Integ Exam 2

These factors make someone more at risk of infection

smoking, poor nutrition, lack of sleep, diabetes

Contamination

bacteria on wound, no bacteria multiplication

All wounds are

contaminated

Colonization

bacteria multiplies with no immune response

Critical Colonization

healing is delayed or stopped due to proliferating bacteria

Infection

multiplication of bacteria resulting in pathophysiologic effects, presence of puss

Signs of critical colonization

discoloration, odor, slough, delayed healing

Signs of acute infection

pain, edema, heat, purulent drainage, erythema

Biofilm occurs during

critical colonization

Biofilm prolongs

healing

Best way to treat biofilm

daily application of antiseptic solution

For a wound to be considered a surgical infection it has to occur within _ days of surgery

30

Wound cultures are recommended for all

diabetic foot infections

Dakin’s, acetic acid, betadine, and hydrogen peroxide

cytotoxic, harmful to healthy tissue too

Non-toxic cleaning solutions

saline, wound cleanser

Topical route of administration

local effects on outer layers of skin

Antimicrobial

agent that inhibits/kills microorganisms

3 classes of antimicrobials

antiseptic, antibacterial, antifungal

Antiseptic

prevents growth of microorganisms

Antibacterial

destroys bacterial growth

Healthcare related MRSA usually from

blood stream infection

Community related MRSA usually from

skin infection

MRSA will appear as

pimples, boils

VRSA

resistant to vancomycin, usually in intestines and female genitals

Acinetobacter infections caused by

feces

Cellulitis

hot, red, swollen, painful LE

Early signs of necrotizing fasciitis

red, swollen, extremely painful cellulitis, fever

A CT scan would show what in someone with necrotizing fasciitis

air pockets

Fungal infections best to treat with _ instead of creams

powder

Where should trash be placed if someone is on contact precautions or above

red bag trash

Selective debridement examples

sharp/surgical

enzymatic

autolytic

Nonselective debridement examples

mechanical

wound irrigation

hydrotherapy

When INR does not allow for sharp debridement, use this

enzymatic debridement

This type of debridement is naturally done by the body

autolytic

Whirlpool is contraindicated for _ wounds

granulating

A PT can debride in a *_ but not a _*

hospital, SNF

Do not debride these wounds

stable eschar on heel

dry gangrene

necrotic arterial wounds

Fastest debridement

sharp

Slowest debridement

autolytic

Ray amputation removes

toe and corresponding metatarsal

Transmetatarsal amputation removes

forefoot

Symes amputation removes

foot from ankle

Which amputation has best recovery rate?

hip disarticulation

AKA

BKA

BKA

Examples of enzymatic debridement

santyl, medihoney

Fistula

Non-surgical opening between 2 epithelial surfaces

clear or white output signifies this type of fistula

esophageal

green output signifies this type of fistula

gastric

brown/tan output signifies this type of fistula

small bowel

Evisceration

internal organ protrudes from wound

Split thickness graft

epidermis and part of dermis

Full thickness graft

epidermis and entire dermis, better cosmesis

Most common skin graft donor site

lateral thigh

Hypolibadermas appear as

tree bark skin

Risk factors of venous insufficiency

thrombosis in deep veins, postphlebitic syndrome, obesity, incompetent valves, pregnancy, varicose veins, muscle weakness, congestive heart failure

Characteristics of venous insufficiency

partial thickness

irregular margins

painless

medial malleoli

hemosiderin staining

drainage

edema

Good way to examine venous insufficiency

ankle brachial index

1+ on pitting edema scale

slight pitting, no distortion, goes away rapidly

2+ on pitting edema scale

deeper than slight, goes away in 10-15 seconds

3+ on pitting edema scale

noticeably deep, lasts > 1 min

4+ on pitting edema scale

very deep, lasts 2-5 mins, distorted

Best treatment for venous ulcer

compression, walking program

If a venous ulcer is < 50% healed at 12 weeks prognosis is

poor

Venous ulcer should heal _ cm per week

0\.1

Shape of venous ulcer is often

upside down bottle

Should whirlpool be used for venous ulcer?

no

Contraindications for compression

ABI < 0.7

thrombus

infection

acute congestive heart failure

Compression should go up to the

tibial tuberosity

Which arteries are most often involved in arterial ulcers?

posterior tibialis

anterior tibilalis

dorsalis pedis

Adventita

outer layer of artery

Media

middel layer of artery, elastic

Intima

inner layer of artery

What tests to look at to assess blood flow

angiogram/arteriogram

Arterial ulcer characteristics

round margins

pale

extreme pain

no drainage

gangrene

full thickness

poor pulse

hair loss

cold

lateral malleolus

dorsal surface of foot

Which type of ulcer requires depth measurement? Venous or Arterial

Arterial

_ gangrene will fall off on its own

dry

_ gangrene often requires amputation

wet

1 cigarette decreases circulation by _% for 1 hour

30

ABI 0.9 - 1

normal

ABI 0.75 - 0.9

moderate

ABI 0.5 - 0.75

severe

ABI < 0.5

pain at rest, need surgery

ABI of a diabetic is

unreliable

Normal capillary refill time

< 3 seconds

Normal venous fill time

< 15 seconds

Wound on plantar surface of foot most likely a

diabetic wound

Most common area to be affected by a diabetic wound

big toe

Wagner grade 0

skin intact, epidermis involvement

Wagner grade 1

partial thickness ulcer, dermis involvement

Wagner grade 2

full thickness, subcutaneous involvement

Wagner grade 3

infection of diabetic ulcer

Wagner grade 4

gangrene of forefoot (diabetic ulcer)

Wagner grade 5

gangrene of majority of foot

Charcot foot presentation

lose arch

Signs of osteomyelitis

ulcer > 1 month

can touch bone

recurrent ulcer in same location

won’t heal / getting worse despite treatment

Can get a false positive for osteomyelitis if _ was used

santyl

PT cannot make a _ goal for diabetic patients

blood sugar

use _g monofilament to assess protective sensation

10

Do not debride gangrene or use the whirlpool for

diabetic ulcers

Diabetics should wear _ socks

white

Best treatment for charcot foot

total contact casting