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40 Cards in this Set
- Front
- Back
What are the phases of wound repair?
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phase 1 - inflammatory phase
phase 2 fibroblastic or proliferative phase phase phase 3 - maturatiion phase |
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Describe inlammatory phase
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1st phase of wound healing, last 3-4 days, or 1- 7 days; aggregation of platelets and hemostasis, coagulation, release of cytokines and mediators
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Describe proliferative phase
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5-20 days -- collagen fibers are produced and lend strength to wound --aniogenesis, fibroplasia, woudn contraction
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Describe remodeling phase
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3 weeks to 2 years
deposition of matrix materials ; collagen depsiton/remodeling, reutrn to preinjury sttes; as long as the scar or past ulcer site is erythematous remodilling is occuring |
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What are some factors that interfere with wound healing?
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age, inadquate pefusion, infection, edema, poor nutrition. vitamin and trace element deficiencies, steroieds, radiation
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What are some diseases which are associated with or predispose one t chronic wounds?
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Diabetes mellitus, venous stasis, collagen vascualr disease
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How could you treat non-healing wounds?
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debridement of necrotic tissue, control of infection, control of diabetesw mellitus, nutriitonal support, avoidance of trauma, coompression therapy, tapering of steroids, revascularization, hyperbaric oxygen, plastic reconstructive surgery
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Name some synthetic absorbable multifilament sutures
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Dexon-S
vicryl |
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Name some synthetic absorbable monofilament sutures
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PDS
Maxon |
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Name some nonabsorbable synthetic monofilament
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dermalon, ethilon (nylon) surgilene (polypropylene)
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Which are more reactive multifilament or monofilament sutures
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Monofilament sutures
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Name some synthetic nonabsorbable multifilament sutures
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ethibond, neurolon, surgilon
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What is primary closure?
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wound is immediately suture; must be a clean wound, good scar
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What is secondary closure?
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infected or dirty wounds are left open, allowed to granulate in from the bottom up, not as good a scar
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What is delyared primary closure
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infected or dirty wound is left open until immediate threat o infection has passed and then later the wound is closed primaryily with sutures
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What is the French Theory for Charcot foot.
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Neurovascular theory --
-Trophic centers in the anterior horn of the spinal cord maintain nutrition to joints. -Trauma to these trophic centers leads to increased blood flow and osteoclastic activity. |
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What is the German Theory for Charcot foot
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Neurotraumatic--
-Repeated trauma from biomechanical stresses during ambulation on an insensate foot. |
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what are the top factors that lead to cardiac emergencies
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1) CHF - manifested by S3 gallop or jugular venous distention
2) rhythm - PAC's or greater than 5 PVC'/min age - over 70 yaers 4) MI iwthin past 6th months |
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What do you do if a patient develops white toe after surgery. What kind of vascular problem causes this?
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-place foot in dependent position -- loosen bandages -- twist he k-wire -- apply heat to small of back -- PT block -- remove the k-wire -- remove dressing, consider opening wound
caused by arterial problem |
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What do you do i post-op patient develops Blue toe. What kind of vascular problem cause this
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elevate foot -- loosen bandage -- twist k-wire -- remove dressing -- consider opening wound
cause by venous problem. |
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post-op pain unresponsive to narcotic analgesi usually indicates what?
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infection , hematoma, or dressing pressure
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What are the 5 W's of post op fever
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Wind - Atelectais, aspiratoin pneumonai, PE
Wound - infection , throbmphelbitis (IV site) , pain Water - UTI, dehydration, constipation Walking - DVT Wonder drugs - any drug can casue fever |
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How can you treate a hematoma?
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EARLY: extravasaion - pop a stitch or twon adn squeeze out the fluid
aspiration - aspriate the hematoma using a large bore needle (20 guage) steroidinjection woudn re-entry - remove in OR LATE - gentle heatoe or physical therapy |
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What does renopathy of the optic fundi indicate
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severe hypertension
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What important periperative effects do steroids have?
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suppression of the hypothalamsus/pituitary adrenal axis
poor wound healing predisposition to infection |
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How long should asthma medicines be continued prior to surgery
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up to 1.5 hours before surgery
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What should yo do for the alcoholic patient befor surgery
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The alcoholic pt. should have 3-4 days of rehydration, vitamins, proper diet and no alchohol prior to surgery
serum slbumin should be < 2.3 gm/dl; total lymphocytes should be <900 |
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What pathway does heparin inhibit
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intrinsic clotting pathway
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Waht pathway does coumadin inhibit
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extrinsic clotting pathway
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what are some drugs that alter platelet function
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aspiroin, NSAIDS, steroids, antihistamines, high doses of iv penicilllin (especially carbenicillin), heparin
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What are the signs of von willebrand's disease andhow do you treat it
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abnormal factor VIII, prolong PTT & bleeding tiem, treat wit hfresh frozen pasma
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What pathway does vitamin K defiency affect?
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both intrinsic and extrinsic clotting pathways
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What kind of patient do you need to order cervical spin x-rays for before surgery (aside from trauma of course)
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patients with rheumatoid arthritis
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How does does penicillamine effect wound healing and who might be on it
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penicillamine can slow wound healing and RA patient might be taking it
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What factors give the most post-op cardiac complications are
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S3 gallop with jugular vein distention -- MI within 6 months -- Rhythm other than sinus on pre-op ECG -- greatger than 70 years old -- premature atrial contractions -- significant aortic stenosis
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How long should elective surgeryn be postpone post MI
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6 monts
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What are the major post-op complications for the pulmonary disease patient
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atelectasis
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What can you do to prevent atelectasis
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use incentive spiromety pre and post op
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How long do you need to D/C smokikng prior ot surgery in a pulmonary disease pt.
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1 week
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What patients should you administer heparin 5,000u subQ as prohylaxis for venous thromboembolic diseae
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idiopathic thromophlebitis, CHF, Other diseases where venous Stasis may occur
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