NUR MISC-WUHS CGN 5643 Critical Point Worksheet 2019 Topic 1-1

NUR MISC-WUHS CGN 5643 Critical Point Worksheet 2019 Topic 1-1 Topic 1 Worksheet - Techniques for Dermatological Conditions 1. What are the two main categories of suture? Absorbable and nonabsorbable are the two main categories of sutures. There are many subcategories that fall under these Absorbable “is a sterile strand of synthetic polymer or mammalian-derived collagen.” Nonabsorbable “is used for skin and for long-term internal placement such as in cardiovascular, orthopedic, and plastic surgery” (Pfenninger, & Fowler, 2011, pp 176). 2. What is the difference between braided and monofilament suture and when would you use each? Braided suture adds strength to secure the knotting but leaks fluid and increases chance of infection. Monofilament’s knots are less dependable but have a reduced chance of infection. Braided suture has more friction than monofilaments. (Pfenninger, & Fowler, 2011, pp 176). 3. What considerations are used in needle selection with suturing referring to size, shape and needle point? There are three types of needles: the closed eye, French eye, and the swaged eye. When considering size, a larger needle is used for deeply buried sutures. A smaller needle can be used to close a thinner layer of skin. The shape of needle is important for both strength and grasping by needle holder. A flattened body with a concave or convex surface helps to reduce unwanted needle rotation when suturing. The needle pint is the most important thing to consider avoiding trauma. The different types of needle points are cutting, tapered, and blunt. The blunt-point needle is used for friable parenchymal tissue such as liver and kidney. In a cutting needle the two opposing edges allows for easier passage through the tissues and ideal for suturing skin with dense structures. However, there is a risk of overcutting with cutting edge points when suturing tendons and oral mucous membranes. The conventional cutting needle has a cutting edge on its inside or concave curvature. This is rarely used because it can cut outside the desired suture channel. The reverse cutting needle is more commonly used as it has a cutting edge on the outer curvature and reduced the chance of sutures pulling through the tissue into the margin of the wound. Tapered cut or round needles have an oval shape to reduce twisting in the needle holder and advantageous in suturing less dense tissue that require small holes such as fascia or bowel (Pfenninger, & Fowler, 2011, pp 172-173) 4. What are the 4 main goals of primary wound closure? The goals of wound closure in the primary care setting are to (1) stop bleeding, (2) prevent infection, (3) speed healing, and (4) preserve the appearance and function of the injured area (Millard, 1998, p 91). 5. What are three contraindications to primary wound closure? Rev. 2019 These are the following contraindications: (1) Concern about wound infection because the outcome may be worse than that caused by the initial injury alone. (2) An acute wound 6 hours old (with the exception of facial wounds). (3) Foreign debris in the wound that cannot be completely removed(e.g., a wound with a lot of embedded dirt that you cannot clean completely). (4) Active oozing of blood from the wound. Dead space under the skin closure. (5) Too much tension on the wound (Millard, 1998, pp 91). 6. After local anesthesia, what steps are there in “wound preparation” prior to suturing? After the initial assessment and administration of local or regional anesthetic, and antibiotics if indicated, wounds should be inspected thoroughly for foreign bodies, deep tissue layer damage, and injury to nerve, vessel, or tendon. X-rays are warranted if retained glass or metal. Wound cleansing should be performed by irrigation with normal saline at approximately 15 psi of pressure. Greasy contaminants can be removed with any petroleum-based product, such as bacitracin ointment. After the cleansing process, wounds should be examined for devitalized tissue that needs removal or debridement. This debridement may convert a jagged, contaminated wound into a clean surgical one and can be accomplished with a scalpel or sharp tissue scissors Undermining can significantly reduce skin tension when there is a gap to be closed; not recommended in dirty wounds (Pfenninger, & Fowler, 2011, pp 160). 7. What are the key components of a patient education after suturing for proper follow up care? The dressing should remain on for the first 24 to 48 hours after closure. Expect there to be some slight oozing of blood. Patient can place a pressure dressing to prevent continuous bleeding by folding gauze over a sterile ointment with tape. They can utilize the gauze dressing provided such as Xeroform, Telfa, or Adaptic. If given a self-adherent wrap like Coban will reinforce the dressing and holds things in place. If dressing is on the lower extremities, elevate for 24 hours, ice over the area to reduce pain, swelling and bleeding. Patient can shower after 24 hours and redress the wound after drying it gently. Can apply white petrolatum jelly to promote quicker healing. If bleeding occurs they can replace the dressing after 24 to 48 hours as needed to support the wound closure (Pfenninger, & Fowler, 2011, pp 168) 8. What are concurrent treatment considerations following suturing that must be addressed? Tetanus prophylaxis based on CDC recommendations based on if patient has had three previous doses. Analgesic medica