Ch. 9 - Wound Management

Front 1

Wound: a disruption of ____________ ____________________ which may be ____________________ (traumatic) or _____________ (surgical.)

Back 1

tissue continuity

accidental

deliberate

Front 2

What are the 3 classifications of wounds?

Back 2

1. clean

2. contaminated

3. infected

Front 3

A "clean" wound is:

Back 3

created during a surgical procedure

Front 4

A "contaminated" wound depends on:

Back 4

the amount of bacteria present

Front 5

An "infected" wound has great than:

Back 5

>10 to th 5th/g of tissue

Front 6

List two advantages of lavage:

Back 6

1. flushes wound of debris, bacteria, necrotic tissue

2. decreases wound complications during healing

Front 7

What fluid is most often used to lavage a wound?

Back 7

normal saline

Front 8

Debridement: definition

Back 8

the removal of debris, hair, necrotic tissue, etc. (wound is cleaned)

Front 9

What should be assessed during wound debridement?

Back 9

tissue viability

Front 10

What would non-viable tissue look like?

Back 10

• white or black-blue
• leathery skin
• thin skin

Front 11

During debridement, what decision must be made?

Back 11

To close the wound or not to close the wound

(based on viability of tissue)

Front 12

What things will determine closure?

(name 5)

Back 12

1. blood supply

2. status of patient

3. sound location (tension, movement, dead space)

4. availability of skin

5. infection

Front 13

Wounds:

Dead space left in a wound will fill with serum causing either a ___________ if clean, or an __________ if dirty.

Back 13

seroma

abscess

Front 14

The process of wound healing begins __________________.

Back 14

immediately

Front 15

4 Physical Phases of Wound Healing:

Back 15

1. Inflammatory

2. Debridement

3. Repair

4. Maturation

Front 16

1. Inflammatory Phase of Wound Healing:

begins _______________

lasts __________________

Back 16

immediately

up to several weeks

Front 17

1. Inflammatory Phase of Wound Healing:

Has 2 Phases:

Back 17

Initial Phase

Phase 2

Front 18

1. Inflammatory Phase of Wound Healing:

What happens in the Initial Phase?

(2)

Back 18

1. vasoconstriction (controls hemorrhage)

2. vasodilation (contains clotting elements)

Front 19

1. Inflammatory Phase of Wound Healing:

What happens in Phase 2, and what cells are predominant?

Back 19

1. Cells adhere to vascular endothelium

2. blood clot forms (stabilizes wound edges)

3. scab forms (protects and promotes healing underneath)

Monocytes

Front 20

2. Cellular Debridement:

1. begins approximately _____________ after injury.

2. contains what type of cells?

Back 20

1. 6 hours

2. monocytes as macrophages

Front 21

2. Cellular Debridement:

WBCs and fluid leaked into wound forms _________ associated with wounds

Back 21

exudate

Front 22

3. Repair

When does repair begin?

What happens?

Back 22

--after clot is formed

(3-5 days into healing process)

--clean up via macrophages

--fibroblasts produce collagen --> scar tissue

Front 23

3. Repair

As fibroblasts and capillaries proliferate, ____________________ tissue is formed and appears ___________ ___________

Back 23

granulation tissue

bright pink

Front 24

Repair Phase: Epithelialization

1. When does it begin?

2. What do epithelial cells need?

3. What does this accomplish?

Back 24

1. within hours of initial wound

2. healthy bed of granulation tissue

3. enhances wound closure

Front 25

Repair Phase: Contraction

1. When does it occur?

2. What happens?

3. Epithelialization is halted in a ___________ _____________.

Back 25

1. 5-9 days after injury

2. edges of wound are pulled together, increases strength

3. desiccated wound

Front 26

Repair Phase: Maturation

What is happening?

Back 26

remodeling of wound

capillaries disappear / wound becomes pale

Front 27

Wound remodeling can go on for how long?

Back 27

years

Front 28

Does wound / scar tissue ever regain the strength of normal tissue?

Back 28

NO

Front 29

Obstacles in Wound Healing:

Physical / Environmental Factors (2)

Back 29

1. temperature

2. O2 levels

Front 30

Outside temperature affects wound healing in what way?

Back 30

affects ability of wound to stretch (tensile strength)

Front 31

What is the ideal temperature for wound healing?

Back 31

30 degrees Celsius

Front 32

Physical Obstacles in Wound Healing:

Wounds have less __________ due to disruption of tissue and vessels.

Back 32

oxygen

Front 33

Name some reasons why wounds have less oxygen than is ideal?

Back 33

1. poor blood supply due to hypovolemia

2. tight bandages

3. presence of necrotic tissue

Front 34

Systemic / Endogenous Factors in Wound Healing:

(condition of the animal)

(4)

Back 34

1. Anemia

2. Hypoproteinemia

3. Uremia

4. Obesity

Front 35

Albumin makes up _______ to ________ % of total plasma protein.

Back 35

35 - 50%

Front 36

Hypoproteinemia = < ______ g/dl?

Back 36

<2.0 g/dl

Front 37

Hypoptroteinemia is seen in what 3 conditions / diseases? (And what happens?)

Back 37

1. liver disease - can't produce albumin

2. renal disease - albumin loss

3. malnutrition - albumin not absorbed

Front 38

Albumin is a _______________ molecule. It maintains ___________ ___________ in vessels which prevents _________________ ____________.

Back 38

transport

osmotic pressure

fluid leakage

Front 39

If albumin is not available, wound healing is _______________.

Back 39

delayed

Front 40

How does uremia affect wound healing?

Back 40

granulation tissue production

poor quality collagen

Front 41

How does obesity affect wound healing?

Back 41

suture holding in SQ fat layers - may be difficult

Front 42

Exogenous Factors in Wound Healing:

(6)

Back 42

1. chemicals

2. corticosteroids

3. immunosuppressive drugs

4. foreign bodies

5. cytotoxic drugs (chemotherapy)

6. Vitamin E

Front 43

How do corticosteroids affect wound healing?

Back 43

Healing time - immune system is suppressed

Inhibits capillary budding

Inhibits proliferation of fibroblasts

Inhibits increase in epithelialization

Front 44

Too much ________________ slows collagen production

Back 44

Vitamin E

Front 45

Immediate wound care:

After occurrence, cover with a __________ _______ ______________. Avoid further contamination

Back 45

clean, dry bandage

Front 46

Immediate Wound Care:

3 steps:

Back 46

1. cover with clean, dry bandage

2. clip hair (use sterile KY to absorb hair)

3. lavage wound using saline (bottles or large syringes)

Front 47

4 Types of Wound Healing / Closure:

Back 47

1. Primary Wound Closure

2. Delayed Primary Closure

3. Secondary Closure

4. Open Wound Management

Front 48

Primary Wound Closure:

Ideal situation is healing by _______ ___________.

Suturing a wound should happen within how long after injury?

Back 48

first intention

<24 hours after injury

Front 49

Delayed Primary Closure:

Delay until ________________ is under control.

Before how many days?

Before what happens?

Back 49

contamination

3 - 5 days

granulation bed develops

Front 50

Delayed Primary Closure -

the wounds are usually:

Back 50

moderately contaminated, traumatized wounds

Front 51

2nd Intention Healing:

these wounds are usually:

Back 51

contaminated, traumatized wounds

Front 52

2nd Intention Healing:

1. Often involves multiple ___________ ___________.

2. What kind of wound mgmt?

3. heals without ____________ __________.

example:

Back 52

1. bandage changes

2. open wound

3. surgical closure

ex. - degloving

Front 53

Secondary Closure:

1. closure after ________ days

2. require a lot of ___________________

3. _______________ wound mgmt.

4. happens after ___________ ___________ has developed

These wounds are __________________________

Back 53

1. 5 days

2. debridement

3. prolonged

4. tissue granulation

Severely contaminated, traumatized wounds

Front 54

Open wound management is based on these two things:

Back 54

1. multiple bandage changes

2. debridement

Front 55

Open Wound Mgmt:

What type of dressings are used to assist in mechanical debridement?

Back 55

wet-dry dressings

Front 56

Open Wound Mgmt:

Bandage changes how often?

What type of dressing does not interfere with granulation?

Back 56

daily

dry, non-stick dressing

Front 57

Materials & Medications that stimulate wound healing at the cellular level:

1. name a topical

2. name a freeze-dried form

3. name another form

Back 57

1. Acemannan

2. Carasorb

3. Maltodextrin