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58 Cards in this Set

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What are examples of SURFACTANTS used in wound cleansing?
Shur-Clens (can put in eyes)
Biolex
Curasol
Sea-Clens
Restore
(use agent w/ lowest cytotoxicity)
What is optimal wound irrigation?
* Optimal at bedside: 35 ml syringe w/ 19G angiocath delivers 8 psi.
* Whirlpool
What are the principles of topical wound therapy?
1. Remove necrotic tissue, foreign bodies & particles
2. Identify and eliminate infection
3. Obliterate dead space
4. Absorb excess exudate
5. Maintain moist wound environment
6. Provide thermal insulation
7. Protect healing wound from trauma and bacterial invasion.
What are the goals of treatment in wound care?
1. Achieve/maintain a clean wound bed
2. Heal the wound
3. Protect the wound from contaminants
4. Place the pt in another setting to continue care (e.g. acute care to home of SNF)
5. If the wound is dry: add moisture
6. If the wound has drainage: absorb it
7. If the wound has necrotic tissue (eschar or slough): debride it (except ischemic wounds and stable heel ulcer)
What are types of moisture retentive dressings?
Hydrocolloids
Hydrogels
Transparent films
Foams (absorb & protect)
Alginates (absorb)
Hydrofiber
Composites (2 dsg in 1)
Contact layers (rayon mesh)
Wound fillers
Antimicrobial dressings
Collagen
Topical preparations
Gauze
Enzymes
Other
What is the composition of HYDROCOLLOIDS?
Carboxymethylcellulose(gelling element & absorbent)
Polysaccharides
Gelatin, pectin
Polyisobutyline
What are characteristics of HYDROCOLLOIDS?
* Semi-occlusive/ occlusive dressings that absorb exudate & form a gel.
* Promote clean wounds to granulate and necrotic wounds to autolycically debride.
* Do NOT use on clinically infected wounds.
What are examples of HYDROCOLLOIDS?
Duoderm (first one, ~1981)
CombiDERM ACD
Comfeel Plus
Cutinova Hydro
Replicare
Restore
Hydrocol
Tegasorb
What is the composition of HYDROGELS?
Water or glycerin based gels that come in gel of solid form.
What are characteristics of HYDROGELS?
* Absorb minimal to moderate amount of fluid
* Some have other ingredients such as an alginate that help increase absorptive capability
* Moist, soothing, cooling
What are examples of HYDROGELS?
Vigilon
Biolex
CarraSmart Gel Wound Dst
CURASOL Gel
Hypergel
Normlgel
Restore Gel
Tender Wet Gel
Tegagel
ClearSite
Flexigel
Intrasite Gel
What is the composition of TRANSPARENT FILMS?
* Thin polyurethane membranes with an adhesive contact surface.
* They don't absorb anything.
What are the characteristics of TRANSPARENT FILMS?
* Transparent, sterile membrane
* Vary in thickness and adhesive quality
* Moisture vapor and oxygen permeable
* Impermeable to external water and bacteria
* Maintain moist wound environment
* No absorptive capacity
What are examples of TRANSPARENT FILMS?
OpSite
Tegaderm
CarraFilm
Bioclusive
Mefilm
What is the composition of FOAMS?
* Non-adherent to wound bed, may adhere to intact skin
* Provide a moist environment (in the presence of moisture) and thermal insulation
* Nonlinting and absorbent
* Conformable
* May use some w/ infected wounds
* Easy to apply and remove
What are examples of FOAMS?
Allevyn, Allevyn Adhesive, Allevyn Cavity
Biatain Adhesive and Non-adhesive
Curafoam, Curafoam Plus
Flexzan
Lyofoam
Mepilex
Mitraflex
PolyMem
Sol-Foam
What is the composition of ALGINATES?
* Naturally derived polysaccharide produced from brown seaweed
* When applied to a wound, an ion exchange occurs between the dressing and wound exudate which turns the dressing fibers into a gel
What are the characteristics of ALGINATES?
* Absorb moderate to large amounts of exudate
* Hemostatic properties
* Available in sheet or rope forms
* Conformable
* Will eventually biodegrade
What are examples of ALGINATES?
Algisite M
Comfeel SeaSorb
Curasorb
Kaltostat
Restore
Calcicare
Sorbsan
Tegagen
What is the composition of HYDROFIBER?
* Non-woven, carboxymethylcellulose spun into fibers and made into sheets and ribbons
* Mirrors properties of alginate but has vertical wicking and will not absorb laterally
* Super absorbent - 33% more than most alginates
What are examples of HYDROFIBER?
AQUACEL
What are the composition/ characteristics of COMPOSITES?
* They combins 2 or more physically distinct products that are manufactured as a single product
* AKA island dressings
* Features include a bacterial barrier; absorbent layer other than an alginate, foam, hydrycolloid or hydrogel; either a semi-adherent or non-adherent surfact that covers the wound; and an adhesive border.
What are examples of COMPOSITES?
Alldress
Covaderm plus
Telfa Island Dressing
What are the composition/ characteristics of CONTACT LAYERS?
* Single layer of woven or perforated polymer net that acts as a low adherence material
* Placed in the base of the wound and stays in contact w/ the wound base
* Acts as a protective interface between wound and secondary dressing
* Wound exudate passes through the perforations into a secondary dressing
* Protects wound bed from trauma
What are examples of CONTACT LAYERS?
Mepitel
N-TERFACE
Profore Wound Contact Layer
Tegapore
What are the composition/ characteristics of WOUND FILLERS?
* Pastes, powders, beads, granules, or strands that are used to fill a wound and absorb exudate
What are examples of WOUND FILLERS?
Flexigel Strands Absorbent Wound Dressing
Multidex Maltodextrin Wound Dressing Gel or Powder
What are the composition/ characteristics of ANTIMICROBIAL DRESSINGS?
Cadexomer iodine
Silver dressings
Impregnated antimicrobial gauze (PHMB)
Address issue of critical colonization
What are examples of ANTIMICROBIAL DRESSINGS?
Iodosorb Gel
Iodoflex Pad
AcryDerm Silver
Actocoat
Arglaes
SilvaSorb
Kerlix AMD
What are the composition/ characteristics of COLLAGEN DRESSINGS?
* Formulated with Type I bovine (cowhides or tendon) or avian collagen
* Encourages deposition and organization of newly formed collagen into the wound bed
What are examples of COLLAGEN DRESSINGS?
Fibracol Plus Collagen Wound Dressing w/ Alginate
Kollagen-Medifil Pads
Kollagen-Skin Temp Sheets
Kollagen-Medifil II Particles
What are the composition/ characteristics of GAUZE?
* Wide variety of products including non-impregnated, impregnated, woven or non-woven, sterile, and non-sterile
* Available in a wide variety of styles
What are examples of GAUZE?
* Impregnated: Adaptic, Mesalt (hypertonic saline), Xerofoam
* Non-impregnated: Nu-Gauze
* Non-adherent: Coverlet Surgical Dressing, Telfa, Exu-Dry
What are the composition/ characteristics of ENZYMATIC DEBRIDERS?
* Enzymes are complex proteins that are capable of inducing chemical changes in other substances w/o being changes themselves
* Digest necrotic debris
* Use thin later, about as thick as a nickel
What are examples of ENZYMATIC DEBRIDERS?
Collagenase-Santyl
Accuzyme
Panafil
Gladase Papain-Urea debriding ointment
Key facts about the skin
Largest organ of the body
Weight is approx 6 pounds
Surface area 18 sq ft
Thickness ranges from 0.5 to 3 mm
pH range 4 to 6.8 (avg 5.5) - "acid mantle"
What are the layers of the epidermis?
* Stratum corneum (outermost): flat dead cells(corneocytes)
* Stratum lucidum: clear, flat, dead cells; absent in thinner skin
* Stratum granulosum: first step of forming keratin and insoluble protein (helps w/ water resistance)
* Stratum spinosum: provides strength
* Stratum germanitivum (innermost): basal layer/basal keratinocytes/ contain melanocytes/ form rete ridges to help anchor epidermis to dermis
What is the Basement Membrane Zone (BMZ)?
* AKA known as epidermal-dermal junction
* Contains 2 layers - lamina densa and lamina lucida
* Facilitates transfer of oxygen and nutrients from the dermis to the epidermis
Dermis
* Contains dermal progeins: collagen (tensile strength) and elastin (elastic recoil)
* Both synthesized and secreted by fibroblasts
* Thick in palms and soles, thin in TM, eyelids, scrotum, penis
* Contains blood vessels, nerves, glands, and hair follicles
What are the layers of the dermis?
* Papillary dermis: upper region, form dermal papillae (upward protrusions that help anchor epidermis), contain nerve endings sensitive to touch
* Reticular dermis: lower region of dense connective tissue, bundles of collagen and coarse elastic fibers, provides skin w/ strength, extensability and elasticity
What is the subcutaneous layer of the skin?
AKA hypodermis
CONTAINS:
* hair epidermis develops down growths into the dermis called hair follicles; hair is fiber of keratinized epithelial cells
* Nails are hard keritinized cells of the epidermis
* Sebacious glands
* Absent in palms abnd soles
* Too much and too little are not good
What are the functions of the skin?
* Protection
* Thermoregulation
* Metabolism: synthesis of Vit D
* Sensation: pain, touch, temperature, pressure
* Communication
What are the effects of aging on the skin?
* Stratum corneum cells show change in size and shape
* Increased epidermal turnover time: age 18=21 days, age 35=42 days, over age 50 increased dramatically
* Rete ridges and dermal papillae flattened
* Increase in keratin cross linking
* Decreased sebum production
* Decreased thickness
* Thinning microvasculature
* Decreased SQ fat
* Decreased inflammatory response
* Decreased perception of pain
What is Capillary Closing Pressure (CPP)?
* Threshold 32 mm Hg widely used
* The pressure needed to occlude the capillary blood flow and therefore cause ischemia and necrosis
What is Tissue Interface Pressure (TIP)?
* Used to evaluate the effectiveness of suport surfaces
* TIP below 32 mm Hg has been used as an endpoint for clinical effectiveness
* Calculated by placing a sensor between the skin and the resting surface
Ways to categorize support surfaces
* Need pressure relief not just pressure reduction
* Air or fluid support: Dynamic vs Static
* Static overlays are pressure reducing
* Dynamic overlays are pressure relieving
What are characteristice of foam?
* Base height
* Density
* Indentation Load Deflection (ILD): Firmness of foam or how much weight produces an indent to 1/4 of thickness of foam
What is the Payne-Martin Classification of Skin Tears?
* Category I: skin tear w/o tissue loss
* Category II: skin tear w/ partial tissue loss
* Category III: Skin tear w/ complete tissue loss
What is a PARTIAL THICKNESS WOUND and what are the phases of wound healing?
Partial thickness wounds extend through the epidermis and into but not through the dermis.
PHASES of PARTIAL THICKNESS WOUND HEALING:
* Inflammation
* Re-epithelialization (resurfaced) & concurrent dermal repair. Peak epithelial proliferation @ 24-72 hours.
What is a FULL THICKNESS WOUND and what are the phases of wound healing?
Full thickness wounds extend through both the epidermis and the dermis and may involve the SQ tissue, muscle, and possible bone.
PHASES OF FULL THICKNESS WOUND HEALING
* Defensive/inflammatory phase
* Proliferative phase, AKA regeneration or fibroblastic phase
* Maturation phase, AKA Remodeling phase
*** Most you can hope for is 80% of original strength***
What is a wound?
A pathologic disruption of the skin or any body tissue.
What are the 3 types of wound closure?
* Primary: wound edges pulled together and secured w/ staples, sutures, or surgical adhesive strips
* Secondary: wound left open and heals w/ deposition of granulation tissue and contraction of wound margins
* Tertiary (delayed primary): delayed surgical closure of wound (granulation) e.g. dirty wound, heals from bottom up.
What is a pressure ulcer?
A pressure ulcer is an area of localized tissue damage caused by ischemia because of pressure.
What are the parameters measured by the Braden Risk Assessment?
* Sensory perception (ability to respond meaningfully to pressure-related discomfort)
* Moisture (degree to which skin is exposed to moisture)
* Activity (degree of physical activity)
* Mobility (ability to change and control body position)
* Nutrition (usual food intake pattern)
* Friction & Shear
What is a Stage I Pressure Ulcer?
Intact skin
Non-blanchable erythema
Caused by pressure
What is a Stage II Pressure Ulcer?
* Partial thickness skin loss involving the epidermis or dermis.
* The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
What is a Stage III Pressure Ulcer?
* Full thickness skin loss involving damage or necrosis of subcutaneous tissue which may extend down to, but not through underlying fascia.
* The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
What is a Stage IV Pressure Ulcer?
* Full thickness skin loss with extensive destruction, tissue, necrosis, or damage to muscle, bone, or support structures (for example, tendon or joint capsule).
* Tunneling and sinus tracts may also be associated with stage 4 pressure ulcers.