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wound care
Animal Tech VI
| Question | Answer |
|---|---|
| 2 types of wounds | open & closed wounds |
| Incision | a clean separation of skin & tissue wit smooth, even edges |
| Laceration | separation of skin & tissue in which the edges are torn & irregular |
| Abrasion | a wound in which the surface layers of skin are scraped away. |
| Avulsion | Stripping away of large areas of skin & underlying tissue, leaving cartilage & bone exposed. |
| Ulceration | shallow crater in which skin or mucous membrane is missing |
| Puncture | an opening of skin, underlying tissue, or mucous membrane caused by a narrow sharp, pointed object. |
| Contusion | Also called a BRUISE, Injury to soft tissue underlying the skin from the force of contact w/ a hard object. |
| Wound | damaged skin or soft tissue results from trauma. |
| Trauma | general term referring to injury. |
| Open wound | the surface of the skin or mucous membrane is no longer intact. |
| Closed wound | there is no opening in the skin or mucous membrane occur from blunt trauma or pressure. |
| Granulation tissue | combination of new blood vessels, fibroblast & epithelial cells. |
| Dehiscence | the parting of the sutured lips of a surgical wound. |
| Evisceration | protrusion of wound contents. |
| Three sequential phases | Inflammation, proliferation, remodeling. |
| Inflammation | Starts immediately after injury, last 2-5 days, limit local damage, prepares wound for healing. |
| Stages of Inflammation | 1st stage-local changes, inflammation (edema), 2nd stage-phagocytosis, redness & warmth, cleaning of the injured area, 3rd pain 4th decrease function. |
| Normal saline | 0.9% sodium chloride. |
| Measure wounds | use sterile qtip (does no hurt pt). |
| Proliferation | New cells fill & seal the wound, 2 days-3 wks after inflammatory phase, Granulation tissue appear. |
| Remodeling | follows proliferation phase, may last 6mths to 2yrs, wound contracts, scar shrinks. |
| 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. |
| 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. |
| 2nd intention healing1 | wound edges are widely separated, margins are not in direct contact, a scar generally forms, presence of body fluid. |
| 2nd intention healing2 | wound debris w/in the wound will prolong the healing; disrupted granulation tissue will retard the healing process. |
| 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. |
| Wound management | promotes healing, goal is to reapproximate the tissue to restore integrity. |
| Serous | clear watery fluid (ex. Blister) |
| Serosanguineous | pink, composed of serum & blood drainage. |
| Sanguineous | Red, relating to blood. |
| Purulent | Pus |
| Dressing | keep wound clean, absorb drainage, controls bleeding, protection from further injury, holds medication in place, maintains a moist environment. |
| Npo pain meds | take 45 mins to work in body. |
| Sq pain meds | take 30-35 mins to work in body. |
| Intramuscular pain meds | take 15-30 mins to work in body. |
| IV pain meds | take 5-10 mins to work in body. |
| Pain meds | Most analgesics have a 4-6 hr window to work. |
| Gauze dressings | woven fibers, highly absorbent, wound assessment can be difficult, granulation tissue may adhere (stick), secured w/tape. |
| Montgomery straps | strips of tape w/eye lids that have a shoe lace through it. |
| Purpose of gauze dressings | for debriment, to address wound drainage. |
| Reason for uncovered wound | to prevent irritation. |
| Transparent dressing | clear wound covering (opsite), assessment w/o removal, less bulky, no tape, non absorbent dressing, common use: IV site. |
| Hydrocolloid dressing | self adhering, Opaque, air & water occlusive (duoderm), Keep wounds moist, leave intact for up to 1 wk, size generously. |
| Dressing changes | wound nds assessment, requires care, dressing is loose, saturation, physician may assume responsibility for 1st change |
| Drains | means for removing blood & drainage, promotes healing, placement direct insertion, separate location besides the wound. |
| 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. |
| Closed drains | tubes terminate into a receptacle (ie: Hemovac & Jackson-Pratt (jp) drain, more efficient than open drains, vacuum or negative pressure. |
| Drains2 | clean using circular motions, precut drain sponge or gauze. |
| Types of closures | Sutures, staples, steri-strips/butterflies. |
| Sutures | hold an incision 2gether, silk or synthetic material (nylon), encircles the wound. |
| Staples | wide metal clips, form a bridge holding 2 wound margins 2gether. |
| Steri-strips/butterflies | closure of superficial lacerations, holds weak incisions 2gether temporarily. |
| Advantage of staples over sutures | sutures will not compress the tissue if it swells, & it does not encircle the wound. |
| Bandages | strip or roll of cloth wrapped around a body part (ex: ace wrap). |
| Binders | type of bandage applied to a particular body part (ex: abd or breast). |
| Bandages/binders1 | hold dressings in place especially when tape cannot be used or the dressing is extremely large. |
| Bandages/binders2 | Support the area around a wound or injury to reduce pain. |
| Bandages/binders3 | Limit movement in the wound area to promote healing. |
| 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. |
| 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. |
| Styles of bandage application | circular turn-wrap, spiral turn-cylindrical, spiral reverse turn, figure 8 turn-joints, spica turn-variation, Recurrent turn-beneficial. |
| 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. |
| Debridement | removal of dead tissue, promotes healing, 4 methods: sharp, enzymatic, autolytic, mechanical. |
| 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. |
| Euchar | hard necrotic tissue (black) depending on location & Dr.’s order may be removed. |
| 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. |
| 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. |
| Mechanical debridement1 | Wet to dry dressing, remove after 4-6 hrs, dead tissue adheres to gauze mesh work, painful, disrupts or removes healthy tissue. |
| Mechanical debridement2 | Hydrotherapy, submerged in a whirl pool tank, antiseptic solution, agitation softens dead tissue, sharp debridement for loose debris. |
| Mechanical debridement3 | Irrigation (uses normal saline to clean out area), flushing debris, wound care, cleaning eyes, ears & vaginal. |
| Wound irrigation | used before applying new dressing, granulation tissue has formed. |
| Vaginal irrigation | also know as douche, sometimes necessary to treat an infection. |
| Eye irrigation | flushes toxic chemical from one or both eyes, displaces dried mucous or other drainage, warm solution to body temp. |
| 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. |
| Heat uses | Provides warmth, promotes circulation, speeds healing, relieves muscle spasm, reduced pain. |
| Cold uses | Reduces fevers, prevents swelling, controls bleeding, relieves pain, numbs sensation. |
| Cold application | Ice bag/ice collar: containers for holding ice, improvised version, reduce swelling, applied after tonsil removal, small injures. |
| 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. |
| 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. |
| Aquathermia Pad (k-pad) 1 | electrical heating or cooling device, use alone or cover over a compress, temp controlled by thermostat, altered body temps. |
| 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. |
| 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. |
| 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. |
| 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/ |
| 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. |
| Pressure ulcer risk factors1 | Inactivity, immobility, malnutrition, emaciation, diaphoresis, excessive sweating, really thin. |
| Pressure ulcer risk factors2 | Incontinence, vascular disease, localized edema, dehydration sedation. |
| 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. |
| Prevention of pressure ulcers | identify pt w/ risk factors. Reduce condition under which pressure ulcers are likely to form. |
| Pressure ulcers stage 1 | intact but red skin. |
| Pressure ulcers stage2 | red, blistering. |
| Pressure ulcers stage3 | shallow skin crater extends sq tissue, yellowing color of cells called slough. |
| Pressure ulcers stage 4 | life threatening, deeply ulcerated, bone & muscle exposure, dead infected tissue may cause sepsis. |
| Nursing diagnosis r/t wounds | Acute pain, impaired skin integrity, ineffective tissue perfusion, impaired tissue integrity, risk for infection. |
| 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. |
| 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. |
Created by:
posiniv
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