30% reduction of venule cross-sections, Overall reduction of blood flow, Reduction of mast cells, ↑ resistance to degranulation, Pain sensitivity ↓ with age > 50 |
| Inflammatory Phase with age | ↑ in platelet and macrophage adhesion, Macrophage function and T lymphocyte proliferation/function decline, Production of lymphokines ↑ (↑ immune response) |
| Proliferation Phase with age | ↓ in fibroblast migration, Cytokine interleukin-1 ↑ (immune response) while PDGF ↓ |
| Wound contraction with age | some data says aging does affect wound healing, some says it doesn’t |
| Epithelialization with age | Epithelialization occurs more rapidly in patients less than 50 compared with patients greater related to growth factors |
| Remodeling phase with age | Neovascularization is diminished |
| Wound Healing and AIDS | Absence of T cells causes ↓ collagen deposition, Wound sepsis ↑ due to overall ↓ in immune function, Inability to mount inflammatory response making it difficult to determine infection |
| What is Karposi's Sarcoma | sarcoma with multiple areas of cell proliferation, can appear in wound edges, looks like volcanoes in skin |
| Possible treatments for Karposi's Sarcoma | A few local lesions - cryosurgery; if widespread into internal organ - systemic interferon alpha, liposomal anthracyclines (such as Doxil) or paclitaxel |
| 2 chemicals who's cellular toxicity exceed their bactericidal potency | Hydrogen peroxide and acetic acid |
| Chemical Thresholds unsuitable for wound care | 1% povidone-iodine, 3% Hydrogen Peroxide, 0.5% sodium hypochlorite, 0.25% acetic acid |
| 3 Appropriate solutions for wound care | Dakin’s Solution 0.25% - 0.5%, Povidone-Iodine (Betadine) 0.001%, Chlorohexidine gluconate (Hibiclens) 1:10,000 dilution |
| Eschar characteristics | ○ Black, dead, hardens Wounds will not heal with the eschar on it, Leave on in heel wounds because it protects it from pressure, Circumferential Burns: escharotomy to allow for ventilation and perfusion, left open because it would contract |
| Indication for hydrotherapy | wound with loosely adherent necrotic tissue, exudate or debris |
| Characteristics of whirlpool | non-selective form of mechanical debridement, agitation of the water leads to tissue being removed, mointor Vital signs for patients with h/o cardiopulmonary disease, stroke or HTN, keep temp at 80-92*F for PVD pts and 92-96*F for pts w/o deficits |
| Comorbidities for wound infection | diabetes, peripheral vascular disease, peripheral neuropathy, previous radiation, age (decreased circulation in older population) |
| Sources of wound injury | Cleanly occurring wounds are less likely to have infection than wounds that occur outside of a controlled setting; Wounds that have a vascular compromise are at a higher risk of infection: Wounds created with a bovie, Wounds of a pedicle or avulsion |
| Primary causes of foot ulceration from DM or neuropathy | Mechanical Stress and Sensory Loss |
| Permissive Factors of sensory loss | Limited awareness, Do not prevent re-injury, Fail to seek treatment |
| Types of mechanical stress | Pressure (force/area), shear (angular force/area), intrinsic stress from deformity, extrinsic stress from outside forces/trauma |
| What can cause repetitive stress? | loss of sensation leads to friction/stress that is unrecognized; Even with a current wound there is no pain |
| Brand’s 5 mechanisms of injury of the insensate foot: | Continuous low stress = tissue necrosis; Repetitive moderate stress = inflammation/autolysis; Concentrated, high stress = cutting/crushing by direct trauma; Chemicals, heat/cold = burning/frostbite; Stress on infected tissues = spread of infection |
| Pts with neuropathy, jt deformity, jt limitation, muscle weakness or atrophy can bear weight differently causing this: | foot ulcers |
| Most common foot ulcer in DM | 1st MT head and great toe |
| Most common foot ulcer in spina bifida, SC tumors, and incomplete paraplegias | Plantar heel |
| Most common calcaneocavus/valgus feet | heel ulcers |
| Devices to off load stress | Crutches or a walker to reduce stress; Walking cast to redistribute weight and prevent other injuries during the healing phase; Walking splint (similar to walking cast) used for stress offload for heel and plantar ulcers |
| How can shoes help off load stress? | Depth inlay with adequate space for plastazote for padding; Goal is to ensure enough space in orthotic shoe for edema and good padded socks; Custom made shoes should be made for patients with severely deformed feet |
| The Classification for risk of plantar ulcers | 0 = no loss of protective fxn; 1 = loss of protective sensation; 2 = loss of protective sensation and deformity; 3= Hx of plantar ulcer |
| Process of selective debridement | Done by Trained professional; Typically done sharply however can be done with scissors; Rarely is viable tissue removed unless there is irregularity of the wound tract |
| Contraindications of sharp/selective debridement | Contraindications: heel eschar, dry gangrene (mass of dead tissue); Relative Contras: impaired clotting mechanisms or on anticoagulants or a tunneling or fistula wound |
| Process of non-selective debridement | Performed by a trained professional; Does not involve sharps; May damage viable tissue; Examples: Pharmacological: wound modalities such as topical enzymes or antiseptic agents; Pulsed lavage; whirlpool; wet to dry dressing |
| Surgical debridement includes | Complete excision and debulking (for melanomas) |
| Color of fat | shiny, yellow, glistening and almost glittery |
| Color of Fascia | glistening and white |
| Color of Muscle | beefy red |
| What is a form of semi-selecitve mechanical debridement | removal of tissue using dressing or swabs - indicated for non adherent, moist and necrotic tissue |
| What is a non-selective debridement for necrotic tissue without granulation tissue and is changed every 12 hours requiring pain control? | Wet to dry dressing |
| What is a high molecular weight dextran derivative that absorbs exudate, bacteria and other debris for heavy exudate? | Dextranomer - contraindicated for dry wound, granulation tissue, fistula/sinus tract |
| What is a Non-invasive mechanical debridement therapy to promote closure of the wound through negative pressure, that creates granulaiton tissue, improves tissue perfusion and removes drainage? | VAC (vacuum assisted closure) |
| How does VAC work? | Different foam sponges are applied to the wound and then applied to wound with occlusive dressing. Then a trac pad (suction device) in applied over the occlusive dressing to applied uniformed megative pressure  |
| 4 types of hydrotherapy | Syringe and Needle irrigation; Canyons Wound Irrigation System (WIS); Jet Lavage (Water Pik); Pulsatile Lavage with Suction |
| What type of debridement uses collagenase and requires a Rx? | Enzymatic - via maceration of necrotic tissue |
| What type of debridement creates an environment that allows macrophage, neutrophil and other phagocytic cells to digest devitalized tissue by releasing proteolytic and collagenolytic enzymes normally present in wound fluids? | Autolytic, which is selective application of moisture retentive dressings to wound |
| What type of debridement should NOT be used on granulation tissue due to its use of powerful nonselective chemical substances to remove bacteria, foreign matter and necrotic tissue? | Chemical debridement |
Created by:
rjchokito
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