Wound care and suturing Flashcards

1
Q

What environment is required for good wound healing?

A

Warm and moist

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2
Q

Give three important principles of wound dressing

A

Aseptic, protect, absorbent

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3
Q

Why is a moist environment good?

A

Encourages synthesis of collagen and ground substance
 Promotes revascularisation
 Decreases length of inflammatory phase
 Reduces pain and trauma due to dressing adherence
 Promotes breakdown of necrotic tissue
 Speeds wound contraction

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4
Q

Two main reasons for swabbing in healthcare

A

Screening (MRSA) and suspected infection

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5
Q

MRSA swabbing - sites

A

Both nostrils (1 swab) and both groins (1 swab)

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6
Q

Give 4 screening criteria for MRSA

A

Patients with a previous history of MRSA
• Patients that have undergone surgical procedures within the last month
• Patients admitted from another hospital facility
• Patients admitted form a nursing/residential care home facility
• Intravenous drug user
• Patients who self-harm (breaking the skin within the last month)
• Patients with chronic wounds e.g. leg ulcers
• Patients with indwelling devices e.g. urinary catheters, PEG

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7
Q

What two things in a wound/ulcer might indicate infection

A

Inflammation, slow healing

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8
Q

Give 4 grades of pressure ulcer

A
Intact skin (non-blanching erythema)
Partial thickness (epidermis +/- dermis)
Full thickness (includes SC tissue)
Necrosis
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9
Q

Wound dressing

a) If unsure what type to use, refer to…
b) If wound is complex, call the…
c) When applying dressing to lower leg, always apply bandage from ___ to ____.

A

a) Formulary
b) TVN
c) Toe to knee

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10
Q

What are the four phases of wound healing?

A

Vascular, inflammatory, proliferative, maturation

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11
Q

Vascular phase:

a) 2 processes
b) Rationale
c) Duration
d) Temporary closure through a _____ mesh

A

a) Vasoconstriction, clotting
b) Prevent blood loss
c) Minutes
d) Fibrin

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12
Q

Inflammatory phase:

a) Vaso_____ occurs - mediated by….?
b) Duration
c) Cellular components and function
d) Defined by what 5 features
e) Dead cellular debris on wound surface can result in the development of ______. How can this be removed?

A

a) Vasodilation - mediated by histamine and other inflammatory mediators
b) ~ 1 week (peaks 20 mins post-injury)
c) Neutrophils (1st on scene, free radicals), Macrophages (phagocytosis, recruit lymphocytes), Lymphocytes (secrete cytokines to recruit fibroblasts)
d) Calor (heat), Rubor (red), Dolor (pain), Tumor (swelling) and Loss of function
e) slough; hydrogel

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13
Q

Proliferative phase:

a) _______ secrete ______ to build new tissue
b) Duration
c) Give three physiological processes that occur

A

a) Fibroblasts; collagen
b) from 72hrs post-injury to ~ 1 month
c) Epithelialisation (formation of new epithelium), granulation (formation of new matrix), angiogenesis

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14
Q

Leg ulcers:

a) Risk factors for (i) venous (ii) arterial (iii) neuropathic
b) Location for each
c) Other features of each
d) ABPI threshold for compression bandaging

A

a) i) varicose veins, DM, phlebitis, previous DVT ii) PVD, DM, CHD, previous stroke/TIA iii) DM, CMT
b) i) calf, medial malleolus, ii) distal, toes, dorsum of foot, iii) pressure points
c) i) lipodermatosclerosis, hyperpigmentation ii) hairless, pale, weak pulses, nocturnal pain, iii) no sensation, punched out
d) >0.8

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15
Q

Maturation stage:

a) Duration
b) Strength of wound at i) week 1, ii) month 1, iii) month 3

A

a) From day 20(ish) for months/years depending on wound size
b) - 10% by end of the first week
- 70% by 4 weeks
- 80% by 3 months

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16
Q

a) Primary intention - define, example and shape
b) Secondary intention - define and example
c) Tertiary intention - define and example

A

a) wound edges apposed; Surgical scar, with sutures/staples; linear;
b) wound edges not apposed, allowed to granulate; ulcer or burn
c) wound purposefully left open; initially cleaned and debrided, later surgically closed (e.g. by graft)

17
Q

Patient barriers to healing

A
Elderly
Diabetes – microvascular disease, neuropathy, raised glucose
Malnutrition
Malignancy – local or general
Renal or hepatic failure
Drugs
Immunosuppressive diseases
Vitamin deficiencies
18
Q

Local barriers to healing

A
Site
Infection
Oedema
Vascular insufficiency
Previous radiotherapy