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31 Cards in this Set
- Front
- Back
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Causes of delayed wound healing
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Malnourishment-zinc,magnesium,copper deficiency, Smoking, Obesity, Anemia, Diabetes, Cancer, Steroid treatment, Hypovolemia, Hypoxia, Immune system compromise, prolonged surgery > 3hrs., Emergency surgery
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Complications
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Dehiscence:
Total or partial opening of a wound or incision Evisceration: Protrusion of a viscera through abdominal wound. |
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Bandages:
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Secures dressings
Applies pressure Supports wound **unsually rolled guaze, Kerlix, Kling or ace of various widths (1-6 inches) |
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Key concepts to Bandages:
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Circulation checks are essential
-warmth Appearence -color -edema Mobility Sensation -numbness -tingling |
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5 "P" Circulation check
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Pallor
Paresthesis Pain Pulselessness Paralysis |
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Bandage Key Concepts cont.
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Need not be Sterile.
Wrap tight enough to hold without constricting blood flow. Avoid bandaging over wrinked dressings to prevent pressure. Avoid bandaging over solied dressings. Apply bandage distal to proximal to facilitate venous return. |
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Circular Turns
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To cover small cylindrical areas.
To anchor bandage before starting another type wrap/ |
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Spiral Turns
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To secure dressings.
To wrap an extremity when contour does not very significally. |
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Reverse Spiral
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To secure dressing.
To wrap an extremity when circumference changes significantly. |
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Figure Eight
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To secure dressings.
To wrap an extremity on or near a joint. |
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Recurrent
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To secure dressing on scalp or stump.
May be compression dressing on stump. |
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Key concepts related to Binders/Supports
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Designed for a specific body part.
Generally made of cloth or elasric material with velco fasteners. Used to hold bandages in place. Used to support tissues. Used to immobilize or splint. Used around the chest, abdomen, or pelvis. |
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T Binders
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Belt around waist with tails to secure pads b/t legs.
-Single -females to secure dressings on rectum, perineum, or groin. _Double _Males to secure dressings on rectum, perieum, groin. |
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Straight
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-Abdomen or chest
-Appied for support when pt.is ambulating, coughing, rig fractures. -Apply while pt.is laying in bed. |
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Slings
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-Support of upper extremity
-Triangle cloth may be used. -Fasten off center behind neck to avoid rubbing on Cervical vertebra. |
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Orthopedic Splints/Orthopedic Immobilizers
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Knee
Shoulder Neck Foot -shoe |
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Principles of applying Bandages and Binders
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-Unclean bandages and binders may cause infection if appied over a wound or skin abrasion-
-First cover site with sterile dressing. -Next appy clean bandage or binder -Wash or replace soiled bandages or binders. |
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Principles of Applying Bandages or Binders
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Prolonged heat and moisture on skin may cause epithelial cells to deterorate.
-Avoid unnecessarily thick bandages. -Avoid excessive heat. -Use porous materials to allow air circulation and evaporation of perspiration. |
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Principles for applying Bandages and Binders
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Place and support body part to be bandaged in normal functioning position.
-Prevents deformities and discomfort. -Enhances circulation. |
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Principles for applying Bandages and Binders
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Avoid excessive pressure on blood vessels.
-Assess circulation by leaving small area of an extremity exposed. -fingers, toes -Avoid inconsistent wraps which allow swelling in unwraped contigous areas. -heels if foot and leg are bandaged. |
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Principles for applying Bandages and Binders
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Tension on each part of the bandage should be uniform
-Pervents undue/uneven pressure. -Hollow areas may be filled with padding to provide comfort and maintain pressure. |
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Principles for applying Bandages and Binders
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Place pins or knots well away from wound, tender areas or pressure points.
-Can cause undue/uneven pressure and/or discomfort. |
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Six Principles of Bandaging
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-Unclean bandages and binders may cause infection if applied over a wound or skin abrasion.
-Prolonged heat & moisture on skin can cause epithelial cells to deteriorate. -Place and support part to be bandaged in normal functioning position. -Avoid excessive pressure on blood vessels. -Tension on each part of the bandage should be uniform. -Place pins/knots well away from wound, tender ares or pressure point. |
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Heat Application
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Causes Vasodilation
- blood flow - nutrient circulation Relieves pain from muscles spams or imjured joint. Can reduce swelling by circulation. Eliminates toxic waste products that accumulate in swollen areas. Promoted healing by oxygenation to tissues. |
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Use for Heat Application
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-Surgical Wounds
-Hemorrhoids -Episiotomies -Phlebitis -IV Infilration -Low Back Pain -Arthritis -Muscle Spams -Cramps |
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Methods of Applying Heat
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-Water-flow heating pad(K-pads)
-Instant hot packs -Hot water bottles -Electric heating pads -Thermal warming blankets -Sitz baths -Warm soaks-limited to 20-30 mins |
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Cold Application
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-Causes Vasoconstriction
-In early wound management -controls bleeding -controls edema -reduces pain |
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Uses for Cold Application
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-Fractures
-Trauma -Lacerations -Puncture wounds -Insect bites -Sprains -Sports injuries -Arthritis |
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Methods for Cold Application
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-Ice Collar
-Ice Bag -Instant ice pack -Frozen bagged veggies -Thermal cooling blanket |
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Concerns related to Heat and Cold Treatment
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-Age of PT.
-Level of consciousness -Circulatory problems -Sensory deficits -PT. diagnosis |
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Nursing Diagnosis
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-Risk for Injury
-Pain -Ineffective Thermoregulation -Hyperthermia -Hypothermia |
