Ulcers (4)
Arterial insuff., venous insuff., neuropathic, pressure
Arterial insufficiency ulcers
Inadequate circulation, avoid leg elevation, get rest, avoid heat/soaking in water
Venous insufficiency ulcers
Tissue damage, ulceration due to inadequate circulation
Venous insufficiency treatment
Compression/elevation to decrease edema, active ROM and exercise
Neuropathic ulcers
Neuropathic, diabetes
Neuropathic treatment
Inspect feet daily, limb protection
Pressure ulcers
Sustained pressure, muscle atrophy, excessive moisture
Pressure ulcer treatment
Reposition every 2 hrs, pressure relieving devices
Wound healing (3 types)
Primary, secondary, tertiary intentions
Primary intention healing (4 definitions)
Acute, minimal tissue loss, surgical means reapprox., minimal scarring
Secondary intention (4 definitions)
infection contamination, lots of tissue loss close on their own, scarring
Tertiary (basically...due to...)
Delayed primary intention, complications
Factors affecting wound healing (5...a,e,i,o,m)
Age, edema, infection, obesity, medications
Wound types (7)
Abrasion, avulsion. Incisional, laceration, penetrating, puncture, skin tear
Abrasion
Friction� scraping of derm/epiderm
Avulsion
Tension � detaches skin
Incisional
Surgery � scalpel, surgery
Lacerational
Trauma � irregular tear of tissues
Penetrating
Various � penetrates organ
Puncturing
Sharp object � risk of infection
Skin tear
Trauma � various damage
Wound assessment (4 types of levels)
Superficial, partial thickness, full thickness, subcutaneous
Superficial wound
Epidermis intact
Partial thickness
Epidermis and part of dermis
Full thickness
Skin depth into fat, heal by 2nd intention
Subcutaneous
Fat, mm, tendon, bone. Heal by 2nd intention
Ulcer stages (6)
Stage I, stage ii, stage iii, stage IV, suspected deep tissue, unstageable
Stage I
Intact skin, discoloration
Stage ii
Partial thickness, shallow and open
Stage iii
Full thickness, fat
Stage iv
Full thickness; mm, bone, tendon, fat
Suspected deep tissue
Intact skin, Maroon/ purple colored
Unstageable
Full thickness, ulcer base covered with slough
Exudate classification (5)
Serous, sanguineous, serosanguineous, seropurulent, purulent
Serous
Clear, watery, normal
Sanguineous
Red, watery, angiogenesis/ disrupted blood vessel
Serosanguineous
Pink, watery, normal
Serpurulent
Yellow, cloudy, possible infection
Purulent
Yellow/green, thick, infection
Wound treatment debridement (2)
Selective, non-selective
Selective (2)
Autolytic, enzymatic
Autolytic
Own body's enzymes, use of dressings, remove nonviable tissue, pain free
Enzymatic
Topical agent, infected/non-infected necrotic tissue
Non-selective debridement (3)
Wet to dry, wound irrigation, hydrotherapy
Wet t dry
Moistened gauze, remove when dry, may be painful
Wound irrigation
Pressurized stream of fluid, suction
Hydrotherapy
Whirlpool; consider: maceration, edema, hypotension
Modalities (2)
Negative pressure wound therapy, hyperbaric oxygen
Npwt
Wound vac, manage drainage, cannot be closed by primary intention
Contrast of npwt
Malignancy in wound, largely necrotic
Hyperbaric oxygen
Hyperoxygenates tissues, closed chamber, diabetic wounds, burns
Types of dressings (6)
Hydrocolloids, hydrogels, foam dressings, gauze pads, alginates, transparent film
Hydrocolloids
Absorb exudate, moist, may disrupt tissue upon removal
Hydrogels
Moisture retentive, use with US, enables autolytic debridement
Foam dressing
Absorb exudate, protect, bandaid for partial and full thickness wounds
Gauze pads
Readily available, infected/non-infected wounds
Alginates
Infected wounds, highly absorptive, non-occlusive
Transparent film
Minimal drainage, moist, transparent bandaid, water and oxygen permeable
Red yellow black sytem
Wound healing assessment
Red
Pink; goal: protect, retain moisture
Yellow
Yellow slough; goal: remove slough, drain
Black
Black necrosis, eschar; goal: remove necrosis
Skin care products (5)
Therapeutic moisturizers, moisture barriers, liquid skin sealants, skin cleansers, wound cleansers
Therapeutic moisturizers
Replace skin moisture, thicker than lotion, prevent tissue cracking
Moisture barriers
Adheres to skin, repel excess moisture, protect surrounding area
Liquid skin sealants
Thin plastic film, protects skin from adhesive related tissue damage
Skin cleansers
For patients with risk to skin breakdown, better cleanser than soap
Wound cleansers
Remove exudate, wound blood, simple saline to more complex solutions
Scar management (3)
Scar: assessment, massage, compression garments
Scar assessment (7)
Location, sensation, texture, pigmentation, vascularity, pliability, height
Scar massage
Cross friction
Compression garment for scars
Burns: >14 days to heal, 15-35mm Hg, 22-23 hrs of wear starting 14 days after initial burn
Rule of nines: head and neck
9%
Rule of nines: anterior trunk
18%
Rule of nines: posterior trunk
18%
Rule of nines: anterior arm, forearm, and hand
4.5%
Rule of nines: posterior arm, forearm and hand
4.5%
Rule of nines: genital region
1%
Rule of nines: anterior leg and foot
9%
Rule of nines: posterior leg and foot
9%
Topical agents: Silver sulfadiazine (advantages)
Can be used with/without dressings, painless, wound directly
Topical agents: ss..disad....
Does not penetrate eschar
Topical agents: silver nitrate (advantages)
Broadspectrum, non allergenic
Topical agents: silver nitrate (disadvantagez)
Poor penetration
Topical agents: poviodine-iodine (A)
Antifungal, easily removed with water
Topical agents: poviodine-iodine (D)
Painful application
Topical agents: mafedibe-acetate (A)
Penetrates burn eschar, may be used with/without dressings
Topical agents: mafedibe-acetate (D)
May cause metabolic acidosis, painful application
Topical agents: gentamicin (A)
Broadspectrum, may be covered or left open to air
Topical agents: gentamicin (D)
Ototoxic, nephrotoxic
Topical agents: nitrofurazone (A)
Baceriocidal, broadspectrum
Topical agents: nitrofurazone (D)
May lead to overgrowth of fungus, painful application
Integumentart pathology (6)
Cellulitis, contact dermatitis, eczema, dry gangrene, wet gangrene, psoriasis
Cellulitis definition
Inflammation from bacterial infection of skin
Cellulitis ss
Quick spreading localized redness, warm/hot skin, chills, fever, malaise
Cellulitis treatment
Physician, antibiotics, gangrenous or spread if not
Contact dermatitis
Local irritation
Contact derm etiology
Exposure to irritant
Contact derm ss
Intense itching, burning, red skin, edema
Contact derm treatment
Identify and remove irritant, topical steroid
Eczema
Chronic skin inflammation due to immune abnormality, allergic rxn, irritant
Eczema etiology
Depends
Eczema ss
Brown itchy skin plaques, oozing, crusty patches
Eczema treatment
Pharmacological intervention, corticosteroid, antibiotics, antihistamines
Dry gangrene
Ischemia � tissue death
Dry gangrene etiology
Blood vessel disease, diabetes, poor circulation
Dry gangrene ss
Brown/black skin
Dry gangrene treatment
Immediate action, pharmacological intervention, hbot, surgery
Wet gangrene
Bacterial infection
Wet gangrene etiology
Frostbit, severe burn, injury
Wet gangrene ss
Swelling, pain, blisters. Pus, fever
Wet gangrene treatment:
Immediate medical attention, antibiotic, hbot, surgery
Plaque psoriasis
Chronic autoimmune disease
Psoriasis wtiology
Accelerated skin growth resulting in raised red patches
Psoriasis ss
Red raised blotches on bilateral body parts
Psoriasis treatment
Control ss with medication, prevent secondary infection, phototherapy