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23 Cards in this Set

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Predisposing factors for nonhealing wounds
nutritional deficiency
uncontrolled diabetes
hypoxia
poor perfusion
immune compromise
immobility
Formal definition of wound infection
> 10^3 CFU per gram of tissue AFTER DEBRIDEMENT, or presence of B hemolytic strep
How do you culture a wound?
One way is to debride with a curette and then take a punch biopsy
What is "bacterial balance"?
< 10^5 CF per gram
T/F A pressure ulcer will nearly always be over a bony prominence.
True
Moisture is [good, bad] for wounds.
Bad, at least for the periwound tissue.
Stage I pressure ulcer: definition
Epidermis or superficial dermis
Stage II pressure ulcer: definition
Full thickness skin loss into adipose tissue
Stage III pressure ulcer: definition
tissue destruction into MUSCLE
Stage IV pressure ulcer: definition
All soft tissue destroyed
Bone or joint structures involved
Any chronic wound is at risk for developing into ?
Marjolin's ulcer (squamous cell cancer)
Why is writing an order for nutritional supplements inadequate?
Patient might refuse to take food
What can you do if patient is refusing to eat?
try appetite stimulant
Why should head of bed be kept < 30 degrees in patient with pressure ulcers?
More than this risks ischial ulcer
What are two ways of check for wound infection?
tissue biopsy
You want moisture in wound but not ?
next to it (periwound tissue)
Ddx for venous ulcers (suspected)
MALIGNANCY
VASCULITIS
cutaneous manifestation of systemic dz:
SICKLE CELL DZ
IBD
pyoderma gangrenosum
Wegener's
cutaneous chronic granulomatous dz
mycobacterial or fungal infection
IgA gammopathy
Dx tests for venous ulcers
Check pedal pulses, perfusion (caution: pink skin does not necessarily prove perfusion)
ABI <0.7; if > 1.2 calcification, sclerosis
color duplex VENOUS REFLUX
TCO2 <30 mm Hg (skin warmed with pads, then O2 of periwound skin is measured. <30 mm Hg, send to vascular surgeon
Tx for venous ulcers
1. compression stockings
2. debride ulcers if indicated
3. topical antimicrobials (systemic less effective) until bacterial balance
Characteristics walking pattern of pt with diabetic ulcers
"post like"
no heoel
Main class of treatment for LE diabetic ulcers.
"off loading"
crutches, walker, wheelchair
Risk conditions in diabetic needing protective footwear
PAD
neuropathy
previous ulcer
callus - sign of increased pressure
foot deformity
How do you diagnose osteomyelitis in chronic wound?
probe wound