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28 Cards in this Set
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Wound Classification Acute
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Abrasions, punctures, lacerations, burns (injury)
Heal in approx. 1 month (healthy pts) Wound depth determines treatment options Self-care appropriate for those not extending beyond dermis |
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Wound Classification Chronic:
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Require triage/intense medical treatment
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Three stages of wound healing:
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Inflammatory- immediate- 3,4 days-Hemostasis/inflammation
Proliferative Day 3 to 3 weeks, building of connective tissue/epidermis Remodeling, 3 weeks--->,Continual collagen formation & breakdown |
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Wound Staging
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Stage 1: no loss of skin layers; reddened, unbroken skin
Stage 2: superficial lesions, partial-thickness skin loss (epidermis +/- dermis) Stage 3: full-thickness skin loss; damage to epidermis, dermis, +/- SC fat Stage 4: full-thickness skin loss, involving more of SC fat, muscle, tendon, bone |
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Treatment for minor wounds
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Treatment goals:
Promote healing, Protect wound from infection/trauma Minimize scarring Treatment approach: Cleanse wound, Select topical antiseptic and/or antibiotics Choose appropriate dressing (moist) |
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Exclusions for self treatment
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Wound with foreign matter after irrigation
Chronic wound Animal or human bite Signs of infection Involves face, mucous membrane, genitalia Deep, acute wound Patient with diabetes, immunocompromised |
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Stage wounds you can self treat
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Stage 1 and 2
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MRSA infections: cellulitis
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Increased prevalence in community
Children, young,adults At-risk: Football players, Wrestlers, Prison inmates REFER!!! |
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Wound Dressing
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The ideal dressing:
1. Removes excess exudate 2. Maintains moist environment 3. Permeable to oxygen 4. Insulates wound 5. Protects from infection 6. Free of contaminants/particulate matter 7. Removable without disruption of new tissue |
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Types of dressings (3)
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1. Moisture-absorbing:
2. Moisture-maintaining: 3. Moisture-providing: |
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1. Moisture-absorbing:
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For Mod/Heavy draining wounds
Foams: Epi-Lock---Mostly non-adhesive, on-occlusive,Comfortable, trauma-free removal, Absorbent, Do not use for minimally draining wounds Alginates: AlgiDERM---Fibers form gel at wound interface, Absorbent, non-occlusiveMore comfortable than foam; trauma-free removal, Use on infected wounds, minor bleeding Carbon-impregnated: Carboflex---Use for malodorous wounds, Require seal, Carbon is inactivated if wet Composite: Nu-Derm---Non-adherent, semi-occlusive, Impermeable to fluid/bacteria, Use for suture/staple lines, May cause trauma to surrounding tissue upon removal |
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2. Moisture-maintaining:
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Hydrocolloid: Tegasorb--- Wafer or paste,** Waterproof**, Occlusive, Long wear time, Self-adherent, Impermeable to
fluid/bacteria, Uninfected wounds only, Transparent film: Tegaderm--- Semi-occlusive, Permeable to gas, Comfortable and self-adherent, Impermeable to fluid/bacteria, May re-injure wound on removal, Uninfected wounds only |
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3. Moisture-providing:
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Hydrogels/Gels: Vigilon
Non-adherent Non-occlusive Reduce pain; cooling effect Comfortable, trauma-free removal Variable absorption Good for BURNS** |
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Moist wound environment (New Strategies)
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1. Prevents scar
formation 2. Removes exudate without dehydration 3. Prevents bacterial growth |
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Gauze pads (?) still use
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Used with semiocclusive
foam dressings for exudate absorption Debridement of necrotic tissue Minor cuts and abrasions |
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TL is a 28 year old WM who sustained full-thickness
burns on his left arm from a four-wheeler accident at deer camp last weekend. His physician suggested he ask his pharmacist to recommend a suitable bandage for his burns. What is the MOST APPROPRIATE type of bandage for TL? A. Hydrogel dressing B. Gauze dressing C. Carbon-impregnated dressing D. Transparent film dressing |
A.. Hydrogel (good for burns)
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50 year old AAF
Wound on her R leg Epidermis and dermis were impacted Moderate drainage from the wound No erythema or purulent discharge Wound is not painful What type of bandage should she use? |
Foam (Epi-Lock)
Alginates: (AlgiDERM) good for heavy drainage |
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Wound irrigants:
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remove dirt/debris
Normal saline or bottled water Chlorhexidine (Hibiclens)® Instructions for use: Brush wound will wet cotton ball 3x4 times a day |
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Antiseptics:
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disinfection for **intact** skin, alcohol is very drying
Ethyl alcohol (48-95%) Isopropyl alcohol (50-91%) Iodine solution or tincture USP-do not bandage a wound you applied iodine to (inc, systemic absorption) Povodine/iodine complex (5-10%) less irritating than iodine Hydrogen peroxide USP (3%) let it dry fully before covering Dakin’s solution (sodium hypochlorite) Bleaching agent, irritates skin, good anticeptic |
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Topical antibiotics:
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Clean area first.
Bacitracin: Gram (+) bacteria Neomycin: Gram (-) bacteria plus some Staph Polymixin B: Gram (-) bacteria |
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Topical antibiotics instructions:
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Apply within 4 hours, after cleansing, to reduce risk of infection
and promote healing Clean wounds have low infection rate; may not require topical abx Use for 3-5 days;consult PCP if no improvement |
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Alternative Therapies: Witch Hazel
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Astringent (contains alcohol)
Inhibits bacterial growth Primarily used for minor skin injuries and relieving itch, pain from hemorrhoids |
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Alternative Therapies: Aloe Vera Gel
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Antiviral, antibacterial, and antifungal
Primarily for burns, frostbite, and some minor cuts/abrasions |
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Alternative Therapies: Goldenseal
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Contains alkaloids with weak antimicrobial activity
No documented evidence of any benefits |
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Alternative Therapies: Vitamins E and C
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Necessary for proper healing
Supplementation acutely probably not necessary for minor wounds Possible antioxidant effects |
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Tetanus Vaccination
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All wounds warrant checking tetanus
vaccination status (1 every 10 years or recommend if deep puncture wound) CDC wound care guidelines must be followed |
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Neosporin vs Polysporin
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Polysporin, better for larger wounds and burns, so no neomycin (amino glycoside) absorption
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Pharmacists Assesment of wounds
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1. Type, depth, location, contamination
2. Signs of infection 3. Patient’s health status, current medications 4. Need for antimicrobials (20 infection) 5. Need for tetanus booster |