Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
87 Cards in this Set
- Front
- Back
|
What are the four stages of wound healing?
|
Inflammatory
Debridement Repair Maturation |
|
|
What happens during the inflammatory stage?
|
INFLAMMATION (duh)
-- increases vascular permeability -- chemotaxis HEMORRHAGE -- flushes contaminants from wound -- clot formation (minimal tensile strenght) forms a scab for protection and a fibrin matrix for repair -- |
|
|
What happens during the debridement stage?
|
WBC infiltration
-- neutrophils and monocytes EXUDATION |
|
|
What do the neutrophils and monocytes do?
|
Neutrophils- exacerbate inflammation
Monocytes- Produce important growth factors for epitheliization, angiogenesis, and fibroplasia (to promote repair) |
|
|
What happens in the repair stage?
|
EPIDERMIS = epithelialization
(mitosis of basal cell layer, proliferation, collagenase, pruritus) DERMIS= fibroplasia (fibroplast infiltration, collagen deposion and remodeling, angiogenesis, granulation tissue, wound contraction) |
|
|
What is the maturation stage look like?
|
Fewer fibroblasts (for continued remodeling and contraction)
MATURE SCAR! (15-20% weaker than normal skin and NO ELASTIN) |
|
|
When does the maturation stage occur?
|
60-360 days post wounding
|
|
|
**What is the effect of physical stress on a would in the maturation stage?**
|
stretching of the scar causes it to "build up" (progressively enlarging)
--can sometimes cause a KELOID (scarred tissue) |
|
|
What is the tensile strength like as the wound heals?
|
0-4 days (fibrin clot)- WEAK, unstable, not enough!
5-7 days (fibroblasts!) minimal strength, poorly organized collagen 10 days- collagen is built up, organized, and stable (no support is necessary) 10-14 days (optimal strength!) |
|
|
**What is the best time for suture removal?**
|
10-14 days because the sutures will begin to "fight" and envelop them
they have enough strength to finish healing alone |
|
|
What is "proud flesh"?
|
exuberant granulation tissue
NOT covered by epithelium (different than keloids) so much granulation happens so quickly that the epithelium can't keep up to cover it and it bulges through |
|
|
What is Cyclooxygenase 1 responsible for?
|
normal functions of platelet aggregation, GI mucosal protection & renal perfusion
SO, if INHIBITED: decreased platelet function, renal perfusion, and GI mucosal protection |
|
|
What is Cyclooxygenase 2 responsible for?
|
synthesis of inflammatory mediators!
SO, if INHIBITED: decreased inflammation, also may delay GI ulcer healing and fracture healing |
|
|
**Which clinical coagulation diagnostic could/should be done in a preoperative patient known to or suspected of having received NSAIDS?**
|
BMBT! (buccal mucosal blood test)
quick and cheap way to test bleeding time! |
|
|
Excessive hemorrhage results in...
|
-INHIBITION OF A CLOT (pressure is too high!)
- HYPOVOLEMIA (need to use fluids!) - ANIEMIA - HYPOPROTEINEMIA |
|
|
How do we intervene with there is excessive hemorrhage?
|
gauze, hemostatic forceps, ligatures, electorcautery, laser, tourniquet, commercial hemostatic agents
|
|
|
When using gauze for hemostasis:
BLOT or WIPE? DRY OR SEMI-SATURATED? and why? |
BLOT!- if you wipe, it will rip the clots off
SEMI-SATURATED (with blood) clot and activated factors in the gauze will help! also, using new gauzes every time gets expensive |
|
|
**How does the crushing action aid in hemostasis?**
|
STOPS BLOOD FLOW!
exposes collagen releases TONS of tissue thromoplastins (explosive stimulation of extrinsic pathway) |
|
|
What can we use to ligate a vessel?
|
sutures or a hemostatic clip
|
|
|
Excessive electorcatery on hemorrhage may impeded healing...why?
|
Tissue is destroyed, then it will take time to debride and then has to heal
|
|
|
How long can you leave a tourniquet in place?
|
TEMPORARILY!
no more then 30 minutes to re-perfuse tissues! then reapply if needed (in a few minutes) LABEL it in case you need to leave the room |
|
|
What are some methods for postoperative hemorrhage management?
|
DRAINS (active= has a vacuum to suck out fluid)
COMPRESSION (gentle!) don't want to suppress blood flow, just want to minimize the seapage CRYOTHERAPY cold! induces inflammatory mediators |
|
|
What are the three types of wound healing?
|
1st, 2nd, and 3rd intention
|
|
|
What is 1st intention healing?
|
PRIMARY CLOSURE
sutured closed for best apposition and least exposed tissue |
|
|
What is 2nd intention healing?
|
GRANULATION
open wound= allow body to naturally heal/cover/contract wound to form a scar |
|
|
What is 3rd intention healing?
|
DELAYED SURGICAL CLOSURE
2nd degree, then 1st degree once its close enough to suture |
|
|
**How may suture material used affect healing?**
|
If it is absorbed by the body it does not create inflammation
if it is chromic gut, it causes inflammation and irritation sometimes |
|
|
Why would we choose 2nd intention healing over 1st?
|
if there is significant contamination
insufficient skin to close |
|
|
Example: Hit by a school bus german shepherd dog
why was there very little bleeding from the wound? |
CRUSHING injury!
clots fastest to start both sides of pathway (squished cells, collagen exposed, etc.) |
|
|
What is the goal of management and bandaging of wounds?
|
to provide an optimal healing micro-environment at the fastest possible rate
|
|
|
Why don't we just let the wound "breathe"?
|
if the wound is left open, it will NOT heal tissue better:
if cold- vessels will vasoconstrict! we want blood to get to the area also, don't want it to get dry and crusty |
|
|
When deciding on bandaging, what are some things to consider?
|
contamination
debridement moisture (exudation) temperature pressure pain |
|
|
What do we use lavage for in wound healing?
|
decontamination
debridement optimal pressure (10-15 psi) |
|
|
What different things can you use for lavage?
|
- syringe and needle
- spray bottle stream - surgilav - water pik NEVER EXCEED 15 psi |
|
|
How will cool lavage fluids adversely affect the patient/wound?
|
vasoconstriction on the vessels will prevent glood blood flow to nutrients, macrophages, etc.
slows down metabolic rate and activity of now growing cells |
|
|
What kinds of fluids do we use for lavage?
|
STERILE, ISOTONIC, BUFFERED
ex: 0.9 Saline ex: LRS ex: tap water if you must |
|
|
How does the Biguanide solution work?
|
its binding effects to kill microbes and not have microbial growth
|
|
|
Why are iodophor solutions more effective when diluted?
|
Higher microbial effect with diluted solution to free iodine from polymers
also, less tissue damage |
|
|
What fluids do we NEVER, EVER use to lavage?
|
HYDROGEN PEROXIDE- only if there are maggots that need to be killed ( otherwise you are putting in O2 free radicals that kill!)
ACETIC ACID (vinegar) SODIUM HYPOCHLORITE (bleach) ANY DETERGENT (kills cells! very alkaline) |
|
|
What material would be appropriate during the debridement stage?
|
Alginates (made from giant kelp) & Hydrogels (synthetic hydrophilic polymers)
-- Amorphous gel over wound promotes autolysis -- Wiped/lavaged away -- Promotes selective debridement – healthy tissues undisturbed -- Sheet dressings useful for transitional & granulating wounds |
|
|
Moisture of the wound is KEY to the healing process.
What happens with the wound though if it is TOO wet or TOO dry? |
TOO WET: friable tissues, easily traumatized, poor wound strength
impedes healing (cellular activity) TOO DRY: Dehydration = cell death Cessation of cellular activity (esp. epithelialization), tissue fractures – additional, prolonged healing needed Scarring likely |
|
|
When a wound has SERIOUS fluid exudates what do we use for absorption?
THICK fluid exudates? |
SERIOUS= dry
THICK= wet goal: to provide rapid movement from the wound to our 2nd bandage layer |
|
|
What (specifically) do we use if there is moderate to heavy/thick exudates?
|
MOIST CONTACT LAYER:
Alginates: -- Can absorb 20X their weight in exudate -- used for further debridement (3-4 days) |
|
|
What (specifically) do we use if there is mild- moderate exudates?
|
Hydrogels:
used in transitional period from debridement to granulation! foam: primary contact or secondary over gels and alginates |
|
|
What do we use (specifically) on wounds with none to minimal exudation?
|
ADAPTIVE (petroleum impregnated):
little to no weeping, granulation tissue FILM (Tefla perforated film): little to no weeping, granulation tissue if used on exudates, would trap them in and cause more bacteria and infection, need to let it drain! transparent film? ABSOLUTELY NO WEEPING! |
|
|
What is key to the secondary layer of the bandage?
|
POWERFUL WICKING ACTION
Adequate storage AWAY from wound WITHOUT strikethrough (cotton) |
|
|
How important is the wound temperature (especially at bandage changes?)
|
VERY!
patient can get wound hypothermia: - vasoconstriction: decreases nutritents, O2, and waste removal - decrease of cellular metabolism, activity, and healing |
|
|
What can we do to prevent wound hypothermia?
|
1st make sure our bandage is going to insulate and keep the body/wound at normal temperature
2nd- can minimize wound exposure to minimize temp reduction, use warm lavage fluids, use warm dressings |
|
|
How should our pressure be on bandages?
|
MINIMAL!
too much pressure can: - tissue hypoxia - slow cellular activity/healing/migration - necrosis of healthy tissue - inhibit ventilation - prevent movement of exudates to 2nd layer - decrease storage capacity of absorptive bandate |
|
|
The 3rd bandage layer is for PROTECTION. (vet wrap, etc.)
How/why do we protect the bandage when the animal needs to go outside? |
use a fluid bag or thick plastic bag
ON when they go outside (protection) and OFF immediately when they come inside (will trap in moisture/etc. and not allow wound to breathe) |
|
|
If you packed an alginate as dry fiber into a would, how long would you leave it in there?
|
3-4 days
will transition to a gelatin-like material rather than fibers |
|
|
What is a penrose drain?
|
A thin rubber tube that penetrates the wound and exits the body so that the fluid can drain out
|
|
|
What are the pros and cons of a penrose drain?
|
Pros: drains and cleans area well and away from the body
Cons: open pathway for organisms to enter! (need to dress! w/o pressure) |
|
|
What are suture loops used for?
|
Tied on outer line of wound to keep the bandage in place!
if not: - will slip around - can get between legs - get gross w/ fecal matter |
|
|
What is the difference between passive and active drains?
|
PASSIVE: uses gravity to pull the fluids down and out of the area
ACTIVE: uses a vacuum force to pull the fluid away |
|
|
What are some good choices for topical wound agents?
|
WATER SOLUBLE
-- silver sulfadiazine (broad spectrum antimicrobial, penetrates necrotic tissue) -- nitrofurazone (Furacin dressing) is a potential carcinogen. - contains propylene glycol - hydrophilicc and renders gauze non-adherent PATROLEUM BASED -- Triple Antibiotic ex: Bacitracin- accelerates epitheliilziation ex: Neomycin, polymycin, bacitracin- possible toxicity, hypersensitivity NOT TO BE USED ON EXUDATE WOUNDS |
|
|
What are some bad choices for topical wound agents?
|
Powders- foreign contaminant in would (prolonged debridement)
Corticosteroids (endogenous or exogenous) - causes no inflammation, no phagocytes, no growth factors= no repair! |
|
|
Let's go over some general case applications! GET READYYY
|
YAY :)
|
|
|
"FRITZ" - bite wound on glute area over hip
Q- why will 3rd intention healing be best? Q- why is there no significant hemorrhage from this wound? |
Contamination and hip impairment!
crushing trauma= much exposure of collagen and massive release of tissue thromboplastins= rapid coagulation |
|
|
"FRITZ" bite wound on hip/glute area
Q- how will you prep for the initial lavage Sx? Q- Why do you anticipate that this wound will be very suppurative? Q- how should your bandage accomadate the exudation? |
PREP:
- protect wound with K-Y for clip - scrub skin, use solution for wound Much trauma and contamination Highly absorbent 2nd layer |
|
|
When there is a wound over the chest and rib region, what concerns do we have with bandaging?
|
not to impair respiration more it already is!
|
|
|
When you "mobilize the skin", what are you doing? How traumatic is it?
|
pulling and stretching for a skin graft?
VERY TRAUMATIC! serious suppuration due to trauma and deadspace permits free flow and filling with serous fluid (seroma formation) |
|
|
ON TO PAIN!
|
ouch!
|
|
|
What is pain?
Why provide analgesia? |
a traumatic stimulus that damages tissues!
if not treated, could further stress, cause windup (in cord), slow healing process (steroids) |
|
|
How do animals exhibit pain?
Why do some animals mask pain? |
How: everyone is different
ex: sounds, shy away, withdraw, aggressive, shaking Why: predator mode (don't want to show weaknesses) |
|
|
How can we provide analgesia?
|
Analgesic drugs: (systemic, regional blocks)
Anesthesia (local, regional, general) |
|
|
What is the difference between analgesia and anesthesia?
|
Analgesia: lack of PAIN (more important!, looks at perception of entire package- covers pre/during/post operative)
Anesthesia: lack of sensation |
|
|
What are some side effects with NSAID analgesics?
contraindications? |
SIDE EFFECTS:
- GI (ulceration and hemorrhage) - Hemorrhage - Toxicity (hepatic and renal) CONTRAINDICATIONS: - impaired renal.hepatic function - GI diseases - dehydration - hypotension - hemorrhage or impaired hemostasis |
|
|
What should clients be instructed to watch for if NSAIDs are perscribed?
|
GI is upset so:
- ANOREXIA! - vomiting/diarrhea - bleeding (frank blood in feces or melena) (vomiting blood- looks like coffee grounds) (hematoma) |
|
|
What are some side effects of opiod analgesics?
contraindications? |
SIDE EFFECTS:
- Cardiopulmonary depression (could kill patient!) **look for weak pulse, hypotension, bradycardia, prolonged CRT - vomiting/diarrhea (common) - CNS depression - Constipation CONTRAINDICATIONS - Hepatic disease - Cardiopulmonary disease - Head trauma - Pre-existing altered bowel motility |
|
|
Why should you never cut a Fentanyl patch?
|
COULD OVERDOSE!!
just cover half of whatever you need |
|
|
How frequently should you monitor patients receiving opiods?
|
EVERY 15 min-hour!
depends on patient, drug, dose, and deliver route "don't monitor the clock, monitor your patient!" |
|
|
What are some examples of regional anesthetics?
|
- Digital nerve block
- Paravertebral (cattle) - Epidural (sm. animals mostly) - Spinal (intrathecal) analgesia (not classically used) |
|
|
LIDOCAINE!
What are the pharmacodynamics? How would the efficacy of it change when added with epinephrine? |
De-sensitized by Sodium channel blockers! (no neurotransmission for sensory)
If it is combined with epinephrine: vasoconstricts so drug stays in longer! |
|
|
BUPIVACAINE!
What are the pharmacodynamics? How does its duration compare? |
Na- channel blocker and protein binding so it lasts for LONGER!
|
|
|
PRESERVATIVE-FREE MORPHINE!
Why use it? |
could be neuro-toxic so since right over cord, don't want any preservatives
|
|
|
What are the different kinds of blocks? (traditionally used in cattle)
|
LINE block (only desensitized on the line)
INVERTED L block (now desensitized in a larger area) PARAVERTEBRAL LUMBAR (BEST! desnsitizes all the layers!) EPIDURAL (desesitizes perineum) |
|
|
Why do you need to be careful when placing your paravertebral lumbar block?
|
The Sx with cattle is usually while they're standing...
SO, if you give it further than L3, the legs will give out and fall over! |
|
|
How does general anesthesia provide analgesia?
|
removed pain perception (at the brain)
|
|
|
If general anesthesia is used alone, why might patients be excessively painful postoperatively?
|
wind-up!
|
|
|
What is wind-up?
|
brain finally perceives the built up pressure (at the cord) and causes spastic painful movement of that muscle
|
|
|
How can windup be prevented?
|
pain block/systemic pain drugs
(done after induction so brain can remember) |
|
|
When should you confer with the clinician regarding pain management?
|
BEFORE the painful procedure!
and when pain is perceived |
|
|
What is OUR role in pain management?
|
- medication administration
- monitoring - intervention (standing orders) - patient advocate!!! |
|
|
What are non-pharmaceutical, palliative nursing care practices that may relieve discomfort in a hospitzlied patient?
|
- CRYOtherapy (ice pack) with padding
- Heat therapy (not for acute injuries, make sure you always rotate!) - Massage (need direction before performing, could damage) - Bandaging - Accupressure |
|
|
Do non-pharmaceutical measures need to be ordered by a DVM?
|
YES!
|
|
|
What are the goals of pain management?
|
OPTIMIZE patient recovery and minimize the risk of chronic pain!
|
