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lift skin on back of hand to check for hydration status
pre-albumin normal levels
- 20-40 mg/dl
- malnuturition if <15 mg/dl
- 3.5-5.5 g/dl
- malnutrition if <3.5 mg/dl
- 18-20 day half life, so it's a better guage of long term nutrition than the pre-albumin with its 2 day half life
glucose fasting norms
- 70-115 mg/dl
- indicates short term management of diabetes
glycosylated hemoglobin norms
- indicates long term management of diabetes
capillary refill test -- looks for what? normal value?
normal refill is < 3 seconds
rubor of dependency test - how? norms?
- elevate LE for 1 min so sole goes pale
- lower it to neutral
- should get red in < 15 sec
- tests the arterial circulation
- tibial systolic divided by brachial systolic
- norm is 1.0
diameter of a worrisome melanoma
> 6 mm (pencil eraser)
side effect of antimicrobial agents (povidone-iodine, bleach, Dakin's, etc)
- they can retard healing
- so, shouldn't be used unless the antimicrobial effect is really desireable
gauze is contraind when?
over granulation tissue unless there's an intermediate nonadherent dressing
occlusive dressings are contraindicated when?
- infected wounds
- deep ischemic ulcers
- full thickness burns
- stage IV ulcers
- heavy exudate
alginates - work how?
derived from seaweed, they react with exudate to form a gel over the wound
when not to use alginates?
dry or lightly exudating wounds (bc alg can dry out the wound bed)
films for wounds
- adhesive clear membrane
- permeable to O2 and moisture vapor
- impermeable to H20, bacteria, contaminants
cons of films
- difficult application
- not for use on wounds with fragile surrounding skin or infected wounds
foams work how?
- cushion and protect wound
- hydrophilic (absorb moisture) on wound side, and hydrophobic on other side
hydrocolloid works how?
- adhesive wafers that form gelatinous mass when they interact with wound
- occlusive or semi-occlusive
- absorbs min to mod exudate
- protects partial thickness wounds
- for partial or full thickness wounds with necrosis
- conforms to wound shape to rehydrate wound
- can be used with infection
- absorb minimal amounts of exudate, letting some pass thru to a secondary dressing
- impregnated w solution to promote granulation or inhibit bacterial formation
- nonstretchable dressing impregnated with ointments
- ex: Unna boot
- used for venous insufficiency ulcers
dressings that promote autolytic debridement
- occlusive dressings
- continuous moist gauze
US setting to promote wound healing
low intensity, pulsed, 3x/week
e-stim for wound healing -- wha tkind of current?
high volt pulsed current
in e-stim the anode (positive pole) promotes what?
epithelial cell migration and reactivation of the inflammatory phase
in e-stim the cathode (negative pole) promotes what?
- control inflammation
- inhibit certain bacteria
vacuum assisted closing is indicated when?
- wound isn't closing
- lack of arterial perfusion
- excessive exudate that can't be controlled with dressing
applied continuously, can be applied if there's an infection
cells common in inflam phase of dermal wound healing
neutrophils and macrophages
predominant cells in granulation formation/proliferation aka fibroblastic phase
- epithelial cells
fibroblasts synthesize what?
collagen, GAGs (glycosaminoglycans) and elastin
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