218 Integ: Wound Healing And Types Of Wounds

Front 1

what are intrinsic factors that can delay healing?

Back 1

1. aging

2. chronic diseases

3. circulatory disease

4. malnutrition

5. neuropathy

Front 2

what are extrinsic factors that can delay healing

Back 2

1. medications (e.g. steroids)

2. necrotic tissue

3. infection

4. excessive pressure

5. wrong dressing choice

Front 3

what are the phases of tissue healing?

Back 3

1. Inflammatory Phase : 3-5 days

2. Proliferative, Granulation or Fibroblastic phase: day 2-3 and extends for several weeks

a. angiogensis

b. granulation formation

c. wound contraction

d. epithelialization

3. Maturation: tissue remodeling lasts up to 2 years

Front 4

what is primary union?

Back 4

the healing that takes place following a non-infected laceration or surgical incision

Front 5

what is secondary union

Back 5

Prolonged process of dermal healing that results from necrosis of tissue due to inflammation or traumatic destruction (decubitus ulcer healing)

-delay of wound healing unless dead tissue and debris are removed from the wound

Front 6

what is Tertiary union?

Back 6

delayed primary union

-delay in suturing of a site for 5-7 days is indicated in presence of wound contamination (risk of infection), large tissue loss, or excessive edema

-healing process similar to primary union except for a delay of about a week

Front 7

Risk factors for pressure ulcers:

Back 7

1.Immobility: primary risk factor
2. Prolonged pressure
3. Repetitive stress
4. Nutritional deficiency
5. Decreased sensation
6. Maceration (softening associated with excessive moisture)
7. Friction or shearing forces
8. Decreased arterial perfusion
9. Abnormally low or high BMI

Front 8

Prevention of pressure ulcers:

Back 8

1. Pressure sensitive areas must be relieved 3-4 times per hour in a recumbent position or every 15-20 minutes while sitting
2. The skin should be inspected and kept clean and dry

3. Risk assessment scales for pressure ulcers include: Braden or Norton

Front 9

What is Stage I of pressure ulcer and characteristics ?

Back 9

nonblanchable erythema

-reversible with intervention

1. discoloration

2. warmth

3. edema

4. induration (firming or hardening of the tissues secondary to edema)

Front 10

what is stage II pressure ulcer and characteristics?

Back 10

Partial thickness skin loss

Epidermis and dermis involved

presents as Abrasion, blister, or shallow crater

Front 11

what is Stage III pressure ulcer characteristics?

Back 11

Full-thickness skin loss
May extend down to, but not through, underlying fascia

-extends into fat layer (subcutaneous tissue), but not through fascia

-Deep crater

Front 12

what is Stage IV pressure ulcer? and characteristics

Back 12

Full-thickness skin loss
Extensive destruction

-extends beyond fascia into the muscle

-other structures (e.g. tendon, capsule or bone) are often exposed

-may extend down to and include bone destruction
Tissue necrosis
Undermining and sinus tracts may be present

Front 13

Unstageable is what?

Back 13

term is used if the wound is obscured by necrotic tissue

Front 14

Examination for Pressure Ulcer (Decubitus Ulcer):

Back 14

1. Use a standardized pressure ulcer assessment instrument (e.g., Bates-Jensen wound assessment tool, pressure ulcer scale for healing, etc.)
2. Circulation
3. Sensory integrity
4. Pain
5. Integumentary

Front 15

Treatment of pressure ulcers in stage I:

Back 15

Vigorous pressure, friction, and moisture-alleviating measures are required

Front 16

Treatment of pressure ulcers in Stage II:

Back 16

-Dermis is exposed
-If there is no infection, an appropriate dressing that occludes the wound from the environment is required
-Similar pressure, friction, and moisture-alleviating measures for a Stage I ulceration are required

Front 17

Treatment of pressure ulcers in stage III:

Back 17

-Subcutaneous tissue is exposed
-This stage often requires debridement (necrotic tissue), dressings, and advanced pressure alleviating measures

Front 18

Treatment of pressure ulcers in stage IV

Back 18

-Extends beyond fascia
-Debridement, appropriate dressing choice, & advanced pressure alleviating measures are required
-Surgery and grafting may be more likely at this stage
-If the wound is infected or healing has occurred in 2 weeks, then antibacterial agents or a treatment modality may be indicated

Front 19

what are causes of arterial insufficiency ulcers?

Back 19

-chronic arterial insufficency

-arteriosclerosis obliterans, often in patients with diabetes

Front 20

what are the characteristics of arterial ulcers?

Location?

Pain?

Color?

Temperature?

Skin Changes?

Back 20

LOCATION: Anywhere in lower leg
Usually located on the lateral malleolus and toes

PAIN: severe, intermittent, progressing to pain at rest

- Exacerbated with limb elevation

COLOR: Pale on elevation
Dusky rubor on dependency

TEMPERATURE: cool

SKIN CHANGES: Trophic changes (thin, shiny, atrophic skin)
Loss of hair on foot and toes
Nails thickened

Front 21

What are signs and symptoms that often precede arterial insufficiency ulcers?

Back 21

signs of Arterial insuf­ficiency
Pulses poor or absent
Intermittent claudi­cation

Front 22

what are the common wound characteristics of arterial ulcers?

Back 22

-irregular, smooth wound edges

-minimum to no granulation

-deep

-painful

-dry wound bed

-Black, gangrenous skin adjacent to ulcer can develop

Front 23

What are important components for arterial insufficiency ulcer examination?

Back 23

1. Pulses
2. Temperature
3. ABI
4. Segmental BP measurements (greater than 20 mm Hg drop between segments is significant)
5. Capillary refill
6. TcP02
7. Outcome measure (e.g., walking impairment questionnaire)

Front 24

WHAT ARE TREATMENTS FOR ARTERIAL insufficiency ulcer?

Back 24

1. bed rest, HOB moderately elevated

2. stop smoking

3. wound care

4. ROM

5. protectiive environment

6. wound VAC

7.ABI of 0.5 or below willl not heal without medical intervention (meds or sx)

Front 25

Venous Ulcer is associated with what?

Back 25

1. Chronic venous insufficiency
2. Valvular incompetence
3. History of deep venous thrombosis (DVT)
4. Venous hypertension
5. Calf muscle pump failure
6. Varicose veins

Front 26

what are characteristics of venous insufficiency ulcers

Back 26

1. Painless
2. Superficial
3. Good peripheral pulses
4. Edema
5. Skin pigmentation (hemosiderinosis)

Front 27

where are venous insufficiency ulcers common to occur?

Back 27

distal lower leg

medial malleolus

Front 28

what is the pain like for venous insufficiency ulcers

Back 28

no pain

possible aching in dependent position (possible cyanosis on dependency)

no pain with elevation

Front 29

what are the characteristics of venous insufficiency wounds?

Back 29

1. irregular: dark pigmentation

2. good granulation

3. shallow

4. little pain

5. mod-large amt exudate

6. Gangrene = absent

Front 30

what should the venous insufficiency ulcer examination include?

Back 30

1. DVT assessment (e.g., venogram [gold standard]
2. Ultrasonography
3. Score of 3 or higher on clinical assessment guideline for DVT
4. Cuff test & Hoffman's sign (have low sensitivity and/or specificity)
5. ABI (will be >0.8 if only venous insufficiency without arterial insufficiency)
6. Venous filling time

Front 31

what is the treatment for venous insufficiency ulcers?

Back 31

1. Elevation and compression to control edema is vital (Unna boot, custom-fitted elastic stockings, intermittent compression therapy)

2. compression is contraindicated with ABI less than 0.7 or active DVT)
3. Active exercise may be helpful along with support garments and elevation of the body part
4. Compression stockings are necessary for long-term management
5. Whirlpool is not helpful due to dependent position

Front 32

when is compression contraindicated?

Back 32

with ABI <0.7 or

with active DVT

Front 33

what are causes of diabetic foot ulcers and characteristics of patients commonly presenting with these ulcers?

Back 33

CAUSES: Peripheral vascular disease
Peripheral neuropathy

ASSOCIATED CONDITIONS/SYMPTOMS

1.Autonomic neuropathy (decreased perspiration, dry cracked skin)
2. Decreased sensation & circulation
3. Charcot foot (later stages secondary to decreased sensation)

Front 34

HOW ARE diabetic ulcers staged?

Back 34

using the Wagner scale

-use of pressure ulcer scale is inappropriate

Front 35

where do diabetic ulcers appear?

Back 35

Where arterial ulcers usually appear
& Where peripheral neuropathy appears (plantar aspect of foot)

Front 36

Pain with diabetic ulcers?

Back 36

Typically not painful
Sensory loss usually present

Front 37

pulses with diabetic ulcers?

Back 37

May be present or diminished
Absent ankle jerks with neuropathy

Front 38

Does gangrene occur with diabetic ulcers?

Back 38

Sepsis common
Gangrene may develop

Front 39

What arer the treatments for diabetic ulcers?

Back 39

1. Standard ulcer management: debride necrotic tissue & promote moist wound healing
2. Offload ulcer from abnormal pressures
-Total contact cast and/or change in WB status with use of assistive device
3. Foot care guidelines

4. Shoe modification:
Rocker bottom sole

Front 40

Contraindications for total contact cast:

Back 40

Infection or ulcer depth greater than width