Wound management

In order to properly assess a wound a ___ must be taken, a ___ exam must be done, and a full ___ is done when they are stable

history, physical, evaluation

History regarding a wound has ___, and ___ regarding the wound itself

general, specifics

The physical exams perform a physical exam to ___

stabilize

An abrasion is when the skin is ___ or ___

rubbed, scrapped

Avulsion is tearing from ___ also known as degloving, and may have a crush component affecting ___

attachments, capillaries

Incision is a type of wound that only occurs in surgery and it is a ___ cut with minimal ___

sharp, minimal

Laceration is ___ and the trauma is variable

tearing

Puncture is a sharp ___ of a tool, and it can be surface or deep

penetration

Contusion is a ___, and the skin is intact

bruise

There are four types of contamination: ___, ___-___, ___, ___

clean, clean-contaminated, contaminated, dirty

The clean catagory of contamincation is when is ___ created, and a lumen is entered ___

surgically, aseptically

The clean-contaminated is via surgery, but there is a minor break due entering a ___, and may have ___ causing minor contamination

lumen, trauma

Contaminated classification is when there is a major ___ or an entry into the ___, or a major ___ break

trauma, colon, asepsisS

Dirty contamination classification is when the perforation is ___, or ___ trauma wounds, or ___

visceral, old, purulent

Whaat factors are in wound management: ___, ___type, the degreee of ___, ___ material, and the ___ themself

time, wound, trauma, foreign, patient

A higher virulence means that less bacteria is needed to ___

infect

A lower resistance means that a lower number of baceteria is needed to ___

infect

A rapid slide technique is can be completed in an ___. A tissue biopsy is obtained, weighed in grams, the tissue is ___, dried and stained

hour, homogenized

When doing an aseptic technique standard attire is ___, ___, and ___ gloves

cap, mask, sterile

A bandage placed on a wound should be sterile and can be moistened ideally with ___, and should be anti___ to ensure nothing harmful in introduced

LRS, microbial

When removing hair for would cleaning first protect the wound using sterile ___ and ___, and ___ wide around the affected area

gauze, lube, clip

Some intrinsic foreign debris includes ___ and normal ___ flora not seen in the normal location

hair, bacterial

Exploration of wound to remove foreign debris may be painful so ___ and often used

analgesics

A manual removal of foreign material is done prior to ___

lavage

When lavaging a wound to clear foreign debris use a large amount, more the ___

better

WHen lavaging the psi should be _-__

7-8

Lavaging at 15 psi removes ___% of IPF

85

The fluid used for lavage can be ___ saline, ___, and ___ water as a last resort

0.9%, LRS, tap

Tap water is ___ and has trace ___ which is why its not preferred for lavage

hypotonic, elements

Saline is ___ and can also cause cell ___ which is why it’s not the best option for lavage

isotonic, damage

For lavage LRS is used as it is ___ and causes ___ damage

isotonic, less

Types of antiseptics added to water for lavage: ___, ___-___, ___-___

Chlorhexidine, povidone-iodine, tris-EDTA

When chlorhexidine is used for lavage the ratio is __ : __

1:40

The ratio of povidone-iodine when mixed for lavage is __:__

1:9

What antiseptic shouldn’t be added to a lavage

H2O2

The goal of debridement is to rid the wound of ___, ___, or ___ tissues, and keep ___ tissue

necrotic, foreign, purulent, healthy

There are two categories of methods: ___ and ___-___

selective, non-selective

The selective methods of debridement: ___, ___, ___

autolytic, enzymatic, biologic

The non-selective methods of debridement includes: ___, ___

surgical, mechanical

Autolytic debridement uses an ___ ___ and it maintains wound fluids and proteolytic enzymes

occlusive dressing

For autolytic occlusive dressing it needs to be changed every ___-___ hours.

48-72

The advantages for autolytic debridement: ___, and it is ___

selective, painless

The disadvantages for autolytic debridement is that it is ___, there can be ___, and the ___ of the process

slow, infection, cost

Using enzymatic debridement may damage ___ tissues, and ___-___ or ___ can used

normal, papain-urea, collagenase

The limitations of enzymatic debridement is that it is ___ and ___

slow, costly

Biotherapeutic debridement is more ___, and utilizes ___ ___ which eats necrotic debris.

selective, fly larva

The advantages to biotherapeutic debridement is that it is ___ and ___

painless, precise

The disadvantages to biotherapeutic debridement is ___, requires ___ changes, and the ___

slow, bandage, cost

Surgical debridement requires knowledge of ___ and ___

anatomy, recognition

Indications for surgical debridement: it is a ___ area, and the patient is ___ of the procedure

large, tolerant

Contraindication for surgical debridement ___ problems

coagulation

There are two methods for surgical debridement ___, and ___

enbloc, layered

Enbloc surgical debridement is removal of the ___ wound, and when there’s ample ___. The wound will be ___ immediately

complete, tissue, closed

Layered surgical debridement is ___ and can be done is any ___. This debridement happens in ___

progressice, location, staged

A ___ is the most efficient tool used for surgical debridement but ___ can also be used

scapel, scissors

Mechanical debridement is ___ meaning that analgesics need to be used

painful

Mechanical debridement can use ___ therapy, and adherent ___

hydrodynamic, bandages

dry to dry bandages are used when there is increased ___, and low ___ exudate

moisture, exudate

wet to dry bandages are used for increased amount of ___ tissue and higher ___ exudate

necrotic, viscosity

When applying a wet to dry bandage, the gauze should be ___ with LRS, or saline. All the ___ surface should be in contact with the gauze, and no contact with ___.

moisten, wound, skin

In a closed wound if there is potential space ___ may accumulate which is why drains are placed

space

Two types of drain types: ___ which uses gravity and ___ which uses negative pressure

passive, active

An indication for a passive drain is that the space is ___ to ___, and minimal amount of ___ is needed

small, moderate, drainage

Passive drainage occurs due to ___ action so no fenetrations in the tube is prefered, and it should have a sterile ___

capillary, covering

Indications for an active drain is ___ wounds and requiring ___ drainage

large, excess

There should be ___ pressure when placing an active drain, it should be air tight, and use a ___ device

negative, suction

The fluid from an active drain shoud be moved into a ___ chamber and ___ periodically

collection, emptied

A fabricated active drain is made with a ___ and ___

syringe, vacutainer

To promote a vascular bed, when caring for the wound ___ technique should be used, prevent further ___, remove ___ debris, sufficient ___, and eliminate ___ via drain

aseptic, comaination, foreign, debridement, space

Promote the vascular bed by protecting the wound by ___ it

bandaging

Primary closure is ___ and has ___ intention healing

immediate, first

Delayed primary healing occurs on a healthy bed of tissue ___ granulation tissue forms. This closure has ___ intention healing

before, first

Secondary closure is done on a healthy bed of tissue ___ granulation tissue, and this healing is ___ intention

over, third

When the wound is left open to heal it is ___ intention

second

Vacuum assisted closure is done on open wounds that are ___ or ___, and it utilizes ___ pressure

chronic, infected, negative

Using a vacuuum assisted closure allows for ___ edema, ___ bacteria, ___ blood flow, and ___ proliferation

decreased, decreased, increased, increased

Preventing hypothermia decreases ___ and maintain O2 levels, and decreases surgical ___

vasoconstiction, infection

Methods to prevent hypothermia: ___ controlled heating, forced ___ warmer, ___ circulation, body ___

sensor, air, water, wraps

In some cases ___ factor stimulation can be used like TGF-beta, PDHF, EGF, but it is ___

growth, expensive