Denise Shared "Wound Care" - 17 Picmonics

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Wound Care

Braden Scale
Characteristics
Sensory Perception
Moisture
Activity
Mobility
Nutrition
Friction and Shear
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2 mins
Interventions for Impaired Skin Integrity
Assessment
Signs of Skin Breakdown
Pain
Redness
Decreased Skin Turgor
Bleeding
Bony Prominences
Intervention
Reposition Q2H
Pressure Relief
Maintain Clean and Dry Skin
Adequate Nutrition and Hydration
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2 mins
Pressure Ulcers
Types
Stage 1 - Non-Blanchable Redness
Stage 2 - Partial Thickness
Stage 3 - Full Thickness Skin Loss
Stage 4 - Full Thickness Tissue Loss
Unstageable
Possible Deep Tissue Injury
Considerations
Skin Color Alterations
Remove Necrotic Tissue Before Staging
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2 mins
Types of Wound Healing
Types of Wounds
Acute
Chronic
Healing Process
Primary Intention
Approximated Edges
Secondary Intention
Edges Not Approximated
Tertiary Intention
Delayed Closure due to Infection and Necrosis
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2 mins
Wound Drainage Types and Devices
Drainage Types
Serous
Serosanguineous
Sanguineous
Purulent
Drainage Devices
T-tube
Penrose
Jackson-Pratt (JP)
Hemovac
Considerations
Record Drainage Amounts
Check Device Function
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2 mins
Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions
Frequently Elevate Legs
Avoid Standing/Sitting for Long Periods of Time
Elastic Compression Stockings
Bilayer Artificial Skin
Daflon
Wound Dressings
Proper Foot and Leg Care
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2 mins
Phases of Wound Healing
Inflammatory Phase
Inflammatory Phase up to Day 3
Clot formation
Neutrophil Migration
Macrophages Clear Debris
Proliferative Phase Day 3- weeks
Mediated by Fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages
Granulation Tissue, Collagen, angiogenesis, wound contraction
Remodeling
Variable 1-6 Months
Mediated by Fibroblasts
Type III Collagen Replaced by Type I
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Debrid/e
meaning
Open a Wound
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55 secs
Wound Healing 1: Inflammatory Phase
Up to 3 days after wound
Mediators
Platelets
Neutrophils
Macrophages
Characteristics
Clot formation
Increased vessel permeability leads to neutrophil migration
Macrophages clear debris
Macrophages and platelets secrete PDGF
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Wound Healing 2-3: Proliferative and Remodeling
Proliferative Phase
Day 3- weeks
Fibroblasts
Myofibroblasts
Endothelial cells
Keratinocytes
Macrophages
Deposition of Type III collagen
Deposition of granulation tissue
Wound contraction
Metalloproteinases encourage myofibroblast ativity
Angiogenesis (days4-5)
VEGF Increases vascular permeability
Remodeling Phase
Weeks-months
Mediated by fibroblasts
Metalloproteinases encourage remodeling
Type III collagen replaced by type I Collagen
Integrin-Fibronectin interaction--> signals that modulate growth, migration, etc
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Post-Op Wound Complications
Hematoma
Increased risk with obesity and anticoagulation
Ice packs, compression
Surgery if in neck
Seroma
Results from disruption of lymph vessels
Most self-resolve in 6 weeks
Superficial Infection
Prevent with ABX 1 hour pre-op
Wound culture
Dehiscence
May feel popping sensation
Fascial dehiscence: "salmon" colored drainage
Early recognition: Return to OR to close
Late recognition: allow to heal by granulation
Enterocutaneous Fistula
TPN
Most self resolve
Surgery if not closed in 6 months
Necrotizing Fasciitis
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Immobility
Assessment
Mobility Continuum
Complications
Cardiovascular
Respiratory
Musculoskeletal
Integumentary
Gastrointestinal
Urinary
Considerations
Turn, Cough, Deep Breathe (TCDB)
Range of Motion (ROM)
Skin Care
Fluids
Balanced Diet
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2 mins
WBC Differential Lab Value
White Blood Cells (WBC)
5-10 (5,000-10,000)
Leukocyte Differential
Neutrophils (50%-70%)
Bands (2%-5%)
Segs (50%-70%)
Lymphocytes (20%-40%)
Monocytes (4%-8%)
Eosinophils (2%-4%)
Basophils (0.5%-1.5%)
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2 mins
Red Blood Cell Count (RBC) Lab Values
Women: 3.5-5.5 million cells/ MuL
Men: 4.3-5.9 million cells/ MuL
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1 min
Hemoglobin (Hgb) Lab Values
Men: 13 - 17 g/dL
Women: 12 - 16 g/dL
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47 secs
Hematocrit (Hct) Lab Values
Women: 36% - 46%
Men: 41% - 53%
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1 min
Platelet Lab Value
150,000-400,000 Micro L
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40 secs

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