Self Care - Burns, Sunburns, Wounds, Fungal, & Warts Study **HIGHLIGHTED Questions**

What are the 3 phases of wound healing?

1. inflammatory

2. proliferative

3. maturation or remodeling

What is the inflammatory phase of wound healing?

wound is prepared for subsequent tissue development and has 2 primary processes

How long does the inflammatory phase last?

3-4 days

What are the 2 primary processes of inflammatory phase?

1. hemostasis (clot formation)

2. inflammation (debris and bacteria are removed and collagen is formed to stimulate wound healing)

What is the duration of proliferative phase of wound healing?

starts on day 3-4 and continues for approximately 3 weeks

What is the proliferative phase of wound healing?

formation of granulation tissues and consists of new connective tissue, capillaries, and inflammatory cells

What is the duration of maturation or remodeling phase of wound healing?

lasts 60 days after occurrence of injury (longest phase)

What is the maturation or remodeling phase of wound healing?

wound is completely closed by connective tissue and resurfaced by epithelial cells

True or False: weak collagen is replaced by high tensile strength collagen during the maturation or remodeling phase of wound healing

True

What are the classifications of healing rates?

acute vs chronic

What is acute rate of healing?

wounds tend to heal within 1 month in healthy adults

What is chronic rate of healing?

any wound that does not heal properly through the normal stages of repair and shows no progress towards healing in 30 days (requires referral)

example: pressure ulcers, diabetic foot ulcers

What are the classifications of depth?

1. superficial skin injuries

2. superficial partial-thickness skin injuries

3. deep partial-thickness skin injuries

4. full thickness skin injuries

What are superficial skin injuries?

involves only the epidermis with no loss of any skin layers

What are superficial burns characterized by?

red skin, dry, unbroken, non blistering, blanches when pressure is applied to the skin, and painful to the touch

What can most superficial injuries be managed by?

self care or ambulatory care and should heal without scarring in 3-6 days

What are superficial partial-thickness skin injuries?

involve all of the epidermis and the superficial or papillary dermis

How long do superficial partial thickness skin injuries last?

healing usually occurs with minimal scarring in 7-20 days

How can minor superficial and superficial partial thickness skin wounds be managed?

self care as long as the TBSA affected by burns is less than 10% (adults) or 5% (children/elderly)

What are deep partial thickness skin injuries?

extend deeper into the dermis, called the reticular dermis

What is the duration of deep partial thickness skin injuries?

healing occurs in more than 3 weeks + there is scarring

True or False: patients with deep partial thickness burns should be evaluated in a hospital ED

True

What are full thickness skin injuries?

extends through the epidermis and dermis and may extend beyond the skin into the subQ fat, tendon, muscle, or bone

Should patients with full thickness skin injuries treat with self care?

No! they should seek immediate emergency care

What are counseling points on cooling and cleansing?

What was the old treatment recommendations for wound dressings?

Historically, wound management involved leaving a wound open to air or covering it with non occlusive dressing, but this can lead to scab formation/tissue and dehydration can delay healing/increase risk of bacterial entry

What is the current treatment recommendations for wound dressings?

Currently, recommendations are based on creating a moist environment to stimulate cell proliferation and encourage cells to migrate to heal the wound

What are the pros of gauze dressings?

Readily available in many sizes,

Cost effective,

Highly absorbent for wounds with exudate,

Nonocclusive,

Conformable

What are the pros of nonadherent gauze?

Readily available,

Less adherent than plain gauze

What are the pros adhesive bandages?

Readily available in a variety of shapes and sizes,

Cost effective,

Less adherent than plain gauze,

Special characteristics available (i.e., clear bandages for discreet wound healing, waterproof adhesion, antibacterial fabric, cushioned fabric, and highly durable adhesion)

What are the pros of hydrocolloids?

Moist healing environment,

Manages exudate by particle swelling,

Long wear time,

Self-adherent,

Occlusive,

Impermeable to fluids/bacteria,

Protective,

Conformable,

Thermal insulation,

Reduce pain

What are the pros transparent adhesive films?

Moist healing environment,

Self-adherent,

Semi occlusive,

Gas permeable,

easy inspection of wound under dressing,

Impermeable to fluids/bacteria,

Protective,

Conformable,

Reduce pain

What are the cons of gauze dressings?

Moist healing environment is not provided unless used with another product (i.e., skin protectant),

Debridement is nonselective,

Removal can cause bleeding/pain,

Secondary dressing (i.e., surgery tape, self-adherent wrap) is required to stick to skin,

Frequent dressing changes required

What are the cons of nonadherent gauze?

Moist healing environment is not provided usually,

Removal can cause bleeding/pain,

Secondary dressing (i.e., surgery tape, self-adherent wrap) is required to stick to skin,

Frequent dressing changes required

What are the cons of adhesive bandages?

Moist healing environment is not provided usually,

Removal can cause bleeding/pain,

Frequent dressing changes required

What are the cons of hydrocolloids?

Dressing is only used for uninfected wounds,

Periwound trauma may occur on removal,

Dressings make assessment of wound difficult,

Impermeable to gasses,

May leave residue on skin or in wound,

Dressings are less cost effective

What are cons of transparent adhesive films?

Dressing is only used for uninfected wounds,

Not absorptive,

Periwound trauma may occur on removal,

Continuous adhesions can reinjure wound upon removal,

Maceration may occur with large amounts of exudate,

Dressings are less cost effective

What is the gold standard for scarring?

silicone therapy

What formulations are available for silicone therapy?

sheets and gels

What is the purpose of silicone therapy?

Should be used in minor burns/wounds only after injury has fully healed,

Prevents scars and improves appearance of existing scars through occlusion and hydration of scar tissue,

May relieve itching and discomfort that often accompany scar formation

What systemic analgesics are available for minor burns, sunburns, or wounds?

NSAIDS: aspirin, naproxen, ibuprofen

or APAP

What skin protectants are available for minor burns, sunburns, or wounds?

Aquaphor healing ointment,

or other emollients and moisturizers

What first aid antibiotics are available for minor burns, sunburns, or wounds?

Neosporin: bacitracin + neomycin + polymyxin B sulfate

Polysporin: bacitracin + polymyxin B sulfate

What topical anesthetics are available for minor burns, sunburns, or wounds?

Dermoplast First Aid Spray: benzocaine,

Alocane Severe Sunburn Gel: lidocaine,

Pramoxine (often added to antibiotics)

What first-aid antiseptics are available for minor burns, sunburns, or wounds?

Hibiclens: chlorhexidine,

Hydrogen Peroxide,

Betadine Antiseptic Soln: providone-iodine soln

What complimentary therapies are available for minor burns, sunburns, or wounds?

Aloe Vera,

Honey,

Calendula,

Officinalis

How to systemic analgesics work?

prostaglandin inhibitors decrease erythema and speeds healing time of sunburn

What dose of ibuprofen is used for minor burns, sunburns, or wounds?

200-400 mg q4-6h (max 1200 mg)

What dose of naproxen is used for minor burns, sunburns, or wounds?

220 mg q8-12h (max 660 mg)

What dose of APAP is used for minor burns, sunburns, or wounds?

325-650 mg q4-6h (max 300 mg)

How often should we apply skin protectants?

2-3x per day

Are skin protectants fragrance and allergen free?

Yes

How do skin protectants work?

protects area from irritation and prevents drying of stratum corneum

How do first-aid antibiotics work?

prevents infection

How does bacitracin work?

inhibits cell wall synthesis in gram +

How does neomycin work?

inhibits protein synthesis in gram - and staph

What are counseling points of first-aid antibiotics?

apply 1-3x per day, apply post cleaning, and apply pre dressing

Which first-aid antibiotics have higher incidence of ACD?

neomycin

How do topical anesthetics work?

temporary relief of pain and itching,

interrupts transmission of electrical impulses along nerves by inactivation of Na channels in sensory neurons

What is a possible side effect of benzocaine?

when systemic, methemoglobinemia

How to first-air antiseptics work?

Destroys and inhibits microorganism growth in tissue,

Broader spectrum of antimicrobial activity,

More cytotoxic than antibiotics,

Exudate/serum/blood reduces efficacy of antiseptics

What are counseling points of first aid antiseptics?

Rinse area to be cleaned with water,

Apply minimum amount of product needed to cover skin,

Wash gently,

Rinse again thoroughly

True or False: there is no evidence supporting aloe vera

True

How does honey work?

delivers moist environment, absorbs exudates, and inhibits bacterial proliferation

How does calendula work?

anti-nflammatory and antibacterial properties

How often do we apply aloe vera?

2-3 times

What are the goals of treatment for minor burns, sunburns, and wounds?

Relieve symptoms,

Promote healing by protecting the burn/wound from infection and further trauma,

Minimize scarring

What are exclusions of self care for minor burns, sunburns, and wounds?

cuts longer than 1/2 inch,

cut that bleeds after applying pressure for 10 minutes,

chemical, electrical, or inhalation burns,

wound secondary to animal/human bite,

deep partial thickness,

full thickness,

any injury that's suspected as non-accidental injury,

signs of infection,

circumferential burns,

patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality, such as diabetes,

wound containing foreign matter after irrigation,

chronic wound,

injury on face, hands, feet, major joints, genitals, or perineum,

burns larger than 3 inches,

skin injury that worsens or doesn't heal in 7 days