Wounds and Wound Management
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Questions and Answers

Which of the following is NOT a characteristic of untidy wounds?

  • They often involve devitalized tissue and multiple irregular wounds.
  • They are commonly associated with fracture of the underlying bone.
  • They are due to crushing, tearing, and avulsion.
  • They are typically caused by sharp objects, like surgical incisions. (correct)

    • What is the main way infection affects wound healing?

  • Infection leads to a decrease in blood flow, reducing nutrient delivery to the wound.
  • Bacteria destroy collagen, hindering wound closure, through the release of collagenolytic enzymes. (correct)
  • Infected wounds are more prone to dehiscence due to increased inflammation.
  • Infection causes an increase in collagen production, leading to scar tissue formation.

    • How do foreign bodies and necrotic tissue negatively impact wound healing?

  • They create a barrier for migrating fibroblasts, impeding tissue repair. (correct)
  • They release toxins that damage surrounding healthy tissue, delaying healing.
  • They trap bacteria, elevating the risk of infection and hindering wound healing.
  • They cause increased inflammation, leading to delayed closure.

    • Which of the following wound types is typically treated with primary suturing?

    <p>Tidy wounds (D)</p> Signup and view all the answers

    Which of the following is NOT a common complication associated with untidy wounds?

    <p>Excessive scar tissue formation (B)</p> Signup and view all the answers

    Which classification of surgical wounds is associated with an infection rate of less than 2%?

    <p>Clean wound (D)</p> Signup and view all the answers

    What is the primary method for controlling bleeding in a surgical wound?

    <p>Direct local compression (D)</p> Signup and view all the answers

    What is a characteristic feature of necrotic muscle tissue that requires complete excision?

    <p>Dark red or gray color (D)</p> Signup and view all the answers

    What is the recommended approach for bone management in a contaminated wound?

    <p>External fixation (D)</p> Signup and view all the answers

    What is the recommended treatment for necrotic muscle tissue in a surgical wound?

    <p>Debridement (C)</p> Signup and view all the answers

    Which wound classification has an infection rate between 10% and 15%?

    <p>Clean contaminated wound (C)</p> Signup and view all the answers

    What is a near miss?

    <p>An incident that could have harmed the patient but did not (B)</p> Signup and view all the answers

    Which wound classification is characterized by the involvement of the epidermis, dermis, subcutaneous fat, fascia, and exposure of bone?

    <p>Contaminated wound (A)</p> Signup and view all the answers

    Which of the following is considered a 'Never Event'?

    <p>A surgical procedure performed on the wrong body part (A)</p> Signup and view all the answers

    What is the primary factor contributing to the higher infection rate in 'Dirty Infected Wounds' compared to 'Clean Wounds'?

    <p>Presence of bacteria in the wound (B)</p> Signup and view all the answers

    Which of these terms describes care that falls below the recognized standard of care?

    <p>Negligence (C)</p> Signup and view all the answers

    What does 'credentialing' refer to in the context of healthcare?

    <p>A way to ensure that clinicians are adequately prepared to deal with specific patient conditions or procedures (A)</p> Signup and view all the answers

    What is the definition of 'competence' in the context of healthcare?

    <p>The knowledge, skills, and attitudes required to carry out one's duties (D)</p> Signup and view all the answers

    What percentage of patients receiving healthcare experience preventable harm?

    <p>10% (C)</p> Signup and view all the answers

    What are some of the financial consequences of unsafe care?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the standard of care in healthcare?

    <p>The care that a reasonable physician with similar training would provide in similar circumstances (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of reactionary hemorrhage?

    <p>It is characterized by a decrease in blood pressure. (A)</p> Signup and view all the answers

    Which of the following is an example of a traumatic cause of hemorrhage?

    <p>Accidental injury. (A)</p> Signup and view all the answers

    What is the main mechanism by which hemorrhage is stopped?

    <p>Vasospasm of the injured blood vessel. (D)</p> Signup and view all the answers

    What is the primary cause of reactionary hemorrhage?

    <p>An increase in blood pressure. (A)</p> Signup and view all the answers

    What is NOT a factor that can increase traumatic and pathological bleeding?

    <p>Increased blood volume. (A)</p> Signup and view all the answers

    Which of the following is a characteristic of spontaneous hemorrhage?

    <p>It can occur with little or no trauma. (C)</p> Signup and view all the answers

    What is the significance of understanding different types of hemorrhage?

    <p>It helps to determine the appropriate treatment plan. (B)</p> Signup and view all the answers

    What is the role of clotting in stopping hemorrhage?

    <p>It prevents blood loss by forming a clot at the site of injury. (C)</p> Signup and view all the answers

    What is the approximate blood volume of an adult weighing 70 kg?

    <p>4900 ml (C)</p> Signup and view all the answers

    What is the primary goal in treating haemorrhage?

    <p>Arrest the bleeding (B)</p> Signup and view all the answers

    Which of these clinical signs is LEAST likely to be observed in a patient with haemorrhage?

    <p>Prolonged fever (A)</p> Signup and view all the answers

    Which of the following factors can worsen a patient's tolerance to blood loss?

    <p>Severe anemia (B)</p> Signup and view all the answers

    What is a potential consequence of aggressively trying to resuscitate a patient with ongoing haemorrhage?

    <p>Physiological exhaustion (A)</p> Signup and view all the answers

    What does the term 'coagulopathy' refer to in the context of haemorrhage?

    <p>Impaired blood clotting (A)</p> Signup and view all the answers

    Which of the following is NOT a method for stopping bleeding?

    <p>Fluid resuscitation (C)</p> Signup and view all the answers

    What is the maximum blood loss percentage that a patient can tolerate without needing therapy?

    <p>15% (D)</p> Signup and view all the answers

    What is the main goal of patient safety training?

    <p>To minimize the impact of human error on patient care. (C)</p> Signup and view all the answers

    Which of the following is NOT considered a Patient Safety Incident (PSI)?

    <p>A patient's death caused by an underlying condition. (B)</p> Signup and view all the answers

    What does the term "evidence-based medicine" suggest in the context of patient safety?

    <p>Using scientific research findings to guide patient care. (D)</p> Signup and view all the answers

    Why is "local wisdom" considered important in patient safety?

    <p>It helps doctors understand the specific needs of their community. (B)</p> Signup and view all the answers

    Which of the following BEST describes the concept of "first, do no harm" in patient safety?

    <p>Doctors should avoid any actions that could potentially harm the patient. (D)</p> Signup and view all the answers

    What is the difference between an adverse event and a near miss event?

    <p>Adverse events result in harm to the patient, while near misses do not. (C)</p> Signup and view all the answers

    The content emphasizes the importance of using evidence-based medicine and local wisdom. What does using "local wisdom" in patient safety mean?

    <p>Recognizing the specific needs and challenges faced by a particular community. (A)</p> Signup and view all the answers

    According to the content, how can the impact of human error be minimized in patient care?

    <p>By using evidence-based medicine and local wisdom in medical practices. (D)</p> Signup and view all the answers

    Flashcards

    Infection in wounds

    Infection occurs when bacteria compete with fibroblasts for oxygen and nutrients, hindering healing.

    Foreign bodies in wounds

    Foreign bodies and necrotic tissue can impede the healing process of a wound.

    Adhesion to bone

    Adhesion to a bony surface prevents wound contraction, affecting healing.

    Tidy wounds

    Tidy wounds are clean, often from surgical incisions, healing primarily through suturing.

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    Untidy wounds

    Untidy wounds arise from trauma, like crushing and burns, often with more healing complications.

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    Epidermis

    The outermost layer of skin that forms a protective barrier.

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    Dermis

    The layer of skin beneath the epidermis, containing blood vessels and nerves.

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    Full Thickness Wound

    Involves loss of the epidermis, dermis, fat, and fascia, exposing bone.

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    Clean Wound

    A wound with the lowest infection risk, typically from surgical procedures.

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    Clean Contaminated Wound

    A surgical wound at moderate risk for infection due to entering the respiratory or gastrointestinal tracts.

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    Dirty Infected Wound

    Wounds with high infection risk, containing necrotic or devitalized tissue.

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    Management of Open Wounds

    Involves controlling bleeding, cleaning, and inspecting that area before further treatment.

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    Necrotic Muscle

    Muscle tissue that is dead or dying, often appearing dark red or gray, which should be excised.

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    Near miss

    An incident that could lead to unwanted outcomes but does not, often due to intervention.

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    No-harm event

    An incident that reaches the patient but causes no injury due to chance or mitigation.

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    Never Event

    Serious adverse events that are preventable and should not occur.

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    Negligence

    Care that falls below the recognized standard of practice.

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    Standard of care

    Care expected from a reasonable physician in similar circumstances.

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    Competence

    Knowledge, skills, and attitudes required to effectively carry out duties.

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    Credentialing

    Ensuring clinicians are prepared to treat specific patient issues safely.

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    Preventable harm

    Harm that could be avoided through better practices or interventions.

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    Patient safety

    A science that promotes the use of evidence-based medicine to minimize human error in patient care.

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    Patient Safety Incidents (PSI)

    Preventable events that could result in unnecessary harm to the patient, including adverse events and near misses.

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    Adverse event

    An incident causing harm to a patient, which may be preventable or non-preventable, related to their condition or treatment.

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    Evidence-based medicine

    The integration of best research evidence with clinical expertise and patient values.

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    Human error

    Mistakes made by healthcare providers that can impact patient safety and treatment outcomes.

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    First, do no harm

    A foundational principle in healthcare emphasizing the importance of preventing harm to patients.

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    Reactionary Hemorrhage

    Bleeding due to eroding vessel walls, occurring within 24 hours after trauma.

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    Causes of Reactionary Hemorrhage

    Can be caused by necrosis, malignancy, or increased blood pressure.

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    Hypovolemia Correction

    Rise in blood pressure due to restoration of blood volume.

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    Insecure Ligature

    A loose knot that may slip or lead to clot dislodgement post-surgery.

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    Spontaneous Bleeding

    Occurs without obvious trauma, often due to bleeding disorders.

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    Pathological Bleeding

    Bleeding due to underlying diseases like atherosclerosis or peptic ulcers.

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    Physiological Response to Hemorrhage

    Integrated mechanisms that act to stop bleeding and maintain organ perfusion.

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    Clotting Mechanism

    Vasoconstriction of injured vessels followed by formation of a clot to stop bleeding.

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    Circulating Volume

    The amount of blood in the circulatory system necessary for vital organ function.

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    Hypovolemia Symptoms

    Signs of low blood volume, including weakness and fainting, especially upon standing.

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    Clinical Signs of Blood Loss

    Pale, tired appearance with tachycardia, hypotension, and oliguria in hemorrhage.

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    Blood Volume Estimates

    Average blood volume is 70 ml/kg in adults and 80 ml/kg in children.

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    Four Classes of Hemorrhage

    Hemorrhage classification based on clinical changes and hemodynamic parameters.

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    Immediate Management of Hemorrhage

    Arrest bleeding first; fluid resuscitation is a secondary measure.

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    Signs of Shock

    Tachycardia, confusion, and cold, clammy skin indicating severe blood loss.

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    Physiological Exhaustion

    A condition that may arise from attempting to resuscitate with ongoing hemorrhage.

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    Study Notes

    Wounds and Wound Management

    • Wound is a disruption of tissue structure and function, caused by a cut, break or injury.
    • Wound healing has three overlapping phases:

      • Inflammatory phase (0.5 days-5 days):

        • Starts at the moment of injury.
        • Clotting cascade initiates.
        • Platelets aggregate.
        • Release cytokines and growth factors.
        • Stimulate chemotaxis of macrophages for phagocytosis and wound debridement.
        • Activation of fibroblasts and endothelial cells.
        • Characterized by heat, swelling, redness, pain, and loss of function.

      • Proliferative phase (3 days-3 weeks):

        • Fibroblasts proliferate, derived from surrounding tissues.
        • Secrete collagen fibers.
        • Endothelial cells form new capillary buds.
        • Together with fibroblasts, form granulation tissue.
        • Epithelial cells migrate to close the epithelial defect.

      • Remodeling or maturation phase (weeks to 1 year):

        • Collagen deposition starts with Collagen type 3, which decreases over time and collagen type 1 increases, making wound stronger.
        • Collagen fibers become thicker and arranged along stress lines.
        • Wound tensile strength increases, yet is never entirely restored to original strength.

    Factors Affecting Wound Healing

    • General factors:
      • Age: slower healing in elderly due to decreased protein turnover.
      • Debilitating diseases (e.g., uremia, jaundice, cirrhosis, diabetes, malignancy).
      • Irradiation inhibits wound contraction and granulation tissue formation.
      • Nutrition (Protein, vitamin C, vitamin A, calcium, zinc, copper, manganese).
      • Drug intake: steroids inhibit inflammatory response and fibroblast formation.
    • Local factors:
      • Vascularity (good blood supply in face and scalp leads to faster healing, and poor blood supply below the knee results in delayed healing).
      • Immobilization (wounds over joints or weight-bearing areas).
      • Tension (sutures under tension, hematomas, increasing wound tension, causing ischemia).

    Classification of Wounds

    • Tidy wounds: surgical incisions, clean sharp objects. Often primarily closed.
    • Untidy wounds: crushing, tearing, avulsions, devitalized injury, vascular injury, multiple irregular wounds, burns. May involve bone fractures, higher risk of complications (e.g., wound dehiscence, infection, delayed healing).
    • Open wounds: Abrasions, incised wounds, lacerated wounds, penetrating wounds, and bite wounds.
      • Abrasions: superficial layers of skin scraped off; treatment for cleaning with antiseptic, non-adherent dressing.
      • Incised wounds: sharp objects (e.g., knives, glass); longer than deep, clean edges.
      • Lacerated wounds: severe violence, blunt objects; irregular shape.
      • Penetrating wounds: pointed objects; more deep than long; can injure deep structures and cause high infection risk.
      • Bite wounds: animal or human; lacerated wound, high risk of infection.

    Types of Wound Healing

    • Primary intention: clean wounds closed immediately; minimal scar.
    • Secondary intention: edges not approximated; healing with granulation tissue; larger scar.
    • Tertiary intention: contaminated wounds, left open initially, then closed later.

    Wound Classification by Skin Layers Involved

    • Superficial: epidermis only.
    • Partial-thickness: epidermis and dermis.
    • Full-thickness: epidermis, dermis, fat, fascia, exposes bone.

    Surgical Wound Classification

    • Clean: low risk of infection (e.g., herniorrhaphy, excisions).
    • Clean-contaminated: slightly higher risk (e.g., appendicectomy, bowel surgeries).
    • Contaminated: significant risk (e.g., acute abdominal conditions, open fresh accidental wounds).
    • Dirty/infected: high risk (e.g., abscess drainage, pyocele).

    Management of Open Wounds

    • Bleeding: control by direct pressure/dressing, possible splinting for suspected fractures.
    • Wound cleaning: using saline irrigation, removal of foreign bodies, use of antiseptic.
    • Inspection: all structures within the wound need assessment for nerve, muscle, bone, etc.
    • Repair: injured vessels, nerves, tendons and muscles.
    • Bone treatment: internal/external fixation should be considered according to infection risk and possible damage.
    • Deep fascia should be left open in contaminated wounds.

    Shock

    • A serious medical condition caused by circulatory system failure.
    • Organs/tissues do not receive enough oxygenated blood.
    • Causes include heart issues, blood vessels, or blood volume decrease.
    • Types of shock:
      • Hypovolemic:
        • blood/fluid loss (e.g., bleeding, dehydration).
      • Cardiogenic: pump failure (e.g., cardiac ischemia, arrhythmias)
      • Obstructive: obstruction in blood flow (e.g., cardiac tamponade).
      • Distributive: blood vessels dilate excessively (e.g., septic shock, anaphylactic shock, neurogenic shock).
        • Septic shock: infection.
        • Anaphylactic: allergic reaction.
        • Neurogenic: loss of sympathetic tone.

    Patient Safety

    • Patient safety is a science to minimize human errors in patient care.
    • Patient safety incidents (PSI) are preventable events causing harm, or potentially harm, to patients.
    • Adverse event: harmful incident to patient.
    • Near miss: incident with no harm.
    • Error models help understand factors causing errors and guide improvements. Examples:
      • Human factors/performance problems (e.g., fatigue, errors of commission, omission).
      • System failures (e.g., poor communication, inadequate staffing, disconnected reporting systems).
      • Medical complexity (e.g., drug interactions, advanced/complex technologies).

    Brain Storming

    • Example of a brain-storming question: At which step in the surgical checklist does the nurse check instruments/supplies? (Sign-In, Time-Out, Sign-Out).

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    Related Documents

    Wounds & Wound Management PDF

    Description

    This quiz covers the essential concepts of wounds and their management, including the three phases of wound healing: inflammatory, proliferative, and remodeling. Understand the biological processes involved in each phase and their significance in effective wound care.

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