Concise Exam 3 Flashcards

What pH is desirable for skin/wounds?

Acidic

How often should wounds be checked by a PT?

Every day

What part of a gown is considered sterile?

Only the front of the gown down to the waist, and the arms.

When is it okay to use whirlpool therapy?

5-10 minutes to warm patient’s body to neutral temperature, burns/thermal injuries that need cleansing

What PSI range is acceptable for Pulsed Lavage?

4-15 PSI

What is the purpose of surfactant use in wound care?

To lower surface tension of the wound and allow for exudate to slide off the wound.

What is the appropriate cytotoxicity ratio for any given surfactant?

1:10

What kinds of wounds are surfactants best for?

Shallow, messy wounds.

What is the PSI limit for surfactant application?

<8

In what instance are surfactants contraindicated in wound care?

If the wound is clean and dry.

What is the most gentle debridement option a therapist can use that is mentioned in the notes?

Saline Bulb Rinse

What is the PSI limit for a Saline Bulb Rinse mentioned in the notes?

<4

What is generally considered the worst option for wound dressing according to the notes?

Wet-to-Dry Gauze

When would Wet-to-Dry Gauze possibly be used?

On an infected wound

What kind of wounds would indicate the use of forceful irrigation (Pulsed Lavage)?

Superficial wounds with non-attached debris.

When in Pulsed Lavage contrainidicated?

Contraindicated for a clean, non-infected wound

What circumstances would be present to contraindicate sharp debridement?

When there’s lots of viable tissue

What kind of wounds are best for chemical/enzymatic debridement?

Smaller chronic wounds with necrotic tissue.

What is the strongest contraindication/reason to not use chemical/enzymatic debridement?

Large wounds or wounds that require more rapid treatment, this takes forever to work

What kinds of wounds are best to use Maggot Debridement Therapy on?

Chronic wounds that aren’t closing, wounds with antibiotic resistant pathogens

What is autolytic debridement?

Self-produced enzymes removing necrotic tissue at a wound.

When is autolytic debridement indicated?

When a wound is NOT infected.

What kinds of wound characteristics would cause autolytic debridement to be contraindicated?

Presence of macerated peri-wound tissue

What is Povidone-Iodine best for in regards to wound care?

Wounds infected with Staph Aerus (still really shouldn’t ever be using this)

What is Sodium Hypochlorite used for in wound care?

Used on infected wounds

When is Sodium Hypochlorite use contraindicated?

In cases of non-infected wounds.

What is Dakin’s Solution made of?

Bleach and Boric Acid

What conditions would cause for the indication of using Dakin’s Solution?

Staph and Strep Infections

When is use of Dakin’s Solution contraindicated?

In the absence of infection

When is use of Acetic Acid indicated?

In wounds infected with pseudomonas and with biofilm

When is use of Acetic Acid contraindicated?

When infection is not present.

What situation would indicate the use of over the counter ointments/creams on a wound?

If infection is suspected, also good for staph and strep

What are the contraindications of using OTC ointments/creams

Non-infection, also increased risk of causing renal issues

What kind of wounds would cause for the indication of Growth Factor Solution use?

Chronic wounds

Why is Growth Factor Solution contraindicated in infected wounds?

Will increase infection rate.

What kind of wounds indicate use of Zinc in wound dressings?

Venous Ulcers

What is the main contraindication for use of zinc?

Infection presence

What kind of wounds is Silver Nitrate use best for, and why?

Good for burn wounds, helps to stop over granulation

When is Silver Nitrate contraindicated?

In healthy granulating wounds

What is Silvadene best for, what is its function?

Best for burn wounds, helps to soften eschar

What is the main drawback for Silvadene use on burn wounds?

Must be removed frequently

What is another patient factor that would contraindicate Silvadene use?

Sulfa Allergy

What conditions would cause for Silvadene to be contraindicated?

Clean, Granulating Wound

What kinds of wounds would indicate use of Medical Grade Honey?

Inflamed wounds with foul odor, or wounds with biofilm.

When would Medical Honey be contraindicated?

Patients with pollen allergy, or patient wound’s with poor granulation tissue presence

What is Kerlix?

Non-stretch Gauze

What is Conform?

Gauze that can contour to surfaces (good for head wounds)

What are 4×4’s?

Square gauze pads that are commonly used to dry peri wound tissue and wiping off tools during debridement

What are the advantages of Gauze use?

View wound frequently, very absorptive

What are the disadvantages of Gauze use?

Permeable to air/bacteria (don’t use if wound isn’t infected), leaves fibers behind in the wound, more expensive than just using another dressing.

What is Telfa?

Non-adherent dressing for lightly draining wounds

What is Adaptic?

Gauze that is impregnated with Vaseline

What is required for Adaptic to remain adhered to a wound?

A secondary dressing

What are Adaptic/Telfa best used for in wound care?

Supplying moisture to dry wounds, wounds that are almost closed.

What is the largest disadvantage of Adaptic/Telfa use?

They are permeable to bacteria, meaning a wound can become infected with these on

What are Calcium Alginates?

Seaweed Derived Wound Dressings

What are the main advantages of Calcium Alginates?

Highly absorbent, easy to remove as they hold their shape

What are the disadvantages of Caclium Alginates?

Require secondary dressings, cannot be used on dry wounds

What are film dressings?

Transparent Membranes placed on a wound to protect intact skin

How long can a film dressing be left on a patient’s wound?

3-5-7 days

What is the main advantage of using a film dressing?

Works as both primary or secondary dressing

What are the disadvantages of film dressings?

Not absorptive, bad on messy wounds, tearing skin on older patients

What are the advantages of foam dressings?

Highly absorbent, controls biofilm, can be used as primary/secondary dressing, can be used on infected wounds

When are foam dressing contraindicated?

For dry wounds

What is a hydrogel dressing best for in wound care?

Autolytic Debridement, Adding Moisture

What wound type is best served by a hydrogel dressing?

Arterial Wounds

What are the disadvantages of hydrogel dressings?

Require second dressing if any exudate is present, cannot be used in the presence of infection, and heightened risk of macerating peri-wound tissue

What happens to hydrocolloids after absorb fluid from a wound?

They turn brown

When would a hydrocolloid be indicated in wound care?

For infected wounds, and to be used alongside maggot debridement therapy

What are the disadvantages of hydrocolloids?

May cause maceration of peri-wound tissues, and patients/family may dislike the color change and will require education

What are hydrofiber dressings?

Similar to Calcium Alginates, they are a spun fiber that absorbs moisture well.

What are the advantages of Hydrofiber dressings?

They are highly absorbent, maintain their shape (just like alginates), and are less expensive than calcium alginate dressings.

When would the use of a hydrofiber be contraindicated?

For dry wounds

What is an Unna’s Boot?

A compression dressing made up of zinc impregnated gauze that is then pressure wrapped.

What are the advantages of an Unna’s Boot?

Absorbs drainage, manages edema via compression

What wound type would cause for use of an Unna’s Boot to be indicated?

Venous Ulcers/Wounds

What are the disadvantages of an Unna’s Boot?

The wound cannot be seen regularly as this is left on, cannot be used in the presence of infection

What is amorphous gel?

Water-based gel used as a primary dressing for small wounds

What is the primary use of amorphous gel application?

Promotion of autolytic debridement

What wound type would cause for amorphous gel application to be indicated?

Arterial Wounds

What wound type would cause for bioengineered tissue to be considered beneficial for application?

Venous Leg Ulcers

How long must conventional wound care be undertaken in order for Medicare to reimburse for application of bioengineered tissue in wound care?

30 Days

What should be checked regarding a patient before bioengineered tissue is applied?

Porcine Skin Sensitivity

What pre-existing condition must be met for ionic silver to be applied to a wound.

The wound must be moist.

What two other dressing types are considered complimentary to ionic silver?

Calcium Alginates and Hydrofibers

What wound types are best suited for use of ionic silver?

Partial thickness burns, infections, skin grafts, and venous or diabetic ulcers.

What are marine collagen peptides? What is their benefit to wound care?

Fish components. They jumpstart keratinocyte production, best used for burn wounds.

What are the three most critical points of pressure relief from a PT’s perspective?

Reduction of sheer forces, lowering the head of a patient’s bed, and maintaining an aggressive 45 minute turning schedule

What is considered the worst option out of all potential Pressure Relief Devices?

Foam

Why are water beds not considered suitable for pressure relief?

They are not user friendly, and are really only useful in patients who are already at minimal risk for pressure injury.

What are the disadvantages of gel pad use for pressure relief?

They’re heavy and expensive. Not ideal for older patients as they will struggle to move them.

What risk category indicates gel pad use as an appropriate intervention for pressure relief?

Moderate to Maximal Risk

What is the main disadvantage of a Static Air PRD?

It is not user friendly

What risk category would indicate that Static Air PRD use is appropriate for pressure relief?

Minimal Risk

What is considered the best option out of all Pressure Relief Devices?

Dynamic Air PRD

What risk category would indicate that Dynamic Air PRD use is appropriate for pressure relief?

Moderate to Maximal Risk

What is a Low Air Loss PRD?

PRD similar to Dynamic Air, but better for larger patients.

What assistive device must be used by a patient if they are to be prescribed a Low Air Loss PRD?

Hoyer Lift

What is the timeframe in which it is considered okay for a patient to use a Low Air Loss PRD, but not beyond it?

2 to 8 weeks

What use does ultrasound have in wound care?

Jumpstarts a sluggish wound, fibroblasts secrete collagen, elastin strengthens scar tissue