Vascular Wound OBJ 9-16

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Vascular Wound OBJ 9-16
2012-04-08 22:36:19
Vascular Wound

vascular/wound obj 9-16
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  1. Obj 9
    Explain why a pressure ulcer may not become visible until days after the insult occurred.
    PU often present like triangular "iceberg" with tip at surface, so may increase in diameter as it's treated. A wound goal for "decreased diameter" may not be appropriate because the wound may get larger at first.
  2. Obj 9
    Liability issues may arise with pressure ulcers, especially if patient is transferred to diff. facility, so thorough examination and photographic documenation needed. Existing lesions document as _____ ______ ______ and documentation of an early stage ulcer could state:
    • 1. Present on Admission
    • 2. expect widening of wound as its concealed breadth becomes exposed
  3. Obj 9
    T or F: New Medicare regulations state that if a PU is not Present on Admission that it will not be reimbursed.
  4. Obj 10
    In healthy wound env, epithelial cells walk their way across highly vascular granulation tissue. Cells continue moving until they touch another epithelial cell (at center of wound), which signals them to stop. This is known as ______ __________
    Contact Inhibition
  5. Obj 10
    _____ _______ ______: when wound does not have hospitable env (chronic slough, eschar and litte vascular granulation tissue) epithelial cells can build up at the perimeter of the wound and prematurely contact each other causing contact inhibition, so they don't migrate to the center of the wound.
    Rolled Wound Margin
  6. Obj 10
    What is diapedesis?
    epithelial cells "walking" across highly vascularized granulation tissue to center of wound
  7. Obj 10
    If you witness a rolled wound margin developing, what do you do?
    Use sterile gloved finger to lightly rub perimeter of wound, which disrupts collagen formation and premature epithelialization.
  8. Obj 11
    7 factors complicating wound repair:
    • 1. unrelieved pressure, friction or shear
    • 2. infection: WBC count > 10,000 indicates systemic infection
    • 3. Corticosteroid use (inhaled corticosteroid not as bad as oral use)
    • 4. Immunosuppresants
    • 5. Anticoagulants
    • 6. Topical cytotoxins
    • 7. Incontinence: moisture can macerate periwound and excrement can contaminate wound
  9. Obj 11
    Factors aiding wound healing
    • 1 maintenance of moist wound env
    • 2 adequate nutritional intake of:
    • - Protein: depends on size of wound, bigger needs more
    • - Vit A: 25,000 micrograms
    • - Vit C: 500 mg
    • - Zinc: 50 mg
  10. Obj 11
    Role of Nutrients
    Iron, B12, folic acid: ________
    Vit C & Zinc: __________
    Vit A: ____________
    Arganine (amino acid): ___________
    • 1 RBC function
    • 2 Tissue Repair
    • 3 Collagen cross linkage
    • 4 immune function
  11. Obj 12
    Sharp Debridement Precautions and Contraindications
    • 1Precautions: insensate foot and/or arterial insufficiency
    • 2Contraindications:
    • - bleeding disorder
    • - if taking anticoagulant
    • - do not sharp debride heel ulcers
    • - dry gangrene forms self-dressing, leave it alone and it falls or sloughs off
  12. Obj 12
    ______ debridement: most appropriate for initial cleansing of heavy debris and foreign material from a wound and also to moisten and remove nectrotic tissue. Use with precaution for venous stasis ulcers.
    Use _______ temp for arterial insufficiency ulcers.
    Use _______ temp for neuropathic ulcers.
    Never point jets at wound.
    • Whirpool
    • cooler
    • cooler
  13. Obj 12
    _________________: sterile, one patient use, disposable, portable - can be done at bedside. More expensive. Different nozzles allow more selective directing of spray. 4-15 cc is pressure range, adjusted for pain/tolerance. ________ protects therapist from stray spraying. Also, patient should be provided with _______ due to aerosolization.
    • Pulsed Lavage with suctions "pulsevac"
    • Universal Precautions
    • mask/shield
  14. Obj 12
    ____________: a transparent film barrier is used that is semi-permeable to gas exchange, but is impermiable to water. Body's own lysozomes trapped under barrier and digest nonviable tissue. Left in places for several days and commonly malodorous when removed. Don't use on _______ wounds.
    • Autolytic
    • infected
  15. Obj 12
    __________ debridement: requires prescription. Selective to nonviable tissue. If eschar is not debriding, crosshatch eschar and pull in edges to allow _____ to penetrate eschar. Certain metals can inactivate and interfere with this type of debridemeent.
    • Enzymatic
    • enzymes
  16. Obj 12
    ______ agents: (nonselective) as additives to whirlpool they kill microbes but also kill viable tissue. Use with caution and not long term
  17. Obj 12
    _______ to ________ ___________: (nonselective) If granulation tissue is present, it will be disrupted. Avoid if <70% necrotic coverage
    Wet to dry dressing
  18. Obj 12
    NPAUP position statement:
    do not debride heel ulcer (if unifected)
  19. Obj 12
    Should gangrene be debrided?
    • No to both.
    • Wet: smells terrible, is life threatening, andrequires surgery
    • Dry: not life threatening, forms own bio-occlusive dressing which falls off on it's own
  20. Obj 12
    Lots of stuff in Myers book
    Who knows if it's important......
  21. Obj 13
    Lots of stuff in Myers book
    I mean it's only a recommended book so....
  22. Obj 13
    Action/Effect of various dressings
    1 add moisture to dry wound bed:
    2 hold in existing moisture:
    3 absorb excessive moisture:
    4 promote autolysis:
    5 promote healing:
    • 1 hydrocolloid wafers, hydrogel
    • 2 semipermeable transparent films, impregnated gauze
    • 3 alginate ropes and pads
    • 4 semipermeable transparent films, hyrdocolloids
    • 5 biological dressings, silver-based ointment and dressings
  23. Obj 14
    What is the APTA's position regarding who should perform sharp debridement?
    Not within scope of PTA practice, exclusive to PT
  24. Obj 15
    I'd just recommend looking at it overall (but lots of info that might not be important). Clean vs sterile technique seems the most important
  25. Obj 16
    I'd take a look at this one too, book and appendix references
  26. Obj 16
    _______ bandage: provides inelastic compression
    non stretch
  27. Obj 16
    ________ bandage: stiffer than traditional elastic bandage
    High or Low resting pressure?
    High or low working pressure?
    • short stretch
    • Low resting - don't exert much compression on resting body part
    • High working - provides significant resistance when muscle flexes or body part moves
  28. Obj 16
    _____________ bandage:
    High resting pressure and low working pressure
    Long stretch
  29. Obj 16
    _______-_________ combinations: long stretch plus short stretch, good evidence fro efficacy with chronic venous insufficiency ulcers
    Four Layer
  30. Obj 16
    _______ ___________ long stretch bandages:
    therapist applies stretch tension until little printed rectangles turn into squares, which yields a specific pressure
    controlled tension
  31. Obj 16
    increased or decreased water in interstitial space?
    improves or worsens with elevation?
    usually symmetrical or asymmetrical?
    usually bilateral or unilateral?
    local, systemic, or both?
    mechanical or dynamic insufficiency of lymph system?
    pitting always present or in certain stages?
    negative or positive Stemmer's sign?
    When is compression garment worn?
    • 1 increased
    • 2 improves
    • 3 symmetrical
    • 4 bilateral
    • 5 both
    • 6 dynamic insufficiency
    • 7 pitting always present
    • 8 negative
    • 9 only worn during waking hours
  32. Obj 16
    increased or decreased water and protein in interstitial space?
    improves or worsens with elevation?
    usually symmetrical or asymmetrical?
    usually bilateral or unilateral?
    local, systemic, or both?
    mechanical or dynamic insufficiency of lymph system?
    pitting always present or in certain stages?
    negative or positive Stemmer's sign?
    When is compression garment worn?
    • 1 increased water and protein
    • 2 initally, may improve, but with chronic no improvement
    • 3 asymmetrical
    • 4 usually unilateral
    • 5 alwals local
    • 6 mechanical
    • 7 pitting in stages I and II
    • 8 positive
    • 9 recommended 23 hrs/day
  33. Obj 16
    Extra stuff about edema and lymphedema:
    Which responds more quickly to compression therapy?
    For which is intermittent compression a controversial treatment?
    Which is usually not associated with wounds?
    • 1 edema responds in a matter of hours, lymphedema can take weeks or months
    • 2 lymphedema. if it's used never >40mm
    • 3 lymphedema