Term
| What are the four stages of wound healing? |
|
Definition
| Inflammatory, debridement, repair, maturation |
|
|
Term
| 2 components of the inflammatory stage |
|
Definition
|
|
Term
|
Definition
| flushes contaminatnts from wound, clot formation minimizes blood loss, provides minimal tensile strength, scab for protection, fibrin matrix provides the temporary foundation for fibroblasts to build on |
|
|
Term
| Importance of inflammation |
|
Definition
| chemotaxis calls neutrophils and monocytes for debridement - increased blood flow and vascular permeability - sets the stage for the rest of the healing process |
|
|
Term
| What is the debridement stage characterized by? |
|
Definition
| WBC infiltration - exudation (pus, purulence, suppuration) |
|
|
Term
|
Definition
| increase inflammation, which increases chemotaxis - phagocytosis |
|
|
Term
|
Definition
| produce important growth factors for epithelialization, angiogenesis, and fibroplasia. |
|
|
Term
| 2 simultaneous processes of the repair stage |
|
Definition
| Fibroplasia (dermis) and Epithelialization (epidermis) |
|
|
Term
| Describe what is happening with fibroplasia of the dermis. |
|
Definition
| Fibroplasts infiltrate the area, collagen deposition and remodeling, angiogenesis, granulation tissue, wound contraction |
|
|
Term
| Describe what is happening with epithelialization. |
|
Definition
| Mitosis of the basal cell layer = proliferation of the epithelium, collagenase, pruritus |
|
|
Term
| After how many days of wound healing does the peak repair take place? |
|
Definition
|
|
Term
| When would epitheliaztion be delayed? |
|
Definition
|
|
Term
| After how many days does the maturation stage occur? |
|
Definition
|
|
Term
| What is taking place during the maturation stage? |
|
Definition
| Fewer fibroblasts remain for continued remodeling and contraction. |
|
|
Term
| What is the effect of physical stress at the site? |
|
Definition
Gentle stretching minimizes but strengthens scar tissue
(must not be done after 60 days due to keloid formation) |
|
|
Term
| Is a mature scar weaker or stronger than normal skin? Why? |
|
Definition
| 15-20% weaker - no elastin |
|
|
Term
| What is a keloid and why does it form? |
|
Definition
| Progressively enlarging scar due to increased collagen deposition in the dermis, still covered by epithelium. Keloids form when stretching occurs after 60 days. |
|
|
Term
at what point does support become unnecessary for a wound?
At what point is their optimal strength? |
|
Definition
|
|
Term
| What is the optimal time for suture removal? Why might this need to be delayed? |
|
Definition
10 days
Inflammation or steroid therapy may delay healing |
|
|
Term
| How many days postwounding are there the greatest fibroblast numbers? |
|
Definition
|
|
Term
| What is proud flesh and what species it common in? |
|
Definition
| Overexuberant granulation tissue (fibroblasts) - epithelial growth cannot keep up with fibroplasia - horses |
|
|
Term
| What initiates the extrinsic coagulation pathway? |
|
Definition
| thromboplastin mediated (cellular guts) |
|
|
Term
| What initiates the intrinsic coagulation pathway? |
|
Definition
| Collagen exposure to blood - excites platelets |
|
|
Term
|
Definition
| Prothrombin time - plasma is mixed with tissue thromboplastin and calcium. Clot time depends on factor 7 and common pathway factors |
|
|
Term
|
Definition
Buccal Mucosal Bleeding Time -
Nonspecific test that primarily evaluates intrinsic (i.e. platelet adhesion and activation)
Platelet defects/deficiency, vWB disease, capillary fragility = prolonged bleeding time
Factor defects = rebleeding from site
I mm incision made into inner lip – siphon excess blood with gauze – record time it takes for the clot to form – normally takes 1 – 5 min |
|
|
Term
What does the platelet count evaluate?
What are the major concerns with performing this test? |
|
Definition
| Platelet adhesion and activation - phlebotomy needs to be PERFECT |
|
|
Term
| What is the ACT test and what factor does it evaluate? What causes a prolonged ACT? |
|
Definition
| Activated coagulation time - measures coagulation time of blood added to diatomaceous earth - evaluates factor 11 - severe thrombocytopenia and intrinsic coagulopathies |
|
|
Term
| What factor does the APTT test evaluate? |
|
Definition
|
|
Term
| What is a fibrinogen assay and why is it used to evaluate hemostasis? |
|
Definition
| Fibrinogen is the most abundant factor in normal plasma - concentrations increase with inflammation and decrease when it is used, such as a DIC - total solids is measured before and after cooking |
|
|
Term
| What is the most reliable assay to evaluate warfarin/second generation coumarin toxicity and why? |
|
Definition
| PT test - evaluates activation of vitamin K dependent factors |
|
|
Term
| What is cox-1 responsible for? |
|
Definition
| Normal functions of platelet aggregation, protection of GI mucosa and renal perfusion |
|
|
Term
| What is cox-2 responsible for? |
|
Definition
| Synthesis of inflammatory mediators |
|
|
Term
What kind of drugs are the following?
Acetaminophen (Tylenol®) (non-NSAID)
Ibuprofen (Motrin®, Advil®)
Aspirin
Phenylbutazone (Butazolidin®, “Bute”)
Ketoprofen (Ketofen®, Orudis®)
Flunixin (Banamine®)
Etodolac (EtoGesic®)*
Meloxicam (Metacam® )*
Deracoxib (Deramaxx®)*
Firocoxib (Previcox®)*
Carprofen |
|
Definition
|
|
Term
| selective cox-2 inhibitors - "cox-1 sparing" or minimal cox-1 inhibition |
|
Definition
Etodolac (EtoGesic®)*
Meloxicam (Metacam® )*
Deracoxib (Deramaxx®)*
Firocoxib (Previcox®)* |
|
|
Term
| selective cox-2 inhibitor - little to no cox-1 inhibition |
|
Definition
|
|
Term
| Which clinical (inexpensive & fast) coag. diagnostic could/should be done in a preoperative patient known to or suspected of having received NSAIDs? (i.e. in ANY clinical setting) |
|
Definition
|
|
Term
| Consequences of excessive hemorrhage |
|
Definition
Inhibition of clot formation in the wound
Hypovolemia
Anemia
Hypoproteinemia |
|
|
Term
| Tools to contain hemostasis intraoperatively |
|
Definition
Gauze
Hemostatic forceps
Ligatures
Electrocautery
Laser
Tourniquet
Commercial hemostatic agents |
|
|
Term
| Should you blot or wipe with gauze? Should it be dry or semisaturated? |
|
Definition
Blot - wiping is abrasive and disturbing to the clot.
Semi-saturated - fibroblasts and platelets will stimulate clot formation. |
|
|
Term
| How does the crushing action aid in hemostasis? |
|
Definition
| Exposes more collagen and releases clotting factors, physically stops blood flow |
|
|
Term
| Difference between monopolar and bipolar electrocautery |
|
Definition
Monopolar = single electrode handpiece. Touch to hemostat to isolate tissue/vessel.
Bipolar = forcep handpiece - current runs from one tip to the other. |
|
|
Term
|
Definition
|
|
Term
| How often must you release a tourniquet to reprefuse tissues? |
|
Definition
| no longer than every 30 min |
|
|
Term
Commercial products used in intraoperative hemostasis:
Gelfoam |
|
Definition
| absorptive, synthetic material that swells with blood and exerts pressure within the wound |
|
|
Term
|
Definition
| cellulose material that becomes a gelatinous mass when exposed to blood/body fluids - provides scaffold for clot formation. Similar to calcium alignate |
|
|
Term
|
Definition
Polysaccharide beads/fibers
Absorbant materal integrated into a clot - activates platelets and clotting factors |
|
|
Term
| 3 ways to manage hemorrhage postoperatively |
|
Definition
| Drains, compression bandages, cryotherapy |
|
|
Term
| What is cryotherapy? Why is it used for postoperative hemorhagge control? |
|
Definition
| application of low temperatures to remove heat from an area ofthe body - causes vasoconstriction, which decreases blood flow and limits edema formation |
|
|
Term
|
Definition
1st intention - primary closure
2nd intention - granulation
3rd intention - delayed surgical closure
3rd intention - |
|
|
Term
| What is a 'clean' wound, 'clean-contaminated' wound, 'contaminated' wound, or 'infected/dirty' wounds? |
|
Definition
clean = surgical incisions under ideal conditions
clean contaminated = surgical incisions with potential of contamination or open wound with healthy granulation tissue
contaminated = acute traumatic wounds, major break in surgical asepsis, acute inflammation
dirty wound = traumatic wound older than 4-6 hrs - perforated hollow organ - visible gross contamination - purulent |
|
|
Term
| What is the golden period? |
|
Definition
| less than 4-6 hours after a wound has been made - when primary closure should take place |
|
|
Term
| Why would we use second intention healing? |
|
Definition
| avoid formation of an abscess - allow debridement to occur - significant contamination or insufficient amount of skin to close |
|
|
Term
| How could 2nd intention healing affect function of a limb/muscle? |
|
Definition
| excessive scarring decreases mobility |
|
|
Term
| What is the main goal of bandaging? |
|
Definition
| Provide the optimal micro-environment for healing |
|
|
Term
| 6 things to consider for bandaging |
|
Definition
CDMTPP
Contamination, debridement, moisture, temperatue, pressure, pain |
|
|
Term
|
Definition
| decontamination and debridement |
|
|
Term
| What is the optimum psi for lavage? What happens if you use too much pressure? |
|
Definition
10-15 psi
If greater than 15 is used, contaminants are driven into the wound |
|
|
Term
| Required properties of lavage fluid |
|
Definition
| sterile, isotonic, buffered |
|
|
Term
| What concentration of chlorhexidine or povidone iodine is the best for the final rinse of a lavage? |
|
Definition
|
|
Term
| how long does chlorhexidine have residual activity and how is it able to do this? |
|
Definition
| 12-24 hrs; binds to tissues with minimal 2 min contact time |
|
|
Term
| What are the disadvantages of using povidone iodine? |
|
Definition
| Even when diluted appropriately, may still inhibit neutrophil activity. Potential systemic toxicity if used on large wounds. No tissue binding - diminished by organic matter - short residual activity (4-6 hrs) |
|
|
Term
| Why should we not use hydrogen peroxide? |
|
Definition
| Very little antimicrobial activity - drying agent - cytotoxic - thrombosis of capillaries |
|
|
Term
| Why should we not use acetic acid? |
|
Definition
| cytotoxic even when diluted, painful |
|
|
Term
| Why should we not use bleach? |
|
Definition
| extremely cytotoxic, even when very diluted |
|
|
Term
| advantage of PHMB dressing |
|
Definition
| decreases microbial contamination of wound and bandage. |
|
|
Term
advantage of Film
Foam
Hydrogels
Hydrocolloids
Alginates |
|
Definition
| decreases access of environmental contaminants |
|
|
Term
adherent dressing =
can be used for how many days? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How and why would we provide moisture to a dry wound? |
|
Definition
| decrease viscosity of thick exudates to increase drainage to secondary layer. Macerates necrotic, dessicated, and healthy tissues. Usually applied wet to dry |
|
|
Term
| What type of bandage should be used to promote autolysis and selective debridement? |
|
Definition
Hydrogels or alignates
amorphous gel over wound is wiped/lavaged away. |
|
|
Term
| What type of bandage can accommodate some exudation, and is good for maintaining granulation or for transition from debridement to granulation? Also good for debridement of deep wounds |
|
Definition
|
|
Term
| What stage of healing is foam best used for? |
|
Definition
| Granulation, except when there is little moisture (will dehydrate wound) |
|
|
Term
| Maceration vs. dessication |
|
Definition
maceration = too wet = friable tissues, easily traumatized, poor wound strength, impedes cellular activity
dessication = too dry = dehydration = cell death - cessation of cellular activity, tissue fractures, increased scarring, prolonged healing time |
|
|
Term
What amount of moisture is the following meant to handle?
foam |
|
Definition
| mild to moderate exudation/serous drainage |
|
|
Term
|
Definition
| Mild serous drainage (can't be left on for too long, can dry and become adherent) |
|
|
Term
|
Definition
| minimal serous drainage - non draining wound |
|
|
Term
|
Definition
| transparent film used for wounds with ZERO exudate only |
|
|
Term
| Should thick exudates have a wet or dry dressing? What about serous exudates? Why? |
|
Definition
| Thick exudates should have a wet bandage to help fluids flow out better. Serous exudates should have a dry dressing |
|
|
Term
Alignate can absorb ___ times its weight in exudate. For this reason it is great for heavily suppurative wounds.
How long can you leave alginate on a wound? |
|
Definition
|
|
Term
| Why is it important to prevent wound hypothermia? |
|
Definition
| slows healing because of vasoconstriction and decreased cellular metabolism and activity. decreased oxygenation and removal of wastes. |
|
|
Term
| What else can we do besides an insulating bandage to keep the wound warm? |
|
Definition
| minimize exposure time during bandage changes, warm lavage fluids, warm topical agents/dressings |
|
|
Term
| pressure influence on deadspace |
|
Definition
| mimimal pressure can be used to decrease dead space and seroma formation. |
|
|
Term
| pressure influence on edema |
|
Definition
| diffuse pressure may be used to stabilize an injury or decrease edema |
|
|
Term
| influence of pressure on blood flow and cellular activity |
|
Definition
| decreases with increased pressure |
|
|
Term
| Influence of pressure on - oxygenation |
|
Definition
| abdominal/thoracic bandages may inhibit ventilation |
|
|
Term
| Influence of pressure on movement of exudates |
|
Definition
| movement into secondary layer inhibited - decreases storage capacity of secondary layer |
|
|
Term
| Why are active drains particularly important for skin grafts? |
|
Definition
Prevent hematoma/seroma formation under the graft and undermined skin.
Gentle suction forces contact between skin and SQ tissue. Applying a bandage would cause too much pressure and lack of blood flow, causing loss of the skin graft |
|
|
Term
| 3 main reasons for drains |
|
Definition
| decrease dead space, remove fluids, decrease contamination |
|
|
Term
| Why do bite wound injuries weep excessively? |
|
Definition
1)microbial contamination
2) Inflammation of underlying tissues that were crushed/torn |
|
|
Term
| Why is honey used as a topical wound agent? |
|
Definition
| antimicrobial due to acidity - osmotic pressure draws fluid |
|
|
Term
| Good choices for topicals |
|
Definition
| water soluble/miscible or petroleum-based |
|
|
Term
| Why shouldn't you use powders or corticosteroids? |
|
Definition
powders act as a foreign contaminant in the wound, prolonging debridement.
steroids decrease inflammation, which decreases debridement and repair. |
|
|
Term
| To prevent proud flesh... |
|
Definition
immediate closure if possible
Bacitracin (accelerates epithelialization)
Nonadherent dressing
Light pressure to reduce blood flow and slow fibroplasia
Steroids after 5 days |
|
|
Term
| How should you prep a wound for surgical closure? |
|
Definition
KY for exposed tissue
Dilute chlorhexidine lavage
Chlorhexidine scrub for periwound skin |
|
|
Term
| Why would a stent suture pattern be used? |
|
Definition
| Create diffuse pressure, so that the pressure is mostly on penrose tubing, not wound edges |
|
|
Term
| Purpose of 'freshening' the edges of a wound for a skin graft |
|
Definition
| blood and clot formations will provide minimal connections between fresh tissue and grafted skin |
|
|
Term
| What is pain and how does it occur? |
|
Definition
| a noxious stimulus causes inflammatory mediators to stimulate nociceptors, which travel up neural pathways to the brain |
|
|
Term
| What occurs during modulation |
|
Definition
| CNS can either depress or amplify an impulse |
|
|
Term
|
Definition
| Windup occurs during general anesthesia when NMDA receptors are stimulated, but impulses are not perceived. When the animal wakes up, CNS hypersensitivity occurs and nerve impulses are amplified |
|
|
Term
| Why do animals mask pain? |
|
Definition
| natural selection - less likely to become prey if they don't visually exhibit pain |
|
|
Term
| Negative ramifications of pain |
|
Definition
1)Patient suffering
2)Stress increases ACTH, cortisol, and epinephrine. decreases insulin
causes decreased appetite, catabolic wasting, and increased risk of infection
- compromised cardiovascular function - increased inflammation - increased risk of chronic pain - increased fear/anxiety - prolonged recovery |
|
|
Term
| Goals behind perioperative analgesia |
|
Definition
optimize patient recovery and minimize risk of chronic pain.
Balance between controlling pain but not so much that the animal will not pay attention to it. |
|
|
Term
|
Definition
| administering analgesics before pain is induced |
|
|
Term
|
Definition
| variety of drugs and mechanisms of action - variety of routes - intervene pain pathway at different areas |
|
|
Term
|
Definition
| when a drug has a maximum effect at a certain blood level, the effect will not increase with higher doses due to all the receptors for that drug already being bound. |
|
|
Term
|
Definition
| GI ulceration and hemorrhage, hemorrhage, hepatic & renal toxicity |
|
|
Term
| contraindications/cautions with NSAIDs |
|
Definition
| Impaired renal or hepatic function, GI disease, dehydration, hypotension, hemorrhage or impaired hemostasis |
|
|
Term
| symptoms that clients should watch for when prescribed NSAIDs |
|
Definition
anorexia, nausea, vomiting, diarrhea, bleeding (or hematemesis, melena, hematochezia)
coffee grounds
bleeding from incision or bruising |
|
|
Term
| systemic side effects of opioids |
|
Definition
| cardiopulmonary depression, emesis and/or defecation, CNS depression, constipation |
|
|
Term
| contraindications/cautions with opioids |
|
Definition
| hepatic disease, cardiopulmonary disease, head trauma, pre-existing altered bowel motility |
|
|
Term
| common initial effects of opioid administration |
|
Definition
|
|
Term
| Adverse side effects you should monitor for with opioids |
|
Definition
hypoventilation, bradycardia, prolonged CRT, weak pulses, hypotension,
nausea/emesis, excessive sedation, dysphoria |
|
|
Term
| how frequently should you monitor patients receiving opioids? |
|
Definition
| every 15 min-every hour, depending on dose, route, patient, and drug |
|
|
Term
| name some alpha2 agonists |
|
Definition
| Xylazine, Dexmedetomidine, Detomidine |
|
|
Term
| same some alpha 2 antagonists |
|
Definition
|
|
Term
| name some sodium channel blockers (local anesthetics) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what type of drug is tramadol? |
|
Definition
|
|
Term
Short duration of analgesia (30-90 min.)
Profound sedation
Cardiopulmonary effects (severe bradycardia, heart block, hypotension, resp. depression, & emesis)
Exacerbated w/opioids
Possible colic in horses (decreased gut motility)
Dex-butorphanol – good combination for minor procedures |
|
Definition
|
|
Term
| affect sensory & motor neurons equally (:. Sensory & motor impairment) |
|
Definition
|
|
Term
2 min (immediate) onset
Painful, due to acidity (buffer?)
Duration 20 min-1h (2h w/epi)
Buffer to avoid pain on initial injection (see pg 185; 0.8 mL Na bicarb to 10mL lidocaine) |
|
Definition
|
|
Term
Na channel blocker; with > lipid solubility & protein binding, rendering prolonged effects compared to lidocaine
20 min. onset
duration 4-6 h. [8 h. w/ epi.)
Poss. sensitivity to drug in larger animals (rats very tolerant; rabbits highly sensitive)
SQ only
Cardiotoxicity – IV route contraindicated! |
|
Definition
|
|
Term
Should be taken with food (may cause nausea)
Mu receptor activity + inhibition of norepinephrine & serotonin reuptake = analgesia |
|
Definition
|
|
Term
| What are non-pharmaceutical, palliative nursing care practices that may relieve discomfort in hospitalized patients? |
|
Definition
Cryotherapy (acute injuries)
Heat therapy (NOT for acute injuries)
Massage
Bandaging
Acupressure
Laser therapy
Other physiotherapies
Padding
Repositioning/turning |
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|
