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76 Cards in this Set

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Where are arterial ulcers located?
Lower one-third leg, dorsum of foot, web spaces, lateral malleoli
Where are venous ulcers located?
proximal to medial malleolus
What is the appearance of arterial ulcers?
smooth edges, well defined, lack of granulation tissue, tend to be deep
What is the appearance of venous ulcers?
Irregular shape, shallow
What is the difference in pain level between arterial and venous ulcers?
arterial ulcers=severe

venous ulcers=mild to moderate
which type of ulcer has edema?
venous ulcer
What are the skin changes with arterial ulcers?
thin and shiny, hair loss, yellow nails
What are the skin changes with venous ulcers?
flaking, dry skin; brownish discoloration
For arterial ulcers, leg elevation _________ pain
increases
For venous ulcers, leg elevation ________ pain
decreases
Which type of wounds are hydrocolloid dressings useful for?
partial and full-thickness wounds

Can be used for granular and necrotic wounds
Which dressings CANNOT be used on infected wounds?
Hydrocolloids
Transparent films
Which dressings CAN be used on infected wounds?
Gauze
Alginates
What are indications for Hydrogels?
superficial and partial-thickness wounds with minimal drainage
What are indications for Foam dressings?
partial and full-thickness wounds with varying amounts of exudate
What are indications for transparent films?
superficial and partial-thickness wounds with minimal drainage
What are indications for gauze?
infected/non infected wounds of any size. Used for wet to wet, wet to moist, or wet to dry debridement
What are indications for Alginates?
Used on partial and full-thickness draining wounds like pressure wounds or venous insufficiency ulcers.
Name the dressings from MOST occlusive to least occlusive
Hydrocolloids, hydrogels, semi-permeable foam, semipermeable film, impregnated gauze, alginates, traditional gauze
Name the dressings from most moisture retentive to least moisture retentive.
Alginates, semipermeable foam, hydrocolloids, hydrogels, semipermeable films
What are the goals for red wounds?
Protect wound, maintain moist environment
What are goals for yellow wounds?
Debride necrotic tissue; absorb drainage
What are goals for black wounds?
Debride necrotic tissue
Name types of selective debridement
Sharps debridement
Enzymatic debridement
Autolytic debridement
Name types of non-selective debridement.
Wet to Dry dressings
Wound irrigation
Hydrotherapy
what types of debridement are useful for infected wounds?
Wound irrigation, Enzymatic debridement
Name the factors that influence wound healing
Age
Illness
Infection
Lifestyle
Medication
Name the medications that interfere with wound healing
Steroids, Anti-inflammatory, heparin, anti-neoplastic agents (cancer drugs), and oral contraceptives
What are the general treatment guidelines for scar management?
Massage cream 2X day on healed wound
Use of sun block and Vitamin E
Pressure garments
Use of silicone gel (softens scar)
Consider US or E-stim
What does a seropurulent wound indicate?
Impending infection
What does a purulent wound indicate?
wound is infected
What are the classifications of exudate for healthy healing wounds?
Serous or serosanguinous
What does sanguinous exudate indicate?
New blood vessel growth or disruption of blood vessels
Describe a Stage 1 pressure ulcer
NON-blanchable intact skin with changes in skin color, temp, stiffness or sensation
Describe a Stage 2 pressure ulcer
Partial-thickness skin loss that involved epidermis and/or dermis.
Blister, abrasion, shallow crater
Describe a Stage 3 pressure ulcer
Full thickness skin loss that involves damage of subcutaneous tissue that may extend down to but not through the fascia.
Deep crater
Describe a stage 4 pressure ulcer.
Full thickness skin loss with extensive destruction, tissue necrosis extends down to muscle, bone, tendon, joint capsule
Name the factors that contribute to pressure ulcers.
shear, moisture, heat, friction, medication, muscle atrophy, malnutrition, debilitating medical conditions
Where are neuropathic ulcers usually found?
Plantar surface of foot, at metatarsal heads
How do neuropathic ulcers appear?`
well defined by callus rim
good granulation tissue, little to no drainage
distal limb shiny and cool
periwound skin dry/cracked
What are the grades for Wagner Scale of diabetic foot ulcers?
0 No open lesion but pre-ulcerative lesions

1 Superficial ulcer, not involving subcutaneous tissue

2 deep ulcer w/ penetration through subcutaneous tissue

3 deep ulcer with osteitis, abcess or osteomyelitis

4 gangrene of digit

5 gangrene of foot requiring disarticulation
What is a superficial burn?
Involves outer epidermis.
May be red with slight swelling. Healing occurs without scarring
What is a superficial partial-thickness burn?
Burn that extends through epidermis and upper part of the dermis.
Extreme pain and blisters.
Minimal to no scarring.
What is a Deep partial-thickness burn?
Complete destruction of epidermis and most of dermis.
Discolored with broken blisters and edema.
Damage to nerve results in moderate pain only.
Hypertrophic scars and keloids.
What is a full thickness burn?
Complete destruction of epidermis and dermis and partial damage subcutaneous tissue.
Eschar formation, minimal pain.
Requires graft, susceptible to infection
What is subdermal burn?
complete destruction of epidermis, dermis, and subcutaneous tissue.
May involve muscle/bone
Require surgery
What is zone of coagulation?
Area of burn that receieved most severe injury along with irreversible cell damage
What is zone of stasis?
Area of less severe injury that possesses reversible damage and surrounds zone of coagulation
What is zone of hyperemia?
Area surrounding zone of stasis that presents with inflammation but will fully recover without any intervention/permanent damage
Describe Rule of Nines
Head and trunk 9%
Anterior trunk 18%
Posterior trunk 18%
Bilateral anterior arm, forearm and hand 9%
Bilateral posterior arm, forearm, and hand 9%
Genitals 1%
Bilateral anterior leg and foot 18%
Bilateral posterior leg and foot 18%

Equals 100%
What is the children's value for rule of nines?
A child under one has 9% taken from LE and added to head. Each year 1% is distributed back to LE until age 9.
Name the types of topical agents used for burns
Silver Sulfadiazine
Silver Nitrate
Povidone-iodine
Mafenide Acetate
Gentamicin
Nitrofurazone
Which type of topical agents kills bacteria?
Nitrofurazone
Which topical agent has the most advantages?
Silver Sulfadiazine
Which topical agent penetrates burn eschar?
Mafenide Acetate
What is an allograft?
A temporary skin graft taken from another human (cadaver)
What is an autograft?
A permanent skin graft taken from donor site on patient's own body
What is a heterograft or xenograft?
A temporary skin graft taken from another species
What is a mesh graft?
A skin graft that is altered to create a mesh-like pattern to cover a large surface area
What is a sheet graft?
A skin graft transferred directly from the donor site to the recipient site
What is a split-thickness graft?
A skin graft that contains only a superficial layer of dermis in addition to epidermis
What is a full-thickness skin graft?
A skin graft that contains the dermis and epidermis
what is the anticipated deformity of burn on anterior neck?
Flexion with possible lateral flexion
What is the anticipated deformity of burn on anterior chest and axilla?
Shoulder adduction, extension, and medial rotation
What is the anticipated deformity of burn of elbow?
flexion and pronation
What is the anticipated deformity of burn of hand/wrist?
Extension/hyperextension of MCP joints; flexion of IPs, adduction and flexion of thumb; flexion of wrist
What is the anticipated deformity of burn at hip?
Flexion and adduction
What is the anticipated deformity of burn at knee?
Flexion
What is anticipated deformity of burn on ankle?
Plantar flexion
What is dermis?
Vascular layer of skin below epidermis that contains hair follicles, sebaceous glands, and sweat glands
What is epidermis?
Superficial avascular layer of skin that contains hair follicles, sebaceous glands, and sweat glands
What is eschar?
Necrotic and non-viable tissue resulting from deep burn.
Hard, dry, does not resemble normal skin
What is escharotomy?
Surgical procedure that removes eschar from burn site and subsequently enhances circulation
What is hypertrophic scarring?
Abnormal and disorganized scar formation characterized by raised, firm scar with collagen fibers that do not follow any pattern
What are pressure garments?
custom-made garment that applies sustained pressure in order to improve structure of a scar.
Worn 22-23 hrs/day
May be required for up to 2 years
What is Z-plasty?
Surgical procedure to eliminate a scar contracture.
Incision in shape of "z" allows contracture to change configuration and lengthen scar