Wound Care and Sutures
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| A Wound is? | A disruption in the continuity of cells-anything that causes cells that would normally be connected to become separated.
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| Surgical wounds that are incisional means? | An intentional cut through intact tissue.
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| Surgical wounds that are excisional means? | Removal of tissue.
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| How many classifications are ther of surgical wounds? | Four.
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| Ideal conditions, no breaks in technique, primary closure, no drain, an infection rate of 1-5% is which classification? | Class I Clean
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| Primary closure wound drain, minor break in technique, controlled entry into GI/GU tract, and infection rate of 8-11% is which classification? | Class II Clean Contaminated
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| Open traumatic wound(less than 4 hours), major break in technique, inflammation is present, entry into GI/GU tract with spillage, and infection rate of 15-20% is which classification? | Class III Contaminated
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| Open traumatic wound(more than 4 hours), prior microbial contamination, perforated viscus, and infection rate of 27-40% is which classification? | Class IV Contaminated
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| Treatment within the first hour increases survival rate, what is this called? | The Golden Hour
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| A Closed Traumatic Wound means? | The skin remains intact
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| An Open Traumatic Wound has four types, what are they? | Simple-integrity of skin is not intact, Complicated-tissue lost or destoyed, Clean-edges can be approximated, and Contaminated-a dirty object damages integrity of tissue; debridement may be necessary
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| What are the Mechanisms of Injury? | Abrasion-Scrape,Contusion-Bruise, Laceration-Cut or tear, Puncture-Penetration, and Thermal-Heat or cold
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| What are the Factors that affect wound healing? | Age, weight, nutrition, dehydration, blood supply, immune response, chronic illness, drugs and radiation therapy, and Smoking
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| What are the basic principles in wound management? | Hemostasis, First priority, Bloodless field, Suture ligation, and Seroma & Hematoma can lead to infection or to a delay in wound healin
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| What is a Seroma? | A pocket of clear serous fluid that sometimes develops in the body after surgery
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| What is a Hematoma? | A mass of blood usually clotted caused by a break in a blood vessel
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| Sterile technique, anesthesia and irrigation are all part of what? | Wound cleansing
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| A delivery of an irrigating solution under pressure for the purpose of cleansing and debridement is what instrument? | Pulse Lavage
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| Handling of the tissue, incision planning and relaxed skin tension lines are all part of what? | Wound closure
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| Air between layers is what? | Dead Space
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| What is the Inflammatory Process? | The body's protective response to injury
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| What are the classic local signs of inflammation? | Pain, heat, redness, swelling and loss of function
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| Wound healing begins with_______and ends with _______________. | Trauma and Scar formation
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| How many Types of Wound Healing are there? | Three
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| What is the First Intention or Primary Union type of wound healing? | Good tissue, healthy tissue, typical of an incision opened under ideal conditions, healing occurs from side to side, Dead Space has been eliminated, wound edges have been accurately approximated, wound heals rapidly with no separation of edges,min scars
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| How many Phases are there to the First Intention? | Three
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| What is Phase I:Lag Phase(Inflammatory Response) of First Intention? | Stage begins W/I minutes of injury, last approx. 3-5 days, manifested by classical signs of inflammation, and initial appearance & infiltration of neutrophils
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| What is Phase II:Proliferation Phase of First Intention? | Begins on approx the 3rd postoperative day & continues for up to 20 days, fibroblast secrete collagen that forms into fibers that provide about 30% of tensile strength, new networks from cappillaries are established, lymphatic networks are reformed
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| What is tensile strength? | The amount of tension anything can withstand before it breaks
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| What is Phase III: Maturation(Differentiation Phase) of First Intention? | Begins on the 14th postoperative day continues until wound is completely healed, wound undergoes a slow, sustained increase in tensile strength, collagen density increases & formation of new blood vessels decreases, cicatrix appears
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| Normal scar formation | Cicatrix
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| Raised, thickened scar due to excessive collagen formation | Keloid
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| Excessive granulation tissue | Proud Flesh
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| Ability to resist rupture | Tensile strength
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| What is the Second Intention or Granulation Healing of Wound Healing? | Occurs when a wound fails to heal by primary intention,occurs in lge wounds that cannot be directly approximated or infection caused breakdown in sutured wound, may occur in a wound where risk of infection is great, may be allowed following debridement
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| Granulation Healing occurs when? | Wound is left open,granulation tissue containing myofibroblasts forms, wound heals inside to outside, wound closes by contraction, wide scarring and Proud Flesh appear
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| What is the Third Intention(Delayed Primary Wound Closure) of Wound Healing? | Occurs when 2 granulated surfaces are approximated, Class III or Class IV wounds have been debrided & purposely left open to heal by 2nd Intention,patients are treated w/systemic antibiotics, special wound care techniques are used to treat/prevent infectn
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| Infection free wound is then closed and allowed to finish the healing process through primary closure is part of which type of Wound Healing? | Third Intention
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| What is Systemic antibiotics? | Given by IV fluids
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| Age, Nutritional status, Disease(Acute/chronic), smoking, radiation exposure, and immunocompromised are all______? | Factors influencing wound healing
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| Intraoperative tissue handling includes what? | Length & direction of incision, Dissection technique, Duration of surgery, Amount of tissue handling, Achievement of hemostasis, Precise tissue approximation, Elimination of Dead Space, and Secure wound closure
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| Complications of wound healing include what? | Dehiscence, Friable Tissue, Evisceration, Hemorrhage, Infection, Adhesions, Herniation, Fistula, Sinus Tract, Suture complications, and Keloid scars
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| Dehiscence is what? | A separation of wound edges
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| Evisceration is what? | Complete, total separation of layers
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| Adhesions are what? | Abnormal scar formation
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| Herniation is what? | Weakening or out pouching in abdominal wall
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| Fistula is what? | Abnormal opening
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| Sinus Tract is what? | Opening to the outside
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| Additional complications of the healing wound are? | Tissue moisture, Dead Space and Postoperative wound stress
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| Sterile Technique, Tissue perfusion, Antibiotic therapy and Eliminate Dead Space are all what? | Factors that influence Decrease in Dehisence/Evisceration
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| What is the goal of postoperative wound care? | To prevent postoperative complications
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| Postoprative wound care includes? | Drains, dressings, and Packing
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| Dressings are determined by what several factors? | Type,size, and location of the wound;Amount of drainage expected; Surgeon preference; Age & size of patient; Underlying medical conditions; Condition of surrounding skin; Comfort of the patient
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| What is Dermabond | Skin glue
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