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57 Cards in this Set
- Front
- Back
Wound: a disruption of ____________ ____________________ which may be ____________________ (traumatic) or _____________ (surgical.) |
tissue continuity
accidental
deliberate |
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What are the 3 classifications of wounds? |
1. clean
2. contaminated
3. infected |
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A "clean" wound is: |
created during a surgical procedure |
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A "contaminated" wound depends on: |
the amount of bacteria present |
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An "infected" wound has great than: |
>10 to th 5th/g of tissue |
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List two advantages of lavage: |
1. flushes wound of debris, bacteria, necrotic tissue
2. decreases wound complications during healing |
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What fluid is most often used to lavage a wound? |
normal saline |
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Debridement: definition |
the removal of debris, hair, necrotic tissue, etc. (wound is cleaned) |
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What should be assessed during wound debridement? |
tissue viability |
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What would non-viable tissue look like? |
|
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During debridement, what decision must be made? |
To close the wound or not to close the wound
(based on viability of tissue) |
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What things will determine closure?
(name 5) |
1. blood supply 2. status of patient 3. sound location (tension, movement, dead space) 4. availability of skin 5. infection |
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Wounds:
Dead space left in a wound will fill with serum causing either a ___________ if clean, or an __________ if dirty. |
seroma
abscess |
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The process of wound healing begins __________________. |
immediately |
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4 Physical Phases of Wound Healing: |
1. Inflammatory
2. Debridement
3. Repair
4. Maturation |
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1. Inflammatory Phase of Wound Healing:
begins _______________
lasts __________________ |
immediately
up to several weeks |
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1. Inflammatory Phase of Wound Healing:
Has 2 Phases:
|
Initial Phase
Phase 2 |
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1. Inflammatory Phase of Wound Healing:
What happens in the Initial Phase?
(2) |
1. vasoconstriction (controls hemorrhage)
2. vasodilation (contains clotting elements) |
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1. Inflammatory Phase of Wound Healing:
What happens in Phase 2, and what cells are predominant? |
1. Cells adhere to vascular endothelium
2. blood clot forms (stabilizes wound edges)
3. scab forms (protects and promotes healing underneath)
Monocytes |
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2. Cellular Debridement:
1. begins approximately _____________ after injury.
2. contains what type of cells? |
1. 6 hours
2. monocytes as macrophages |
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2. Cellular Debridement:
WBCs and fluid leaked into wound forms _________ associated with wounds |
exudate |
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3. Repair
When does repair begin?
What happens? |
--after clot is formed
(3-5 days into healing process)
--clean up via macrophages
--fibroblasts produce collagen --> scar tissue |
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3. Repair
As fibroblasts and capillaries proliferate, ____________________ tissue is formed and appears ___________ ___________ |
granulation tissue
bright pink |
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Repair Phase: Epithelialization
1. When does it begin?
2. What do epithelial cells need?
3. What does this accomplish? |
1. within hours of initial wound
2. healthy bed of granulation tissue
3. enhances wound closure |
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Repair Phase: Contraction
1. When does it occur?
2. What happens?
3. Epithelialization is halted in a ___________ _____________. |
1. 5-9 days after injury
2. edges of wound are pulled together, increases strength
3. desiccated wound |
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Repair Phase: Maturation
What is happening? |
remodeling of wound
capillaries disappear / wound becomes pale |
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Wound remodeling can go on for how long? |
years |
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Does wound / scar tissue ever regain the strength of normal tissue? |
NO |
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Obstacles in Wound Healing:
Physical / Environmental Factors (2) |
1. temperature 2. O2 levels
|
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Outside temperature affects wound healing in what way? |
affects ability of wound to stretch (tensile strength) |
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What is the ideal temperature for wound healing? |
30 degrees Celsius |
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Physical Obstacles in Wound Healing:
Wounds have less __________ due to disruption of tissue and vessels. |
oxygen |
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Name some reasons why wounds have less oxygen than is ideal? |
1. poor blood supply due to hypovolemia
2. tight bandages
3. presence of necrotic tissue |
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Systemic / Endogenous Factors in Wound Healing:
(condition of the animal)
(4) |
1. Anemia 2. Hypoproteinemia 3. Uremia 4. Obesity |
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Albumin makes up _______ to ________ % of total plasma protein. |
35 - 50% |
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Hypoproteinemia = < ______ g/dl? |
<2.0 g/dl |
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Hypoptroteinemia is seen in what 3 conditions / diseases? (And what happens?) |
1. liver disease - can't produce albumin
2. renal disease - albumin loss
3. malnutrition - albumin not absorbed |
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Albumin is a _______________ molecule. It maintains ___________ ___________ in vessels which prevents _________________ ____________. |
transport
osmotic pressure
fluid leakage |
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If albumin is not available, wound healing is _______________. |
delayed |
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How does uremia affect wound healing? |
granulation tissue production
poor quality collagen |
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How does obesity affect wound healing? |
suture holding in SQ fat layers - may be difficult |
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Exogenous Factors in Wound Healing: (6) |
1. chemicals 2. corticosteroids 3. immunosuppressive drugs 4. foreign bodies 5. cytotoxic drugs (chemotherapy) 6. Vitamin E |
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How do corticosteroids affect wound healing? |
Healing time - immune system is suppressed
Inhibits capillary budding Inhibits proliferation of fibroblasts Inhibits increase in epithelialization |
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Too much ________________ slows collagen production |
Vitamin E |
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Immediate wound care:
After occurrence, cover with a __________ _______ ______________. Avoid further contamination |
clean, dry bandage |
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Immediate Wound Care:
3 steps: |
1. cover with clean, dry bandage
2. clip hair (use sterile KY to absorb hair)
3. lavage wound using saline (bottles or large syringes) |
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4 Types of Wound Healing / Closure: |
1. Primary Wound Closure
2. Delayed Primary Closure
3. Secondary Closure
4. Open Wound Management |
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Primary Wound Closure:
Ideal situation is healing by _______ ___________.
Suturing a wound should happen within how long after injury? |
first intention
<24 hours after injury |
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Delayed Primary Closure:
Delay until ________________ is under control.
Before how many days?
Before what happens? |
contamination
3 - 5 days
granulation bed develops |
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Delayed Primary Closure -
the wounds are usually: |
moderately contaminated, traumatized wounds |
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2nd Intention Healing:
these wounds are usually: |
contaminated, traumatized wounds |
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2nd Intention Healing:
1. Often involves multiple ___________ ___________. 2. What kind of wound mgmt? 3. heals without ____________ __________.
example: |
1. bandage changes
2. open wound
3. surgical closure
ex. - degloving |
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Secondary Closure:
1. closure after ________ days 2. require a lot of ___________________ 3. _______________ wound mgmt. 4. happens after ___________ ___________ has developed
These wounds are __________________________ |
1. 5 days 2. debridement 3. prolonged 4. tissue granulation
Severely contaminated, traumatized wounds |
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Open wound management is based on these two things: |
1. multiple bandage changes
2. debridement |
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Open Wound Mgmt:
What type of dressings are used to assist in mechanical debridement? |
wet-dry dressings |
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Open Wound Mgmt:
Bandage changes how often?
What type of dressing does not interfere with granulation? |
daily
dry, non-stick dressing |
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Materials & Medications that stimulate wound healing at the cellular level:
1. name a topical 2. name a freeze-dried form 3. name another form |
1. Acemannan 2. Carasorb 3. Maltodextrin |