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Wound Care 3

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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