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B260 Week 3
Transcript of B260 Week 3
Two types of wounds
B260 Wounds, Drains, and Central Lines
Jackson Pratt: JP: Grenade
Heat and Cold Therapy
heat and cold therapy causes systemic and local responses....
Central Venous Catheters (central lines)
What are they???
When obtaining a wound culture to determine presence of infection, where should the specimen be taken?
A. Necrotic tissue
B. Wound drainage
C. Drainage on the dressing
D. Wound after being cleansed with NS
Acute: proceeds through an orderly healing process resulting in sustained restoration of functional integrity
Those with loss of tissue
Those without loss, or little loss, of tissue
Wound with little tissue loss:
clean surgical wound, trauma
loss of tissue: vascular issues, breakdown
Caused by trauma or surgical incision
edges are clean and intact
Chronic wounds do not proceed through an orderly/timely process to produce functional integrity
Vascular compromise, chronic inflammation or repetitive insults to tissue
Chronic wounds affect 6.5 million patients (cdc, 2009).
cost associated with chronic wound care is 25 billion annually (cdc, 2009).
Primary intention: wound is closed (sutured, stapled)
Secondary: edges are not approximated (pressure ulcers, tissue loss)
Tertiary: wound left open for a period of time and then closed (contaminated, observation for s/s of infection. Necrotizing fasciitis patients...)
What conditions predispose patients to wounds and/or impaired healing?
Why insert a drain?
Penrose drain: typically put in place during a surgical procedure with a goal to prevent accumulation of fluid.
If a penrose drain is under a surgical dressing, what do you expect to see?
Do you have to measure drain output? How do/can you describe drainage?
If you are frequently emptying a jp drain, what may this indicate?
Heat therapy: what does it do?
Heat increases blood flow to injured area.
Heat applied for > 1 hour has the opposite effect! (Reflex vasoconstriction!)
Cold: initially diminishes swelling and pain
Prolonged exposure results in reflex vasodilation..
Why do you need to be aware of neuropathy and shivering when considering cold therapy?
Moist Application Advantages
reduces drying, softens exudate
conforms to body parts
penetrates deep into layers
does not promote sweating
Dry Application Advantage
less risk of burns
does not cause maceration
retains temp. longer (evaporation)
See tables 48.9 & 48.10 as well as box 48.15 & 48.16
used to give medications, fluids, nutrients, or blood products over a long period of time.
Catheters are typically inserted in the arm into a large vein, and "end" near the heart. Can be left in place longer than an IV
PICC: peripherally inserted central catheter.
inserted into a vein in the arm and not the neck or chest.
Tunneled catheter: surgically inserted into a vein in the neck or chest and passed under the skin. Only the port is accessible. this helps keep it in place, allows for easier movement, is less visible.
Implanted port: similar to tunneled cath., but is left entirely under the skin. meds are injected through the skin and into the catheter.
Which skin care measures are used to manage a patient who is experiencing fecal and urinary incontinence?
A. Keeping buttocks exposed to air at all times
B. Using a large absorbent diaper, changing when saturated
C. using an incontinence cleaner, followed by a moisture barrier cream
D. Frequent cleaning, applying an ointment, and covering the areas with thick absorbent towel
What does the Braden Scale evaluate?
A. Skin integrity at boney prominences, including any wounds
B. Risk factors placing patient at risk for skin breakdown
C. Amount of repositioning the patient can tolerate
D. Factors that place the patient at risk for poor healing
Skin edges are approximated (closed) and risk of infection is low. Healing occurs quickly, minimal scar formation.
Wound is left open until it becomes filled with scar tissue. This method takes longer to heal, and chance of infection is greater.
Do not cover an area of active bleeding with warm application
DNU with acute localized inflammation (appendicitis will rupture)
patients with CV issues should not have heat therapy applied covering large portions of the body: massive vasodilation disrupts blood supply to vital organs
Do not apply to an area that is already edematous. Why?
Contraindicated in neuropathy. why?
Do you need to wear gloves when accessing ports?
Even if you are simply pushing a medication?
what are bathing requirements for patients with central lines?