Animal Tech VI
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| 2 types of wounds | open & closed wounds
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| Incision | a clean separation of skin & tissue wit smooth, even edges
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| Laceration | separation of skin & tissue in which the edges are torn & irregular
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| Abrasion | a wound in which the surface layers of skin are scraped away.
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| Avulsion | Stripping away of large areas of skin & underlying tissue, leaving cartilage & bone exposed.
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| Ulceration | shallow crater in which skin or mucous membrane is missing
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| Puncture | an opening of skin, underlying tissue, or mucous membrane caused by a narrow sharp, pointed object.
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| Contusion | Also called a BRUISE, Injury to soft tissue underlying the skin from the force of contact w/ a hard object.
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| Wound | damaged skin or soft tissue results from trauma.
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| Trauma | general term referring to injury.
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| Open wound | the surface of the skin or mucous membrane is no longer intact.
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| Closed wound | there is no opening in the skin or mucous membrane occur from blunt trauma or pressure.
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| Granulation tissue | combination of new blood vessels, fibroblast & epithelial cells.
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| Dehiscence | the parting of the sutured lips of a surgical wound.
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| Evisceration | protrusion of wound contents.
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| Three sequential phases | Inflammation, proliferation, remodeling.
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| Inflammation | Starts immediately after injury, last 2-5 days, limit local damage, prepares wound for healing.
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| Stages of Inflammation | 1st stage-local changes, inflammation (edema), 2nd stage-phagocytosis, redness & warmth, cleaning of the injured area, 3rd pain 4th decrease function.
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| Normal saline | 0.9% sodium chloride.
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| Measure wounds | use sterile qtip (does no hurt pt).
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| Proliferation | New cells fill & seal the wound, 2 days-3 wks after inflammatory phase, Granulation tissue appear.
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| Remodeling | follows proliferation phase, may last 6mths to 2yrs, wound contracts, scar shrinks.
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| Factors affecting wound healing | type of wound injury, expanse or depth of wound, quality of circulation, amt of wound debris, presence of infection, status of the pt’s health.
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| 1st intention/Primary intention healing | wound edges are directly next to each other, small amt of scar tissue, surgical wound closely approx. ex:paper cut.
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| 2nd intention healing1 | wound edges are widely separated, margins are not in direct contact, a scar generally forms, presence of body fluid.
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| 2nd intention healing2 | wound debris w/in the wound will prolong the healing; disrupted granulation tissue will retard the healing process.
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| 3rd intention/tertiary intention | Widely separated margins, closure material to bring edges 2gether,broad deep scar formation, wounds usually deep, extensive drainage & tissue debris, may contain drains, may pack w/ absorbent gauze.
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| Wound management | promotes healing, goal is to reapproximate the tissue to restore integrity.
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| Serous | clear watery fluid (ex. Blister)
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| Serosanguineous | pink, composed of serum & blood drainage.
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| Sanguineous | Red, relating to blood.
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| Purulent | Pus
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| Dressing | keep wound clean, absorb drainage, controls bleeding, protection from further injury, holds medication in place, maintains a moist environment.
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| Npo pain meds | take 45 mins to work in body.
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| Sq pain meds | take 30-35 mins to work in body.
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| Intramuscular pain meds | take 15-30 mins to work in body.
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| IV pain meds | take 5-10 mins to work in body.
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| Pain meds | Most analgesics have a 4-6 hr window to work.
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| Gauze dressings | woven fibers, highly absorbent, wound assessment can be difficult, granulation tissue may adhere (stick), secured w/tape.
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| Montgomery straps | strips of tape w/eye lids that have a shoe lace through it.
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| Purpose of gauze dressings | for debriment, to address wound drainage.
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| Reason for uncovered wound | to prevent irritation.
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| Transparent dressing | clear wound covering (opsite), assessment w/o removal, less bulky, no tape, non absorbent dressing, common use: IV site.
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| Hydrocolloid dressing | self adhering, Opaque, air & water occlusive (duoderm), Keep wounds moist, leave intact for up to 1 wk, size generously.
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| Dressing changes | wound nds assessment, requires care, dressing is loose, saturation, physician may assume responsibility for 1st change
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| Drains | means for removing blood & drainage, promotes healing, placement direct insertion, separate location besides the wound.
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| Open drains | flat, flexible tubes, pathway for drainage toward the dressing, drains passively by gravity & capillary action secured w/ safety pin or clip, may shorten drainage decrease.
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| Closed drains | tubes terminate into a receptacle (ie: Hemovac & Jackson-Pratt (jp) drain, more efficient than open drains, vacuum or negative pressure.
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| Drains2 | clean using circular motions, precut drain sponge or gauze.
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| Types of closures | Sutures, staples, steri-strips/butterflies.
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| Sutures | hold an incision 2gether, silk or synthetic material (nylon), encircles the wound.
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| Staples | wide metal clips, form a bridge holding 2 wound margins 2gether.
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| Steri-strips/butterflies | closure of superficial lacerations, holds weak incisions 2gether temporarily.
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| Advantage of staples over sutures | sutures will not compress the tissue if it swells, & it does not encircle the wound.
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| Bandages | strip or roll of cloth wrapped around a body part (ex: ace wrap).
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| Binders | type of bandage applied to a particular body part (ex: abd or breast).
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| Bandages/binders1 | hold dressings in place especially when tape cannot be used or the dressing is extremely large.
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| Bandages/binders2 | Support the area around a wound or injury to reduce pain.
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| Bandages/binders3 | Limit movement in the wound area to promote healing.
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| Principles of roller bandages1 | elevate/support the limb, wrap from closet (distal) to farthest (proximal), avoid gaps between each turn of the bandages, Exert equal but not excessive, tension w/each turn.
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| Principles of roller bandages2 | keep bandage free of wrinkles, secure end of roller bandage w/metal clips, check the color/sensation of exposed fingers or toes often, remove bandage for hygiene/replace twice a day.
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| Styles of bandage application | circular turn-wrap, spiral turn-cylindrical, spiral reverse turn, figure 8 turn-joints, spica turn-variation, Recurrent turn-beneficial.
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| Binder application | not commonly used, replaced by commercial devices, T-binder, used to secure a dressing to anus or perineum or w/in the groin.
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| Debridement | removal of dead tissue, promotes healing, 4 methods: sharp, enzymatic, autolytic, mechanical.
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| Sharp debridement | removal or necrotic tissue, sterile scissors, forceps or other instruments, preferred for infected wound, preformed @ bedside or in surgery, Painful, Bleeding may occur.
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| Euchar | hard necrotic tissue (black) depending on location & Dr.’s order may be removed.
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| Enzymatic debridement | topically applied chemical substances; wound debris is broken down & liquefied, dressing keeps enzyme in contact w/ wound, uninfected wounds, poor tolerance to sharp debridement.
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| Autolytic debridement | small wound, infection free, prolonged time to achieve results, painless, natural physiological process, occlusive or semi-occlusive dressing, monitor for s/s of infection.
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| Mechanical debridement1 | Wet to dry dressing, remove after 4-6 hrs, dead tissue adheres to gauze mesh work, painful, disrupts or removes healthy tissue.
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| Mechanical debridement2 | Hydrotherapy, submerged in a whirl pool tank, antiseptic solution, agitation softens dead tissue, sharp debridement for loose debris.
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| Mechanical debridement3 | Irrigation (uses normal saline to clean out area), flushing debris, wound care, cleaning eyes, ears & vaginal.
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| Wound irrigation | used before applying new dressing, granulation tissue has formed.
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| Vaginal irrigation | also know as douche, sometimes necessary to treat an infection.
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| Eye irrigation | flushes toxic chemical from one or both eyes, displaces dried mucous or other drainage, warm solution to body temp.
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| Ear irrigation | Removes debris, perform gross inspection 1st, contraindicated w/ a perforated ear drum, avoid occluding ear canal w/ syringe, trapped pressure can cause rupture of ear drum, loose cotton ball to absorb drainage.
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| Heat uses | Provides warmth, promotes circulation, speeds healing, relieves muscle spasm, reduced pain.
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| Cold uses | Reduces fevers, prevents swelling, controls bleeding, relieves pain, numbs sensation.
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| Cold application | Ice bag/ice collar: containers for holding ice, improvised version, reduce swelling, applied after tonsil removal, small injures.
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| Chemical packs | strike or crush to activate, included in 1st aid kits, commercial cold packs 1 time use, gel packs for hot or cold are reusable, store in freezer/heat in microwave.
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| Compresses | moist, warm, or cool cloth, appropriate temp, plastic wrap, remove excess moisture, gloves if applied to draining wound, aseptic surgical technique if open wound.
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| Aquathermia Pad (k-pad) 1 | electrical heating or cooling device, use alone or cover over a compress, temp controlled by thermostat, altered body temps.
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| Aquathermia Pad (k-pad) 2 | Nurse responsibility, assess skin freq, remove device periodically, cover pad to prevent thermal skin damage, monitor Vs closely pt w/ altered body temp.
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| Soaks & moist packs | submerge body part to warm or apply medication, keep temp constant, never use pack on unresponsive or paralyzed pt, potential for burn, freq assessment, remove park periodically.
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| Therapeutic baths | Non hygienic purpose, fever reducer, application of medicated substances, reduce discomfort, baking soda, cornstarch or oatmeal paste bath, most common is sitz bath.
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| Therapeutic baths2 | Nurse responsibility: assess temp of application freq, monitor skin condition, avoid direct contact between skin & heating device, exposure of skin to extremes of temp can result in injures, use cautiously in children younger than 2 & older adults, pt w/
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| Pressure ulcers(decubitus ulcers)/bedsores | caused by prolonged capillary compression, resulting in impaired circulation to skin & underlying tissue, reddened area over bony prominence that doesn’t go back to normal color when pressure is released.
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| Pressure ulcer risk factors1 | Inactivity, immobility, malnutrition, emaciation, diaphoresis, excessive sweating, really thin.
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| Pressure ulcer risk factors2 | Incontinence, vascular disease, localized edema, dehydration sedation.
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| Pressure ulcers | May also develop over elbows, shoulder blades, back of head, & places of unrelieved pressure d/t infreq movement, primary goal: prevention, nursing measure: reduce size & restore integrity.
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| Prevention of pressure ulcers | identify pt w/ risk factors. Reduce condition under which pressure ulcers are likely to form.
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| Pressure ulcers stage 1 | intact but red skin.
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| Pressure ulcers stage2 | red, blistering.
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| Pressure ulcers stage3 | shallow skin crater extends sq tissue, yellowing color of cells called slough.
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| Pressure ulcers stage 4 | life threatening, deeply ulcerated, bone & muscle exposure, dead infected tissue may cause sepsis.
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| Nursing diagnosis r/t wounds | Acute pain, impaired skin integrity, ineffective tissue perfusion, impaired tissue integrity, risk for infection.
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| Gerontologic considerations1 | wound healing delayed in older adults d/t diminished collagen, blood supply, decreased quality of elastin, dermal layer becomes thinner, decreased amt of sq tissue.
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| Gerontologic considerations 2 | diminished immune response increases risk for infection, absorbent under garments may contribute to skin break down, co morbidities may delay wound healing diminished mobility.
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