PTH 121: Intro to Wound Care

What does our skin do? (Part 1)

Prevents dehydration

What does our skin do? (Part 2)

Synthesizes Vitamin D

What does our skin do? (Part 3)

Provides physical beauty

What does our skin do? (Part 4)

Protects our tissues

What does our skin do? (Part 5)

Regulates temperature

What does our skin do? (Part 6)

Excretes oil and sweat

What does our skin do? (Part 7)

Is a sensory organ

What are the phases of healing?

1\.) Hemostasis

2\.) Inflammatory

3\.) Proliferation

4\.) Maturation

How long does the normal healing take?

28 days

If a wound takes longer than 28 days to heal, what kind of wounds are they considered as…?

chronic and may require skilled physical therapy to heal

Why are older people more likely to develop a chronic wound? (part 1)

The skin is thinner and drier

Why are older people more likely to develop a chronic wound? (part 2)

The immune system is less robust

Why are older people more likely to develop a chronic wound? (part 3)

They are more likely to have comorbidities

Why are older people more likely to develop a chronic wound? (part 4)

They are more sedentary

What are fungating lesions?

a result of cancerous cells infiltrating epithelial tissue?

What are Fungating lesions also known as?

Ulcerative lesions

True or False: the skin is an organ that can fail at the end of life?

True

What are Kennedy Terminal Ulcers?

Ulcers that begin to develop as the skin fails

What must a physician do if a Kennedy Terminal Ulcer appear?

the Physician must document that they are Kennedy terminal ulcers (nobody’s fault)

What occurs when a Kennedy Terminal Ulcer appears?

Death usually occurs within a week

What does Debride mean?

to remove dead, foreign or infected tissue to improve the healing of the remaining tissue

What are some types of Debride?

can be surgical, mechanical, chemical, autolytic or by maggots

As PTA’s are we allow to use a scalpel, scissors or tweezers to cut away nonviable tissue?

No, not according to the APTA (not legally binding)

What does the American Medical Association (AMA) state about PTAs performing sharp debridement of wounds?

the AMA states that yes, if PTA possesses the skill and the supervising PT approves (not legally binding)

True or False: STATE LAW determines if a PTA can perform sharp debridement of wounds

True

What does the VA Practice Act state about PTAs performing Sharp Debridement of Wounds?

Nonspecific: PT can cause judgement to delegate

What does the MD Practice Act state about PTAs performing Sharp Debridement of Wounds?

Specific: PTAs cannot perform sharp debridement

What is Exudate?

the fluid that leaks out of the capillaries in the inflammatory phase

What occurs in acute wound exudate?

they contain factors that stimulate fibroblasts and endothelial cells

What occurs in chronic wound exudate?

it contains decrease growth factors, increase proteases that slow or block cell proliferation

What is a Dead Space?

an empty space in tissue that tends to fill in with fluid that can then become infected (an abscess)

What is periwound?

the intact skin surrounding the open wound

What causes wounds in health care settings? (part 1)

Pressure: skin is pressed between the patient’s bones and the bed or chair

What causes wounds in health care settings? (part 2)

Friction: skin is rubbed across a surface

What causes wounds in health care settings? (part 3)

Shear forces: friction and gravity act within the patient’s own tissues

What are common pressure points?

Ear & Occiput (back of head), cervical spine, scapula, elbow, sacrum/coccyx, iliac crest, trochanter (hip), malleolus (ankle), and heels

How does friction occur?

when two surfaces rub together

What are 2 common sites in where friction occurs?

elbow and heels

How does shearing occur and what happens in shearing?

shearing is caused by gravity and friction, it decreases or stops blood flow through the vessels

What is the difference between a wound from shearing as oppose to shearing?

shearing usually causes a more serious wound

What is a form of preventing shearing occurring? (part 1)

Suspend ('“Float”) the heels

What is a form of preventing shearing occurring? (part 2)

Turning the patient every 2 hours, while in bed

What is a form of preventing shearing occurring? (part 3)

Positing: use pillows between bony prominences; do 30-40 degree turns to keep patient off greater trochanter

What are some ways to reduce pressure while sitting? (part 1)

teach patients to shift weight often

What are some ways to reduce pressure while sitting? (part 2)

reposition every hour (document repositioning)

What are some important points about pressure injuries? (part 1)

can get worse (stage 1 can become stage 2)

What are some important points about pressure injuries? (part 2)

stages can’t become a less serious stage (a stage 2 doesn’t heal to a stage 1- it is said to be a “healed stage 2”)

What occurs in stage 1 of a pressure injury? (part 1)

non-blanching erythema of intact skin

What occurs in stage 1 of a pressure injury? (part 2)

when you press your finger over a reddened area for 15 seconds, then lift, it stays red

What occurs in stage 1 of a pressure injury? (part 3)

Redness in lightly pigmented skin

What occurs in stage 1 of a pressure injury? (part 4)

red, blue, or purple hue occurs in darker skin tones

What occurs in stage 2 of pressure injury?

partial-thickness skin loss of epidermis and/or dermis

What can a stage 2 pressure injury appear as?

abrasion, blister or shallow crater

What occurs in stage 3 of a pressure injury?

Full thickness (entire epidermis and dermis) skin loss involving damage or necrosis of subcutaneous tissue possibly extending to underlying fascia

How does a stage 3 pressure injury present as?

a deep crater

What occurs in a stage 4 of pressure injury?

Full thickness (entire epidermis and dermis) skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structure

When is a pressure injury consider as unstageable? (part 1)

when it is covered in eschar/necrotic tissue

When is a pressure injury consider as unstageable? (part 2)

when 60% of wound bed is not visible and depth of injury cannot be determined

What is Eschar?

Black or brown hard dead tissue

When is a suspected deep tissue injury?

Intact, non-blanchable dark red or purple tissue highly suspicious of deep tissue injury

How do you know if you have a suspected deep tissue injury?

it may feel boggy and cool or warm to touch

When does a venous insufficiency ulcer occur?

it occurs due to incompetent valves or venous calf pump (muscles)

How much is a venous insufficiency ulcer accounted for?

its accounted for 70-90% of all ulcers

True or False: a venous insufficiency ulcer is unable to effectively circulate venous blood from the legs to the heart?

True

What are some characteristics of venous insufficiency ulcers? (part 1)

Swelling that eventually alters skin integrity

What are some characteristics of venous insufficiency ulcers? (part 2)

Common areas include medial ankle

What are some characteristics of venous insufficiency ulcers? (part 3)

Heavy drainage

What are some characteristics of venous insufficiency ulcers? (part 4)

Shallow/superficial crater appearance

What are some characteristics of venous insufficiency ulcers? (part 5)

Little or no pain unless infected

True or False: Severe lymphedema isn’t a result in ulcers

False, severe lymphedema can result in ulcers

What are the causes of an arterial ulcer?

the result of an alteration of arterial blood circulation

What can occur in an arterial ulcer? (part 1)

decrease of O2 to the tissue resulting in tissue ischemia

What can occur in an arterial ulcer? (part 2)

decreased skin temperature

What can occur in an arterial ulcer? (part 3)

Shiny taut dry skin

What can occur in an arterial ulcer? (part 3)

hair loss

What needs to be reestablished in an arterial ulcer?

blood supply (vascular surgery)

What are common areas for an arterial ulcer?

toes, feet, and lateral ankle

What are some common characteristics of an arterial ulcer? (part 1)

punched out edges

What are some common characteristics of an arterial ulcer? (part 2)

pale/necrotic ulcer base

What are some common characteristics of an arterial ulcer? (part 3)

minimal drainage

What are some common characteristics of an arterial ulcer? (part 4)

frequently painful

What can contribute to Neuropathic ulcer? (part 1)

a patient has neuropath: unnoticed injury can lead to ulceratioin

What can contribute to Neuropathic ulcer? (part 2)

PVD (peripheral vascular disease) contributes to decreased healing and increased risk of infection

What is another name for neuropathic ulcers?

diabetic ulcers

Where are neuropathic ulcers usually located?

on the bottom of the feet

How do the edges of a neuropathic ulcer look like?

edges often have deep hard callous present

How do you classify a wound? (part 1)

Whether or not is it a pressure injury? If so, what kind?

How do you classify a wound? (part 2)

Is it a partial or full thickness wound?

What does a partial pressure injury include?

Moisture Associated Skin Damage (MASD)

What is Moisture Associated Skin Damage (MASD) caused by?

urine, feces, exudate, inflaming and eroding to the skin

What is maceration?

loss of periwound integrity due to moisture

What is denudement?

damage to epidermis due to moisture

What does a Non-pressure partial thickness wound involve?

the epidermis and/or dermis

What does a Non-pressure Full Thickness wound involve?

damage, extensive damage or necrosis of subcutaneous tissue, muscle, bone or supporting structures

Wounds are always measured in…?

centimeters

Wounds are always recorded as…?

(longest) Length x (greatest) Width x (greatest) Depth

How do you measure a wound?

measure opening of wound inside edge to inside edge (include shape if possible)

When measuring a wound, the head is always…?

at 12 o’clock

When measuring a wound, the feet is always…?

at 6 o’clock