What is Surgical asepsis?

What is Disinfection?

1) Practices that keep an area or objects free of all microorganisms including spores.

2) Disinfectants- destroy patogens except for spores.

 Define: Epidermis, Stratum corneum,  Dermis

Subcutaneous

• location of the skin problem
• size of the skin problem
• color of the lesions, or wound.
• temperature change to the site.
• odor
• any drainage/ exudate/ crusts/ erosions/ scales
• elevation: Raised/ flat/ Smooth
• distribution: symmetrical vs asymmetrical vs scattered

Wet-to-dry moist dressings are used for wounds requiring debridement.  However,this dressing is a nonselective method of debridement, and exposed healthy tissue in the wound bed may be damaged. This dressing is best used with heavily necrotic, infected wounds. Because granulation tissue is fragile and bleeds easily, damp dressings are less likely to result in tissue damage where old dressings are removed.

What is a wound V.A.C.?

• Serous (clear, watery plasma)
• Sanguineous (fresh bleeding)
• Serosanguineous (pale, more watery drainage than sanguineous drainage)
• Purulent (thick, yellow, green, or brown drainage)

• Fever
• Chills
• Excessive thirst
• Elevated WBCs

• Swelling
• Opening of wound edges
• Inflammation
• Drainage

Then palpate for tenderness along wound edges.

1) Primary intention

2) Secondary Intention

3) Tertiary  Intention

RISK:

Risk for skin infection

ACTUAL:

1) Impaired tissue intergrity,

2) Imparied tissue prefusion,

3) Acute Pain

What drainage involvescapillary damage, large # RBC, severe inflammation: bright red - fresh, dark red - old.

1) What kind of wound are pressure ulcers considered to be?

2) What do you need to do before treating one?

1) pressure ulcers are considered "dirty wounds"

2) you need to apply standard precautions.  ou need non sterile gloves to undress wound then don sterile to dress it.

1) Stage I: transparent film

2) Stage II: Hydrocolloid, Hydrogel

3) Stage III: polyurethane foam, hydrocolloid, hydrogel, calcium alginate

4) Stage IV: hydrocolloid, hydrogel, gauze roll

they're used in stage II, II, VI wounds. (class note says also stage I - but not sure about that)

They come in waffer, powder or paste form.  THey cushion wound and provide barrier that is wet and mosit- good for healing. (They also help liquify dead tissue?)

1) When do you use foam dressing?

2) When do you use Alginate dressing?

1) used for full thickness wounds, deeper wounds w/ a lot of drainage.

2) used for a lot of drainage. Made of seaweed. comes in sheets or granuels, changed about 2x a week.

1) keep healthy tissue dry and wound tissue moist.

2) if using enzymes for debridement, apply ONLY to dead tissue.

3) make sure you secure dressings

4) Place lable on dressing with date, time and initials

5) make sure patient is safe- bed- locks- call bells

6) Document. Document. Document!

Sterile technique when there is an acute wound.  Sterile tech. is usually ALWAYS used in an acute care setting (hospital)

Clean technique when there's a general wound.

Heat therapy promotes vasodilation, reduces blood viscosity, reduces muscle tension, increases tissue metabolism and capillary permeability.

1) It's good for improving blood flow to body parts delivering nutrients, removing waste products and it keeps blood flowing. 2) Improves delivery of leukocytes and antibodies  3) promotes muscles relaxation and reduces pain from stiffness ans spasms.

It is used for vasoconstriction, local anesthetic, reduces cell metabolism, increases blood coagulation, decreases muscle tension.

1) it prevents edema formation 2) reduces localized pain 3) reduces body tissue oxygen needs  4) promotes blood coagulation 5) reduces pain related to inflamation.

It may occur early or late in post-op period. Observe patient for: 

• Blood loss
• Increase P
• Decrease B/P
• Decrease UO

• Healing for wounds with tissue loss.
• Examples: burns, pressure ulcers, severe uneven laceration, or infected surgical area.
• Skin layers are not approximated - wound left open until scar tissue or granulated tissue forms. 
• Wet-moist dressings are usually required.

• In Secondary healing, there are:
• More gaping wound edges than Primary
• More granulation filling wound from the bottom and edges
• More scar tissue, maybe even keloid formation
• Sometimes difficult to heal due to complications

• Healing occurs when a wound is closed at a later time, after the wound surfaces have already started to granulate. 
• This type may be used when wounds are deep or until no more signs of infection. (combination of secondary followed by primary). There is often a delay between wound and closure of the wound.
• Greater risk for infection.
• Late suturing.
• More scarring.

1) What are the phases of wound healing?

2) What should you expect in each phase of wound healing?

• Inflammatory Phase –
• Hemostasis
• Phagocytosis –
• Regeneration/Proliferative Phase –
• Remodeling Phase –

1) circular

2) spiral

3) spiral-reverse

4) figure eight

5) recurrent

ACTIVITY: Dressings by Ulcer Stage

Stage I – Transparent film

Stage II – Hydrocolloid, Hydrogel

Stage III – Polyurethane foam, Hydrocolloid, Hydrogel, Calcium Alginate

Stage IV – Hydrocolloid, Hydrogel, Gauze roll

Review your Evolve Online Module, and your text and indicate:

1. How each dressing works
2. For which stage is this dressing indicated

Define these skin layers

Epidermis –

Stratum corneum

Dermis

Subcutaneous

Epidermis –

Stratum corneum

Dermis

Subcutaneous

What is Petechiae?

• Drainage - results as chemical mediators of the inflammatory response cause vascular changes and exudation of fluid and cells from blood vessels.
• Function of drainage.
  • Dilution of toxins produced by bacteria, and dying cells.
  • Transport leukocytes, plasma proteins, and antibodies to the site.
  • Remove bacterial toxins, dead cells, and debris away from the site.

OPEN wound: edges torn apart

CLOSED wound: underlying soft tissue and blood vessle damage w/ot edges or epiderms torn.  (sutured closed)

• Clean:  Closed surgical wound not entering GI, Rasp., uninfected GU, genital, and/or oropharyngeal cavities.

• Clean–contaminated:  surgery into resp. GU, and alimentary under controlled conditions.

• Contaminated: major break in aseptic technique, spillage from GI, or incision into infected areas.

• Open: surgical incision left open usually due to infected site or nature of surgery, with draining wound.

• Closed: part of body being injured by blunt object, a twisted limb, tearing of visceral organs.

Infected - bacterial organisms present in wound > 10⁵

Colonized - containing Microorganisms ( usually multiple but < 10⁵

• J.P - (Jackson-Pratt) - Closed suction drainage system
• Hemovac - Closed suction drainage system
• JP and Hemovac - closed suction drainage system, empty when 1/2 full
• JP - compress bulb when spout open then close to cause vacuum. Holds 100-200 ml
• Hemovac – larger than J.P, holds 500 ml similar J.P principles apply

1. Assess equipment for safety

2. Protect skin from extreme temp. Note: pallor, redness, numbness, pain at treated site

3. Maintain patient comfort and safety

4. Record observations

5. Never apply directly to skin (cover equipment)

6. Use cautiously on the debilitated, unconscious, and children

7. Assess skin q 5 - 10 min

The skin and SC tissue can tolerate some pressure, however, when pressure is > the pressure in the capillary bed, and if the capillaries get closed off and cause hypoxia, the vessels collapse and thrombus forms.

If pressure is relieved before that critical point, than circulation is restored through reactive hyperemia.

Capillary closing pressure is about 16-37 mm hg.

Reactive hyperemia - the body's response of vasodilation to the lack of blood flow to the tissues. If you press on a red area and it blanches, that is a good sign. Reactive hyperemia lasts less than one hour.

So if you turn someone and their coccyx area is reddened, it would be hyperemia, but should be gone within an hour.

Braden Scale - (more commonly used) sensory, moisture, activity, mobility, nutrition, friction and shear

A perfect score on either scale is "20"

"12" - high risk for ulcers

< "16" - interventions are begun

"6" - minimum score achieved

• Change positions q 2 hours
• Provide appropriate nutritional support (vitamins - A, B complex, C, K and minerals, high protein)
• Frequently reassess wound for healing and for other areas of breakdown
• Cleaning or Irrigating
• Dressings (with or without topical agents)
• Specialty beds (dependent)

Stage I – Transparent film

Stage II – Hydrocolloid, Hydrogel

Stage III – Polyurethane foam, Hydrocolloid, Hydrogel, Calcium Alginate

Stage IV – Hydrocolloid, Hydrogel, Gauze roll