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Wound Care & Bandage
Wound Care & Bandaging - VTT 226
| Question | Answer |
|---|---|
| What initiates wound healing? | Platelets |
| What are the four phases of wound healing? | Inflammatory, debridement, repair, maturation |
| What happens in the inflammatory phase? | Blood fills the wound to clean surface, vasoconstriction slows hemorrhage, blood clot forms, clot forms a scab, and blood vessels leak WBCs into the wound |
| When does the inflammatory stage begin? | Immediately after injury. |
| When does the debridement phase begin? | 6 hours after injury. |
| What happens in the debridement stage? | Neutrophils and Macrophages appear in the wound to remove necrotic tissue, remove bacteria and remove foreign material. |
| When does the repair stage begin? | After a blood clot has formed, and necrotic tissue and foreign material have been removed. |
| What happens in the repair phase? | An invasion of fibroblasts to produce collagen and new capillaries develop to feed the area with oxygen and nutrients. |
| What does collagen do? | Helps contract the edges, reducing the size of the wound. Also gives a significant increase in wound strength. |
| What does capillaries + fibroblasts + fibrous tissue equal? | Granulation tissue |
| What does granulation tissue do? | Fills in the area of a wound, under the scab, known as the tissue deficit. It protects the wound and provides a barrier against infection, providing a surface for new epithelial cells to form across. |
| What happens in the maturation phase? | Wound strength increases to the maximum level, the number of capillaries decreases. it's the final form of healing and may continue for several years. |
| What are some external factors that can effect healing? | Foreign material (debri, maggots), bacteria, tight bandages, and movement. |
| What are some host factors that can effect healing? | Drugs (steroids, chemotherapy, aspirin), malnourishment, age, Hyperadrenocorticoidism (Cushing's), Diabetes, Liver disease, and Renal disease |
| What shouldn't you use on an injury? | Abx creams or powders (they delay the healing process), and ointments (they can seal in bacteria and bring on a bigger problem). |
| What do you use for wound lavage? | Moderate pressure (25-60mL syringe w/ 18-20g needle), large volumes of warm, balanced electrolyte solutions (saline or LRS). |
| Lavage supplies are? | Fluid, needles, syringe, 3-way stop cock, line |
| What is Primary or First Intention healing? | Fresh, clean wounds. Minimal trauma, minimal contamination. Treated within 6-8 hours of injury. Closed with suture. Surgically created wounds. |
| What is Delayed Primary healing? | Closure 3-5 days after injury, before development of granulation tissue. Moderately traumatized, moderately contaminated wounds. |
| What is Second Intention healing? | Wound heals without surgical closure, relies on the body to form tissue over the wound with skin contraction and new epithelial tissue. May not be possible or desirable in all wounds. |
| What is Third Intention healing? | Secondary closure. Closure after 3-5 days. Granulation tissue has already been developed. Severely contaminated and severely traumatized wounds. Requires considerable debridement, usually needs drains. |
| What are factors in wound healing decision making? | Time since injury, degree of contamination, degree of trauma, blood supply, patient physical status, location of the wound. |
| What types of wounds are there? | Abrasions, lacerations, burns, punctures, and degloving. |
| How to care for abrasions: | Keep surface moist and protected. Change the bandage every 3-4 days. Usually left to Second Intention healing. |
| What type of healing is degloving? | First Intention healing |
| What is the purpose of bandaging? | Promotes wound healing. Protects from additional trauma & contamination. Immobilizes wound of fracture. Minimizes post-op edema. Absorbs exudates. Lifts away foreign material. Promotes an acidic environment. |
| What are the layers of bandaging? | 1- Primary (adherent). 2- Secondary (padding). 3- Tertiary (conforming, protective) |
| What are the types of bandaging? | Robert Jones, Modified Robert Jones, Wet to Dry Bandage, Ehmer Sling, Velpeau Sling, and Carpal Flexion Sling |
| How long can a Modified RJB be left on, before it needs to be changed? | 14 days |
| What is a Wet to Dry Bandage? | First layer- sterile saline soaked gauze, on the wound. Then regular Modified Robert Jones. Indicated for highly contaminated wounds. Needs to be changed every 12-24 hours. |
| What is an Ehmer Sling? | Prevents weight bearing. Immobilizes hind limb. Minimal padding is suggested. |
| What is a Velpeau Sling? | Holds the flexed forelimb. Prevents movement in all joints. |
| What is a Carpal Flexion Sling? | Immobilizes the carpus. Relieves tension on flexor tendons. Maintains flexion after tendon repair. |
| Types of splints | Quick splints, "Green" plastic splints, Carpal splints |
| How often should bandages with open wounds be changed? | Every 12-48 hours. |
| How many layers of bandaging are there? | 3 (sometimes 4) |
| What is the purpose of an acidic environment? | Prevents co2 loss, absorbs ammonia broduced by bacteria, increases O2 availability to the wound |
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PimaVT
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