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Topical therapy

WOCN program

describe the signs and symptoms of infection in chronic wounds inflammation(or not) delayed healing, friable wound bed, wound breakdown, foul odor, serous drainage, pocketing at base of wound
define bioburden the presence of microorganisms in a wound, colonization, critical col., biofilm, infection. includes quantity, virulence, and type of bacteria
define contamination presence of NON replicating organisms. No host response. all wound contaminated by skin flora doesn't impair healing
define colonization bacteria are on the wound bed, have begun to replicate and attach to surface. No host response Doesn't impair healing
define critical colonization considered present if wound not healing or not decreasing in size after 2weeks defined by response to treatment
define infection bacteria invade tissue and cause a host response.
compare three techniques used to obtain a wound culture tissue biopsy, needle aspiration, swab technique, Levine technique
which of the following criteria is an indication to obtain a wound culture: decrease exudate and odor, lack of healing after 2wks in a clean wound, lack of healing after 4 wks in a clean wound, increase in wound size lack of healing after 2wks in a clean wound
true or false: all chronic wounds are colonized with bacterial organisms true
define the difference between colonization and contamination colonization has bacteria that are replicating and adhere to wound surface contamination is with microorganisms that are non replicating, are ON surface but not attached
true or false: wound contamination will contribute to delayed wound healing false
True or false: biofilm is best managed by frequent debridement true
identify the term NERDS and what it is used for assessment for critical colonization Non healing wound Exudating (incr. in exud.) Red and/or bleeding wound (incr from baseline) Debris (necrotic tissue) Smell Topical anti-bx for 2weeks if no tissue invasion
what is the most accurate swab method for a wound culture Levine technique
What is a less invasive technique to determine osteomyelitis MRI
What is the gold standard for wound culture biopsy
define biofilm bacteria in a self secreted matrix that is permanently adhered to wound surface (or nonbiologic surf. like implant)
treatment for biofilm sharp debridement followed by moisture retentive dsg and wound irrigation, antimicrobial dsg, to prevent reformation, maintenance debridement (incl autolysis)
define STONEES to assess for deep tissue infection Size increased Temp inch's O- New Opening New breakdown Erythema/Edema Exudate Smell requires systemic ABX
when would sodium hypochlorite be used to irrigate a wound local infection or critical contamination, MRSA, e coli present best at 0.0125% (1/4 strength) odor control use short term only
when would acetic acid be used if pseudomonas aeruginosa is present- green drainage, use 1/4 strength
what is the goal of cleansing wounds flush away exudate without damage to healthy and newly formed tissues dirty or necrotic wounds require 4-15 psi
when is cytotoxic cleansing indicated, when is noncytotoxic indicated cytotoxic- dirty, infected, heavily necrotic noncytotoxic can irrigate dirty wounds but won't have bateriocidal action.
what irrigation solution is effective against psuedomonas aeruginosa acetic acid 0.25-0.5%
what does cadexomer iodine do eff. against MRSA, nontoxic to fibroblasts
hydrofera blue effective against MRSE, VRE, E COLI
mupirocin 2% effective against MRSA, beta-hemolytic strep, contraindicated for large burns, blocks activity of enzyme in bacteria that make proteins
silver off. against MRSA, VRE, do not use if there is a low bioburden, can delay epithelialization
AMD, PHMB broad spectrum
strength of irrigation 4-15 psi-35 ml syringe and 19 gauze IV catheter (7psi)
what are the principles of topical therapy obliterate dead space, identify and eliminate infection, remove necrotic tissue maintain moist wound, thermal insulation, protect wound
Created by: Beth Perry