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