WOUND CARE WOCN QUESTIONS WITH CORRECT ANSWERS GRADED A+

TEWL - Transepidermal water loss What is the most common type of skin cancer? - basal cell carcinoma (BCC) How does basal cell carcinoma present? - "pearl like" translucent papule with central ulceration What is the second most common type of skin cancer? - Squamous cell carcinoma (SCC) How does squamous cell carcinoma present? - Enlarging keratotic papule ABCDEs of melanoma - Asymmetric, border irregular, color variance, diameter >0.6 cm, evolution What is the order of repair in an acute wound? - Brief inflammatory phase, epithelial resurfacing and granulation tissue formation and remodeling What is the max tensile strength for a full-thickness wound healing by scar tissue formation? - 80% of original tissue strength What strategy is used to help convert a chronic wound into an acute wound? - Surgical debridement intermittent claudication - pain and discomfort in calf muscles while walking; a condition seen in peripheral arterial disease What are the nutritional requirements of patients with open wounds or at risk for pressure ulcer? - 30 to 35 cal/kg/day; 1.25 to 1.5 proteins/kg/day; and 30mL/kg/day of fluids Moisture retentive dressings - permit evaporation of moisture from the skin ad wound--NOT OCCULSIVE TIME framework for wound healing - tissue management, control of inflammation/infection, moisture balance, edge advancement Appropriate wound cleansers that flush away exudate without damaging proliferative cells include: - saline, commercial wound cleansers, and potable tap water Cleansing of "dirty" wounds - Require 4 to 15 psi irrigating force and may involve cytotoxic solutions contact layers - 1. single layer of woven net 2. protects new granulation tissue 3. can irrigate through it 4. can use with topical med 5. needs a secondary dressing 6. not to be used with think exudate Hydrocolloid dressing - Inappropriate for infected wounds and exudative wounds. transparent adhesive dressing - semipermeable, bacteria do not penetrate the wound. When is debridement contraindicated? - In a closed uninfected wound that is poorly perfused and when the goal of care is maintenance or comfort as opposed to healing surgical debridement - The use of scalpels, scissors, or lasers in a sterile environment by a physician or podiatrist to remove necrotic tissue, foreign material, and debris from the wound bed. Debridement to the point of bleeding may stimulate healing via the release of platelet-derived growth factors. autolytic debridement - using body's enzymes to break down tissue; Requires a moist wound surface and normal WBC counts (no infection) Enzymatic debridement - topical application of enzymes to surface of necrotic tissue. can be used on infected and non-infected wounds with necrotic tissue. may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques. can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage; Nickle thick application chemical debridement - Using sodium hypochlorite ( Dakin's solution) and similar agents. Typically reserved for wounds that are necrotic, infected, and malodorous; remains controversial mechanical debridement - Physical removal of debris by irrigation, hydrotherapy or wet-to-dry dressing application; Non selective and painful. Generally contraindicated Indicators of critical colonization - Levine technique - 1. Moisten swab with saline or medium 2. Rotate over 1 cm square area of viable tissue with pressure Cadexomer Iodine - Provides sustained release of iodine to maintain a steady-state level of iodine that is toxic to bacterial but nontoxic to the "good cells" in the wound bed Polyhexamethylene Biguanide (PHMB) - A biocide that has been used for many years with no known resistance; generally considered more appropriate for prophylaxis or management of critical colonization than for primary treatment of infected wound Dialkylcarbomyl Chloride (DACC) - Work by physically binding and removing bacteria as apposed to killing it Refractory wound - If there has not been improvement within 2-4 weeks bacaplermin gel - Growth factor currently available commercially; Is approved for use only with DFU that are viable, uninfected and effectively offloaded How does NPWT accelerate wound healing? - Vacuum-assisted wound closure devices, commonly called wound VACs, distribute negative pressure over the entire wound surface to help drain excess debris and exudate, reduce bacterial count, decrease edema, and promote contraction of the wound's edges. This modality combines the benefits of both open and closed or moist traditional dressings. NPWT involves placing a foam dressing over an acute or chronic wound and attaching it to a device designed to exert negative pressure over the area.