Term
| Medical conditions that may influence wound healing (6) |
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Definition
1. DM - dec. healing rate and ability to fight infection; inc. susceptibility
2. PVD - dec. blood flow
3. CHF - inc. girth of LE results in inc. difficulty to nourish tissue and inc. tissue tension
4. Cancer - chemo and RT dec. healing rate; RT results in sclerosis of vessels
5. Organ transplant - meds inc. chances of infection and dec. strength of c.t.
6. HIV - inc. incidence of infection; dec. healing rate |
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Term
| Medications which may influence wound healing (5) |
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Definition
| 1. steroids (i.e. prednisone, DEXA), 2. NSAIDs (i.e. aspirin, motrin), 3. immunosuppressive drugs (i.e. cyclosporin), 4. chemotherapeutic agents (i.e. methotrexate), 5. anticoagulants (i.e. coumadin, heparin) |
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Term
| steroids and wound healing |
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Definition
| inhibit fibroblast and phagocyte function |
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Term
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Definition
| reduces initial inflammatory response |
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Term
| Immunosuppressive drugs and wound healing |
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Definition
| decreases tensile strength of c.t. |
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Term
| Chemotherapeutic agents and wound healing |
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Definition
| decreases cell replication and injures fibroblast and endothelial cells |
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Term
| Anticoagulants and wound healing |
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Definition
| decreased platelets lead to inc. bleeding |
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Term
| What to ask in pt's PMH for wounds? (3) |
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Definition
1. any medical conditions which may influence healing
2. medications
3. history of prior wounds (similarity to current wounds and method of tx) |
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Term
| Questions to ask about the etiology of the wound (4) |
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Definition
1. primary cause of wound
2. duration and course of wound
3. previous txs and results
4. current tx |
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Term
| Questions to ask about social history (2) |
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Definition
1. smoker? (smoking reduces blood flow and inc. risk of atherosclerosis)
2. job/activity level |
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Term
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Definition
| to determine how to proceed with mechanical debridement |
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Term
| Nutritional status and wound healing (4) |
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Definition
1. healing requires inc. caloric demands
2. vitamin A required for epithelial differentiation and inc. macrophage activity
3. vitamin C (ascorbic acid) is essential in cross-linkage of collagen fibers in collagen formation and it inc. leukocyte response
4. protein is the structural basis of collagen and all connective tissue fiber (normal albumin=3.5-5.0 g/dl) |
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Term
| Ambulation considerations |
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Definition
| det. need for an assistive device, dec. WB on wound, shoe wear mod., pressure relieving techniques |
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Term
| Dressing management considerations |
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Definition
| Should wound be drained or moistened? How are ppl changing their dressings? |
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Term
| Medical tests for wound pts |
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Definition
1. wound cultures: >10^5 organisms per gram of tissue indicates poor prognosis for healing
2. non-invasive peripheral vascular studies (arterial - segmental pressures per Doppler to locate obstruction, ankle-brachial index indicates presence/absence of arterial disease, toe systolic pressures; venous - PPG measures venous refilling time assessing the severity of venous valvular dysfunction) |
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