Exam (elaborations)
Basic Principles Of Wound Management: Q’s And A’s
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Basic Principles Of Wound Management: Q’s And A’s
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Basic Principles Of Wound Management: Q’s And A’sWound bed preparation Right Ans - For optimal wound healing, the wound
bed should be:
-well vascularized
-free of devitalized tissue
-clear of infection
-moist
Debridement Right Ans - Sharp surgical debridement is recommended over
nonsurgical methods for the initial debridement of devitalized tissue
associated with acute and chronic wounds or ulcers when feasible (Grade 2C)
Topical Therapy Right Ans - -Agents such as antiseptics and antimicrobial
agents can be used to control locally heavy contamination.
-Significant improvements in rates of wound healing have not been found, and
toxicity to the tissues might be a significant disadvantage.
Antisceptics Right Ans - Typically should NOT be used in open wounds
-kills both bacteria and healing cells
-betadine
-hydrogen peroxide
-Dakin's Solution (sodium hypochlorite)
Role of antibiotics Right Ans - -All wounds are colonized with microbes;
does not indicate the presence of an acute infection
-Abx not indicated for all wounds; reserved for wounds that appear clinically
infected.
-No evidence to support Abx prophylaxis in noninfected chronic wounds, or to
improve the healing potential of wounds without clinical evidence of infection.
Clinical signs of wound infection that might warrant antibiotics Right Ans -
-Local - cellulitis, lymphangitic streaking, purulence, malodor, wet gangrene,
osteomyelitis
-Systemic - fever, chills, nausea, hypotension, hyperglycemia, leukocytosis,
change in mental status
Glycemic control Right Ans - -Most clinicians make glycemic control a
priority when treating wounds, although there is no robust clinical evidence
,in support of short-term glycemic control as directly affecting wound healing
potential.
-However, clinical studies suggest that intensive glycemic control can reduce
incidence of diabetic foot ulceration by approximately 23 percent.
-Patients at risk for the development of chronic wounds often have comorbid
conditions associated with immunocompromised states (eg, diabetes) and
may not have classic systemic signs of infection such as fever and leukocytosis
on initial presentation. In these patients, hyperglycemia may be a more
sensitive measure of infection.
Wound Debridement Methods Right Ans - -Irrigation
-Surgical
-Enzymatic
-Biologic
Irrigation Right Ans - - part of routine wound management
-Low-pressure irrigation <15 psi using a syringe or bulb
-act and volume of irrigant probably provides the primary positive benefits
-Warm, isotonic (normal) saline is typically used; systematic reviews show no
significant differences in rates of infection for tap water compared with saline
for wound cleansing.
-addition of dilute iodine or other antiseptic solutions is generally
unnecessary
antiseptic solutions Right Ans - chlorhexidine, hydrogen peroxide, sodium
hypochlorite
Biofilm Right Ans - bacterial overgrowth on the surface of the wound
Characteristics of chronic wounds that prevent an adequate cellular response
to wound-healing Right Ans - -accumulation of devitalized tissue
-decreased angiogenesis
-hyperkeratotic tissue
-exudate
-biofilm formation
*majority of wounds often require planned serial debridement to restore an
optimal wound healing environment
, Bleeding during wound care Right Ans - -impairs the ability to see what
tissue should be debrided
-should be stopped before commencing debridement
-an occur from the healing surfaces or from the deep layers of the skin at the
wound edge
-from healing surfaces --> gentle pressure
-from deep payers--> subdermal vessel can be coagulated w/ electrocautery
or a silver nitrate stick.
Surgical Debridement Right Ans - -Sharp excisional debridement
(scalpel,scissors or curette)
-removes devitalized tissue and accumulated debris (biofilm).
-decreases bacterial load and stimulates contraction and wound
epithelialization
-most appropriate choice for removing large areas of necrotic tissue
-indicated whenever there is any evidence of infection (cellulitis, sepsis).
-indicated in the management of chronic nonhealing wounds to remove
infected tissue, handle undermined wound edges, or obtain deep tissue for
culture and pathology.
-associated with an increased likelihood of healing.
chronic critical limb ischemia Right Ans - surgical debridement should be
coupled with revascularization in order to be successful
Enzymatic debridement Right Ans - -involves applying exogenous
enzymatic agents to the wound. -results of clinical studies are mixed and their
specific effect remains unclear.
-Ulcer healing rates are not improved with the use of most topical agents,
including debriding enzymes.
-However, collagenase may promote endothelial cell and keratinocyte
migration, thereby stimulating angiogenesis and epithelialization as its
mechanism of action, rather than functioning as a strict debridement agent.
-It also remains a good option in patients who require debridement but are
not surgical candidates.
Enzymatic Debridement Agents Right Ans - -Collagenase (Santyl Ointment)
-Papain
-Bromelain
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