Dressing Change/wound Care

Front 1

What is medical asepsis?

Back 1

Practices that are used to decrease the number and transmission of microorganisms; termed clean technique and includes: hand washing, clean enviornment, exam gloves or gowns, etc.

Front 2

What is surgical asepsis?

Back 2

Practices that are used to eliminate microorganisms from an area or equipment; termed sterile technique and includes: sterile fields, sterile gloves, sterile supplies & equipment, etc.

Front 3

True or False? If a sterile glove contacts a sterile field or sterile dressing the glove and the field/dressing are considered contaminated.

Back 3

False, sterile-to-sterile rules apply and a sterile glove touching a sterile field would remain sterile.

Front 4

When is sterile technique used?

Back 4

In the operating room, when inserting an indwelling catheter or on some dressing changes.

Front 5

What is the "no-touch technique" used on dressing changes?

Back 5

A method of changing topical dressings without touching the wound or any surface that will or might come in contact with the wound.

Front 6

What are some different types of wounds?

Back 6

Intentional, unintentional, closed, open, acute, chronic, and pressure ulcers.

Front 7

What is an example of an intentional wound?

Back 7

when an incision is made during surgery.

Front 8

What is a closed wound?

Back 8

A wound which the edges are well approximated or sutured or stapled together.

Front 9

What are pressure ulcers?

Back 9

localized areas of tissue necrosis that develope when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time.

Front 10

What are some other names for pressure ulcers?

Back 10

decubitus ulcer, bedsore, or dermal ulcer

Front 11

What are some factors that can affect wound healing?

Back 11

The extent of the damage or injury, the general health of pt (immune deficiencies, chronic illnesses, etc.), age, nutritional status, effectiveness of the circulatory sys, and medications

Front 12

What are three possibile methods to wound closure?

Back 12

Primary intention, Secondary intention, or tertiary intention

Front 13

What is primary intention of wound closure?

Back 13

This method occurs when the wound edges are well approximated and sutures or staples are used to maintain and intact the wound.

Front 14

What is secondary intention of wound closure?

Back 14

This is used when extensive tissue loss occurs and the wound is open with dressings covering the wound and it heals from the base of the wound.

Front 15

What is tertiary intention of wound closure?

Back 15

When a wound is left open because of potential for bacterial contamination. They wounds are kept moist with dressings and closed when risk of infection is minimal.

Front 16

What are the phases of wound healing?

Back 16

1. inflammatory phase 2. proliferation phase 3. maturation phase

Front 17

The activities of the inflammatory phase include __________ and __________.

Back 17

hemostasis, phagocytosis

Front 18

What is the first step of the inflammatory phase?

Back 18

Vasoconstriction occurs and coagulation begins as the body attempts to stop the bleeding.

Front 19

True or False? During the inflammatory phase growth factors are released by platelets which attract inflammatory cells to the area.

Back 19

True

Front 20

During the inflammatory phase migration of _________ cells, __________, and __________ cells is initiated.

Back 20

epithelial, fibroblasts, vascular

Front 21

During the inflammatory phase why does edema occur around the wound?

Back 21

Edema occurs becuase of vasodilation around the area of injury. This fluid contains proteins, enzymes, antibodies and growth factors necessary for healing.

Front 22

What do macrophages do during wound healing?

Back 22

They digest microorganisms and other debris, release chemicals that cause vasodilation, and stimulate the activity of the fibroblasts.

Front 23

What do fibroblasts do during wound healing?

Back 23

They initiate the production of collagen

Front 24

What happens during the proliferation phase?

Back 24

fibroblastic and collagen activity increases, new blood vessels and granulation tissue begins to form, epithelial cells migrate across the wound from its edges, collagen increases and the scar begins to change, and sensory nerves begin to develope (in minor wounds)

Front 25

What is contraction?

Back 25

Contraction is when the wound edges move toward the center and the size of the wound bed decreases.

Front 26

What happens during the maturation phase?

Back 26

Collagen is rearranged and is termed remodeling. The cells become less vascular and the strength of the tissue increases.

Front 27

The scar that is formed over a wound is not as strong as the original tissue, why is this?

Back 27

The reason for this is the scar consists of collagen rather than the original tissue, elastin.

Front 28

How long do each of the stages of wound healing normally last?

Back 28

Inflammatory phase: 3-4 days
Proliferation phase: 4-24 days
Maturation phase: several months

Front 29

What does the acronym "TIME" mean when considering barriers to healing?

Back 29

T=tissue
I=infection
M=moisture
E=edges

Front 30

True or False? Nonviable tissue, such as necrotic tissue, can interfere with the movement of cells needed to build granulation tissue and therefore removal of this tissue is important.

Back 30

True

Front 31

What is debridement and what are some different methods to doing it?

Back 31

It is the removal of necrotic tissue. Surgical debridement is removal using instruments, Mechanical debridement uses force to remove, autolytic debridement is removal using mositure and body's own enzymes, Enzymatic debridement uses topical enzymatic drugs to remove and biological debridement which uses maggots for removal.

Front 32

True or False? Low amounts of bacteria may actually help healing through the release of proteases or stimulate the release of proteases from neutrophils.

Back 32

True

Front 33

wounds with low levels of bacteria that are not replicating or are replicating (colonizing) is considered normal. What is NOT considered normal?

Back 33

Critical colonization of bacteria that delays wound healing is not normal.

Front 34

What are some signs and symptoms of critical colonization and impending infection in a wound?

Back 34

serous exudates, friable granulation tissue, bright red granulation tissue, increase pain, wound odor, fever, warmth, edema, pain, erythema, and purulent drainage.

Front 35

What is granulation tissue?

Back 35

New tissue made of collagen, fibroblasts and rich vascularity. It is seen as a shiny red tissue and bleeds easy. It fills the wound bed and provides a surface for epithelialization.

Front 36

True or False? A moist enviornment delays wound healing.

Back 36

False, it supports wound healing because the epithelial cells migrate faster in an appropriately moist enviornment.

Front 37

What are some things that can be done if a wound bed is TOO moist?

Back 37

Diuretics may be ordered or compression therapy. Also hydrocolloid, alginate, foam, or specialty absorbent dressings may be used. Wounds with extreme amounts of moisture may need negative pressure wound closure therapy (wound vac)

Front 38

What is undermining of a wound?

Back 38

When the epithelial cells cannot slide over each other properly and you see a hard rolled wound edge.

Front 39

What are some ways to manage problems with wound edges?

Back 39

debridement of wound edge, application of biological factors such as growth factor, skin grafts, electrical wound stimulation or wound vacs.