Nrs 332 Acute Care Midterm

Front 1

Infant developmental stage according to Erickson

Back 1

Trust v. Mistrust

Front 2

Toddler developmental stage according to Erickson

Back 2

Autonomy v. Shame

Front 3

Preschooler developmental stage according to Erickson

Back 3

Initiative v. Guilt

Front 4

School Aged developmental stage according to Erickson

Back 4

Industry v. Inferiority

Front 5

Adolescent developmental stage according to Erickson

Back 5

Identity v. Role

Front 6

Distribution of Body Fluid in Adults

Back 6

Total body water: 55-60%
% ECF: 20%
% ICF: 35%

Front 7

Distribution of Body Fluid in Pre-Schoolers

Back 7

Total body water: 60-65%
% ECF: 30%
% ICF: 35%

Front 8

Distribution of Body Fluid in Infants

Back 8

Total body water: 75-80%
% ECF: 40%
% ICF: 35%

Front 9

Physiological factors that lead to dehydration in peds

Back 9

Brain: Larger, more vascular
Skin: Proportionately greater BSA, more insensible loss
Higher metabolic rate
Immature renal function
Can't verbalize thirst

Front 10

Signs and symptoms of dehydration in peds

Back 10

Dry skin and mucous membranes; ↓ Skin turgor; ↓ tears; ↓ U.O. ; Sunken fontanel
; Fever; tachycardia; Pale color; cool extremities; Weight loss; Lethargy/irritability; Hypotension (late sign)

Front 11

Response to pediatric dehydration

Back 11

Careful rehydration: 10-20ml/kg bolus; Replace remainder of deficit over 24-48 hrs

Front 12

Two age groups which have the greatest increase in Type I Diabetes

Back 12

<5 yo group and 14-18 yo group
note: 40% of <5 yo present with DKA

Front 13

Outward signs and symptoms of pediatric DM

Back 13

Polyuria: Sudden onset of bed-wetting
Polyphagia: Weight loss despite good appetite
Polydipsia: Can’t verbalize thirst, dependent upon caregivers
General lack of energy
Poor school performance
Vaginal thrush or balanitis
UTI

Front 14

Response to pediatric DM DKA or Hyperosmolar in Peds

Back 14

Limit fluids to only what is needed to combat shock; replace rest over 48 hours
Slowly reduce glucose (50-100mg/dL per hour); Add glucose to IV fluids when reaches 300mg/dL
Don’t use sodium bicarbonate

Front 15

S&S in mild pediatric dehydration

Back 15

normal vitals or slight tachycardia, fussy, alert, slightly dry mucus membranes, mildly decreased urine output

Front 16

S&S in moderate pediatric dehydration

Back 16

↑pulse, restless, lethargic but arousable, dry mucus membranes, sunken fontanel, decreased urine

Front 17

S&S in severe pediatric dehydration

Back 17

↑pulse, rapid & deep respirations, low BP, drowsy to comatose, decreased skin turgor, markedly sunken fontanel, anuria. HYPOTENSION IS A LATE AND OMINOUS SIGN OF VOLUME DEPLETION

Front 18

Talipes equinovarus

Back 18

Talipes equinovarus (Club foot)
Affects boys 2x as often; Treated with serial casting till 8-12 wks old; Then splint and special shoes; If unsuccessful, will need corrective surgery

Front 19

Developmental Dysplasia of the Hip

Back 19

Occurs 4x more in girls;
Diagnosed with Allis Sign (one knee lower than other when knees flexed) and Barlow & Ortolani Maneuvers (lifting thighs up, out, and down feeling for clunk as femoral head fits into acetabulum;
Treated with Pavlik harness or spica cast

Front 20

Allis Sign

Back 20

Screening performed for Developmental Dysplasia of the Hip by raising infant's knees to chest; if one knee is lower than the other, positive sign

Front 21

Barlow & Ortolani Maneuver

Back 21

Used to diagnose developmental dysplasia of the hip; lifting thighs up, out, and down, feeling for a clunk as femoral head fits into acetabulum

Front 22

Pathophysiology/Treatment for Genu varum

Back 22

Genu varum (bowlegs)
Normal up to 5yo; May be due to rickets (Vit D/Ca deficiency) or Blounts Disease (abnormal growth on medial side of proximal tibia)

Front 23

Genu valgum

Back 23

Genu valgum (knock knees) Normal up to 5yo; May be due to rickets (Vit D/Ca deficiency)

Front 24

Pathophysiology/Treatment for Osteogenesis Imperfecta

Back 24

Osteogenesis Imperfecta (Brittle-bone disease);
Biochemical defect in production of collagen;
Genetically transmitted; no cure; S&S: blue sclera, translucent skin, dental caries,
hyperlaxity of joints, pliable brittle bones→ multiple fractures, may be mistaken for child abuse

Front 25

Pathophysiology/Treatment for Muscular Dystrophy

Back 25

Muscle fiber degeneration and muscle wasting diseases, muscles infiltrated with fatty tissue; X-linked recessive disease (carrier females transmit it to 50% of sons; daughters of carriers have 50% chance of being carriers themselves); Duchenne is most common form; Becker is milder form; One way to diagnose is by Gower’s maneuver (gets up from floor by starting in position with hands and feet on floor and raising self by pushing up with hands on ankles and then knees)

Front 26

Gower’s maneuver

Back 26

Used to diagnose muscular dystrophy. Gets up from floor by starting in position with hands and feet on floor and raising self by pushing up with hands on ankles and then knees

Front 27

Klippel-Feil Syndrome

Back 27

Congenital fusion of any 2 of 7 cervical vertebrae; S&S: Short neck, Low hairline, ↓mobility of upper back; May be associated with scoliosis or spina bifida; Treated surgically with good prognosis

Front 28

Marfan syndrome

Back 28

Abnormal formation of fibrillin matrix in connective tissue;
Average age for diagnosis is 3yo with heart murmur;
S&S: Heart valve defects,
Tall stature, Abnormally long hands and feet, Elongated head, Scoliosis

Front 29

Pathophysiology/Treatment for Slipped Capital Femoral Epiphysis

Back 29

Femoral head displaced from femoral neck; Occurs during adolescent growth spurt at 12-15 yo in boys, 10-13 yo in girls, Associated with obesity;
S&S: pain and limp; treated surgically with hip screw for stabilization or with bedrest/traction

Front 30

Pathophysiology/Treatment for Osgood-Schlatter Disease

Back 30

Overuse knee injury seen in active adolescents; Tender bump on tibial tuberosity below kneecap, Treated with ice/NSAIDs; Most often during 10-15yo growth spurt

Front 31

Scoliosis

Back 31

S- or C-shaped curvature of spine >10o;Most often in girls, during growth spurt at ages 10-13; Boston or Milwaukee brace used for 20-30o curve; Spinal fusion surgery for >40o curve

Front 32

Fractures that could indicate abuse in children

Back 32

In infants and children less than 3 yrs, all fractures;
Multiple fractures in different stages of healing, femur fracture in child not walking yet; Skull, rib, scapula fractures; Corner or chip fractures of tibia (twisting injury); Midshaft ulna fractures (nightstick)

Front 33

Paranoid Personality Disorder

Back 33

Suspicious
Mistrust and suspicious of others
Restricted affect, withdrawn, guarded
Doesn't understand humor
Nursing Intervention: serious, straightforward approach

Front 34

Schizoid Personality Disorder

Back 34

Detached from social relationships; they like social isolation
Unable to express joy and pleasure and aren't distressed about this
Restricted affect
Communication is confused and lacks focus
Minimum introspection and self-awareness
Nursing Intervention: Focus on improving functioning in the community

Front 35

Schizotypal Personality Disorder

Back 35

Pervasive pattern of social and interpersonal deficits
Can become psychotic; disheveled
Void of close friends
Cognitive or perceptual distortions and eccentricities; hallucinations
Constricted or inappropriate mood
Odd, eccentric, or peculiar appearances
Nursing Intervention: is focused on development of self-care, and social skills

Front 36

Borderline Personality Disorder

Back 36

Have difficulty regulating emotions
Have extreme fears of abandonment; inability to be alone
Often engage in self-injury
Chronic depression
Characteristics/Presentation:
Can have a history of sexual abuse; Impulsive aggression; Don't learn to regulate behavior or self-soothe; Cognitive Dysfunctions; Dichotomous thinking (Black and white; No gray); Splitting
Behavioral Dysfunctions: Impaired problem solving; Impulsivity; Self-destructive behaviors; Manipulation; Clinging and distancing
Nursing Interventions:
Prevention and treatment of self-injury
Establishing a trusting relationship
Recognizing the abandonment and intimacy fears
Establishing personal boundaries and limitations.
Challenging dysfunctional thinking

Front 37

Antisocial Personality Disorder

Back 37

Impulsivity and interpersonal irresponsible
Fails to plan ahead or consider alternatives
Lack a sense of personal obligation to fulfill social and financial responsibilities
No remorse
Deceitful and charming (con artists)
Blame their behavior on others
Fire-starters and cruelty to animals are signs in childhood
Disdainful of traditional values
Fail to conform to social norms and values
Easily irritated, often become aggressive
Disregard for own safety as well as others
Nursing Interventions:
Help to develop problem-solving behaviors
Focus on forming a therapeutic relationship and promoting self-responsible behavior
Limit setting in non judgmental way
Confront by pointing out problematic behavior

Front 38

Histrionic Personality Disorder

Back 38

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts.
Uncomfortable when not the center of attention.
Inappropriate sexually seductive or provocative behavior.
Nursing Interventions: focus on giving feedback about their inappropriate social interactions, not just criticism, but appropriate alternatives.

Front 39

Narcissistic Personality Disorder

Back 39

Grandiose sense of self-importance
Believes that he or she is “special” and unique
Requires excessive admiration
Has a sense of entitlement
Lacks empathy
The nurse must avoid getting angry and frustrated at their behavior, because the goal is to gain cooperation of these clients with other treatment as indicated.
Nursing Intervention:
Develop appropriate ways to get needs met
Help to rebuild self-esteem
Develop appropriate problem solving skills
Nurse-patient relationship that allows for independent decision-making skills
Reinforcing strengths, conveying confidence in patient’s ability to handle situations

Front 40

Avoidant personality disorder

Back 40

Avoids significant interpersonal contact
Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
Preoccupied with being criticized or rejected
Nursing Intervention: They need a lot of support and reassurance; develop a non-threatening relationship with the nurse in order to explore positive self-aspects, positive responses.

Front 41

Dependent Personality Disorder

Back 41

Difficulty making everyday decisions
Needs others to assume responsibility for most major areas of their lives.
Difficulty initiating projects or doing things on their own
Goes to excessive lengths to obtain nurturance and support from others
Nursing Intervention focuses on helping clients to identify strengths and needs

Front 42

Obsessive-Compulsive Personality Disorder

Back 42

Preoccupied with details, rules, lists, order, organization, or schedules
Shows perfectionism that interferes with task completion
Excessively devoted to work and productivity
Nursing Intervention: is to help the client develop a different perspective regarding completing a job.

Front 43

Lab: Sodium Normal Limits

Back 43

136-145 mEq/L

Front 44

Lab: Potassium Normal Limits

Back 44

3.5-5.0 mEq/L

Front 45

Lab: BUN Normal Limits

Back 45

10-20 mg/dl

Front 46

Lab: Hematocrit Normal Limits

Back 46

Male: 42-52%
Female: 37-47%

Front 47

Lab: Mg Normal Limits

Back 47

1.3-2.1 mEq/L

Front 48

Lab: Calcium Normal Limits

Back 48

9.0-10.5 mg/dl

Front 49

Lab: Hemoglobin Normal Limits

Back 49

Male: 14-18
Female: 12-16

Front 50

Lab: WBC Normal Limits

Back 50

5-10K /mm3

Front 51

Lab: Platelets Normal Limits

Back 51

150-400K /mm3

Front 52

Lab: Phosphate Normal Limits

Back 52

3.0-4.5 mg/dl

Front 53

Lab: Albumin Normal Limits

Back 53

3.0-5.0 g/dl

Front 54

Lab: Chloride Normal Limits

Back 54

98-106 mEq/L

Front 55

Lab: Creatinine Normal Limits

Back 55

Male: 0.6-1.2 mg/dl
Female: 0.5-1.1 mg/dl

Front 56

Lab: Glucose Normal Limits

Back 56

Fasting: 70-110 mg/dl
Casual: Less than or equal to 200 mg/dl

Front 57

ABG: Blood pH Normal Limits

Back 57

7.35-7.45

Front 58

ABG: PaCO2 Normal Limits

Back 58

35-45 mm Hg

Front 59

ABG: PaO2 Normal Limits

Back 59

80-100 mm Hg

Front 60

ABG: HC03 Normal Limits

Back 60

22-26 mEq/L

Front 61

ABG: O2 Saturation Normal Limits

Back 61

95-100%

Front 62

Respiratory Acidosis Risk Factors

Back 62

Central Respiratory Depression & Other CNS Problems: Drug depression of resp. center (eg by opiates, sedatives, anesthetics), CNS trauma, infarct, hemorrhage or tumor; Nerve or Muscle Disorders: Guillain-Barre syndrome, Myasthenia gravis; Airway Disorders: Upper Airway obstruction, Bronchospasm/Asthma

Front 63

Metabolic Acidosis Risk Factors

Back 63

Ketoacidosis; Lactic Acidosis; Renal Failure (Uremic acidosis); Severe diarrhea

Front 64

Respiratory Acidosis Risk Factors

Back 64

Central Causes: Head injury, stroke, anxiety-hyperventilation; Pulmonary embolism, pneumonia, asthma, pulmonary edema

Front 65

Metabolic Alkalosis Risk Factors

Back 65

Gain of alkali in the ECF: IV infusion, citrate transfused in blood; Loss of H from ECF via diuretics or vomiting and NG suction

Front 66

pH < 7.35
PaCO2 > 45
HCO3 Normal

Back 66

Acute Respiratory Acidosis

Front 67

pH > 7.45
PaCO2 < 35
HCO3 Normal

Back 67

Acute Respiratory Alkalosis

Front 68

pH < 7.35
PaCO2 Normal
HCO3 < 22

Back 68

Acute Metabolic Acidosis

Front 69

pH < 7.45
PaCO2 Normal
HCO3 > 26

Back 69

Acute Metabolic Alkalosis

Front 70

pH Normal
PaCO2 > 45
HCO3 > 26

Back 70

Compensated Respiratory Acidosis

Front 71

pH Normal
PaCO2 < 35
HCO3 < 22

Back 71

Compensated Respiratory Alkalosis

Front 72

pH Normal
PaCO2 < 35
HCO3 < 22

Back 72

Compensated Metabolic Acidosis

Front 73

pH Normal
PaCO2 > 45
HCO3 > 26

Back 73

Compensated Metabolic Alkalosis

Front 74

Leftward shift in oxyhemoglobin dissociation curve
1.) Causes
2.) Effect

Back 74

1.) Low temp; low CO2, alkalosis
2.) Increased affinity for O2

Front 75

Rightward shift in oxyhemoglobin dissociation curve
1.) Causes
2.) Effect

Back 75

1.) High temp; high CO2, acidosis
2.) Decreased affinity for O2

Front 76

Signs and symptoms of fluid excess

Back 76

Crackles in lungs
Moist mucus membranes
I/O imbalance (excess intake)
Peripheral edema
Shortness of breath (d/t CHF)
Altered mental status

Front 77

Signs and symptoms of fluid deficit

Back 77

Vital signs: may be tachycardic and hypotensive
Lungs should sound clear
Cheeks & eyes may appear sunken
Poor skin turgor
Dry mucus membranes, dry & cracked lips
Diminished LOC

Front 78

What acid-base imbalance affects serum potassium and how?

Back 78

Alkalosis leads to hypokalemia
Acidosis leads to hyperkalemia

Front 79

D5W
1.) Osmolarity
2.) Indications

Back 79

1.) Isotonic (becomes hypotonic once glucose is broken down)
2.) Used to treat a dehydrated patient and to decrease sodium and potassium levels (pushes K into cell, helps kidneys flush solutes and improves liver function)

Front 80

D10W, D50W
1.) Osmolarity
2.) Indications

Back 80

1.) Hypertonic
2.) Dextrose can be given to diabetic patients in acute illness as long as the patient's blood glucose is closely monitored so the balance of blood glucose and insulin is maintained.

Front 81

1/2 NS (.45%)
1.) Osmolarity
2.) Indications

Back 81

1.) Hypotonic
2.) Expands the intracellular compartment, is indicated for hypertonic dehydration, gastric fluid loss, and cellular dehydration from excessive diuresis

Front 82

NS (0.9%)
1.) Osmolarity
2.) Indications

Back 82

1.) Isotonic
2.) Expand the extracellular compartment during times of circulatory insufficiency, replenish sodium and chloride losses, treat diabetic ketoacidosis, and replenish fluids in the early treatment of burns and adrenal insufficiency.

Front 83

Ringer's Lactate
1.) Osmolarity
2.) Indications

Back 83

1.) Isotonic
2.) Electrolyte fluids provide hydration and electrolytes for patients who can't take in food or fluid orally and for those who've experienced abnormally high fluid losses from severe vomiting, diarrhea, or diuresis. Lactated Ringer's solution is also used for volume replacement in patients with third-spacing.

Front 84

3% NaCL
1.) Osmolarity
2.) Indications

Back 84

1.) Hypertonic
2.) Hypertonic fluids pull fluid from the cells (intracellular space)- draws fluid into the intravascular compartment from cells and interstitial compartments

Front 85

D5 in NS
1.) Osmolarity
2.) Indications

Back 85

1.) Hypertonic
2.) Hypertonic saline fluids such as 5% dextrose in 0.9% sodium chloride solution are used cautiously to treat severe hyponatremia.

Front 86

Hyponatremia Risk Factors

Back 86

Hyponatremia is caused by conditions such as water retention and renal failure that result in a low sodium level in the blood:
Hypoglycemia
Compulsive drinking
Severe vomiting/diarrhea
Fluid retention due to liver cirrhosis, heart disease, or nephrotic syndrome

Front 87

Hypernatremia Risk Factors

Back 87

Diabetes insipidus (caused by deficiency of or insensitivity to ADH)
Diarrhea
Diuretic medication
Excessive salt intake
Excessive vomiting
Heavy respiration (e.g., exercise, exertion)
Severe burn
Sweating

Front 88

Hypokalemia Risk Factors

Back 88

The most common cause of potassium depletion is diuretic medication that increases urination. Diuretics are prescribed for medical conditions and are used in weight-loss programs. Other causes include:
• Diarrhea
• Dietary deficiency
• Excessive sweating
• Magnesium deficiency (causes overexcretion of fluid)

Front 89

Hyperkalemia Risk Factors

Back 89

Burns
Chemotherapy
Hemolysis (red blood cell destruction caused by infection or burn)
Rhabdomyolysis (destruction of skeletal muscle; associated with acute tubule necrosis, or ATN)
Strenuous exercise (rarely)
Urinary excretion of potassium can be impaired by the following:
Acute renal failure (ARF)
Chronic renal failure (CRF)
Impaired aldosterone release or production
Medications that decrease potassium excretion:
○ Amiloride (diuretic)
○ Bactrim® (antibiotic)
○ Cyclosporine (immunosuppressive)

Front 90

Hyponatremia Signs and Symptoms

Back 90

The first symptoms are fatigue, weakness, nausea, and headache. More severe cases cause confusion, seizure, coma, and death

Front 91

Hypernatremia Signs and Symptoms

Back 91

Same symptoms as hyponatremia (fatigue, weakness, nausea, and headache. More severe cases cause confusion, seizure, coma, and death); Delirium
Irritability
Muscle twitching

Front 92

Hypokalemia Signs and Symptoms

Back 92

Cardiac arrhythmia, muscle pain, general discomfort or irritability, weakness, and paralysis

Front 93

Hyperkalemia Signs and Symptoms

Back 93

Causes electrocardiogram (EKG) changes, ventricular fibrillation, and cardiac arrest. Other symptoms include tingling in the extremities, weakness, and numbness

Front 94

Hyponatremia treatment

Back 94

Fluid and water restriction
Intravenous (IV) saline solution of 3% sodium
Salt tablets

Front 95

Hypernatremia treatment

Back 95

Slowly replenishing water loss, usually over 48 hours, through drinking or intravenous (IV) solution. In cases of diabetes, the imbalance is treated with adequate water intake and nonsteroidal anti-inflammatory drugs or with synthesized hormones (e.g., desmopressin) that aid in fluid retention and decrease urination

Front 96

Hypokalemia treatment

Back 96

Potassium supplements, proper diet, and intravenous (IV) solution. The best way to maintain an adequate potassium level is to eat foods such as sweet potatoes, bananas, avocados, spinach, and oranges. Patients taking diuretic medication are also given potassium supplements. Potassium is given slowly to avoid hyperkalemia

Front 97

Hyperkalemia treatment

Back 97

Treatment of low-grade hyperkalemia may involve diuretics and calcium given intravenously to promote potassium excretion. Insulin is given with glucose to help cell absorption of potassium, and albuterol may be added to increase absorption. Drugs that bind to potassium, such as Kayexalate®, force potassium into the intestine to be excreted

Front 98

Hemodilution

Back 98

Increasing fluid content of blood resulting in lowered concentration of formed elements

Front 99

Hemoconcentration

Back 99

Decreasing fluid content of blood resulting in higher concentration of formed elements

Front 100

Arthritis risk factors

Back 100

Gender - female
Age
Obesity
History of trauma
Joint overuse – e.g. repetitive motion injury
Genetic factors – with autoimmune disorders (e.g. RA) and osteoarthritis

Front 101

Arthritis treatment

Back 101

Muscle strengthening – exercise
PT
Weight loss
Anti-inflammatories
Analgesics
Invasive methods: surgical joint replacement

Front 102

Compartment syndrome

Back 102

An acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use, in which increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply

Front 103

List and Describe the 4 Wound Healing Phases

Back 103

1.) Vascular response; Coagulation/Hemostasis (Platelets): Vascular smooth muscle contracts to limit bleeding & stop invasion of foreign substances, platelet aggregation, fibrin mesh forms, capillaries dilate, phagocytes inflow
2.) Inflammatory Phase (Platelets, Macrophages, Neutrophils): Inflammation 4-6 days in length; influx of WBCs is hallmark. Neutros are first responders – phagocytize. Monocytes/macrophages second - phagocytosis and angiogenesis. Macros stimulate fibroblasts and release growth factors/cytokines. Oxygen-critical. Other WBCs: lymphos help with phagocytosis, eos and basos minor roles. Lymphatic vessels are plugged, walling off the wound and sequestering contaminants. Exception: streptococci can dissolve walls and spread easily (cellulitis, strep throat.)
3.) Proliferative Phase (Macrophages, Lymphocytes, Fibroblasts, Epithelial cells, Endothelial cells): Proliferation - collagen deposition, angiogenesis, granulation tissue forming, and wound contraction. Re-epithelialization. Lasts up to 2 weeks.
4.) Remodeling (Fibroblasts): Remodeling or maturation phase – can take 1 + yrs after injury. Wound contracts, scar lightens in color (or becomes more like surrounding skin) d/t and gets smaller

Front 104

Tegaderm (Transparent film): What is it and when do you use it?

Back 104

Clear, adherent and non-absorbent
Semi-permeable to oxygen and water vapor, but not water itself
Used to promote autolysis on wounds with eschar (black leathery necrotic tissue)
Great for IVs – really not used so much anymore in wound care – but you may see them over skin tears

Front 105

Solosite (Hydrogel Dressings) What is it and when do you use it?

Back 105

Water or glycerin-based polymer dressings that don’t adhere to wounds.
Dry wounds
Wounds with minimal drainage
Wounds with necrosis or slough

Front 106

Duoderm (Hydrocolloid Dressings)
What is it and when do you use it?

Back 106

Adhesive, moldable wafers made of carbohydrate based material. Most have waterproof backing w/ some absorption. Help retain moisture and promote autolytic debridement.
Dry wounds (protective dressing)
Wounds with minimal drainage
Wounds with necrosis or slough
Can serve as secondary dressings

Front 107

Versiva or Lyofoam (Foam dressings)
What is it and when do you use it?

Back 107

Versiva is semi occlusive while lyofoam is open to air, but both wick moisture away from wounds.
Wounds with minimal to moderate drainage
Lyofoam is usually used in tandem with another form of absorbent dressing (gauze)

Front 108

Bacitracin, Dakin’s, Silvedene, Acticote (Antimicrobial Dressings)
What is it and when do you use it?

Back 108

Protect against bacteria while maintaining a moist healing environment. Active ingredients: Silver, iodine and ployhexethylene.
Infected Wounds
Wounds with minimal to heavy drainage
Non-Healing wounds

Front 109

Gauze, ABDs, Alginate (Absorptive Dressings)

Back 109

Chosen depending on the type of wound and the amount of exudate.
Wounds with moderate to heavy drainage
Wounds with tunneling

Front 110

Factors that may impair wound healing

Back 110

Disease states, e.g. diabetes, venous or arterial insufficiency
Malnutrition – Vit C. , zinc, iron important in collagen synthesis & deposition
Hypoxia – local or systemic
Corticosteroid therapy – causes immunosuppression; Vitamin A may help reverse
Smoking or any nicotine ingestion Infection or wound debris
Aging
Keloid formation

Front 111

Types of wound debridement

Back 111

Surgical/Sharp: Fastest. But not always feasible. Must be performed by licensed provider
Mechanical = Wet to dry dressings: No longer first choice, painful, damaging to new growth, makes bacteria airborne
Enzymatic: moderate speed. Works best in conjunction with sharp or surgical debridement. (Accuzyme)
Autolytic: body uses intrinsic factors to remove debris (primarily macrophages); slow, only effective in people with robust immune systems; Minimal pain. Low cost. Decreased frequency of dressing changes