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Periop 101
Wound Healing
43
Nursing
Undergraduate 1
09/07/2016

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Cards

Term
The correct sequence of events involved in the body’s defense mechanisms for a wound is as follows
Definition
Stop the blood loss (hemostasis)

Clean up pathogens/debris in the wound

Seal the would against infection

Regenerate the natural epidermal covering

Repair deeper tissue damage
Term
Phases of healing:
Definition
Inflammation: Edema
Phagocytosis
Hemostasis
Proliferation: Epithlialization
Neovascularization
Collagen Synthesis
Contraction
Remodeling: Collagen Remodeling
Tensile Strength
Term
Why is collagen production so important in wound healing?
Definition
• Important phase that contributes to the tensile strength of the wound
Term
. Matching the types of healing
Primary Union (First Intention)
Definition
Minimal tissue loss, wound margins approximated.
Term
Matching the types of healing:
Granulation or second intention –
Definition
significant tissue loss. Wound left open and allowed to heal from the inner layer to the outer surface without additional surgery
Term
Matching the types of healing:

Delayed Primary closure (third intention)
Definition
Wound kept open to monitor infection, gauze packing, closed on day 3-5.
Term
What are the Preoperative systemic factors that negatively affect wound healing?
Definition
Inadequate Nutrition
• Protein deficiency
• Carb and fat deficiency
• Deficiency in Vitamin A, B, C and mineral zinc
Physical conditions
• Older age
• Medications such as sterioids
• Obesity
• Smoking
• Chronic diseases such as diabetes
Term
Classifications:

CLASS I CLEAN WOUNDS
Definition
• No inflammation encountered
• No breaks in sterile technique
• No hollow viscous entered
• Respiratory, alimentary, genital or infected urinary tracts are not entered
• Examples
• Thyroidectomy, mastectomy, ganglion excision, herniorrhaphy, laminectomy
Term
Classification:

Class II Clean contaminated
Definition
• Nontraumatic wounds
• No inflammation encountered
• No breaks in sterile techniques
• Hollow viscous entered
• Respiratory, alimentary, genital or urinary tracts entered under controlled conditions
• Examples
• Cholecystectomy, Hysterectomy abdominal or vaginal
• C-section, tracheostomy, appendectomy, cystoscopy
Term
Classification:

Class III CONTAMINATED WOUNDS
Definition
• Open fresh accidental wounds
• Major break in technique occurred
• Entrance into genitourinary or biliary tracts with infection
• Examples:
• Inflamed but unruptured appendix or gallbladder, open fractures or penetrating wounds.
• Procedures performed with unsterile instruments
Term
Classification:

Class IV DIRTY OR INFECTED WOUNDS
Definition
• Old Wounds with retained devitalized tissue
• Perforated viscera ( Perforated appendix)
• Chronic infected wounds
• Example
• Incision & drainage of an abscess
Term
Select the systemic factors that affect wound healing:

Age of the patient
Sex of the Patient
Preoperative Stress
Medications
Definition
Answers:

Preoperative Stress

Medications
Term
Name 5 factors affecting healing that are controlled by the surgical team:
Definition
• Maintenance of sterile and aseptic techniques to prevent infection.
• Hemostasis
• Removal of necrotic tissue and foreign material
• Choice of closure material
• Closing with sufficient tension
Term
Perioperative factors that affect wound healing
Definition
For Ex. many surgical patients are at risk for unplanned hypothermia in the relatively cool environments of the OR suite.
Hypothermia causes peripheral vasoconstriction, which can compromise wound healing. Periop RNs should implement measures that assist the patient in maintaining normothermia during operative procedures.
Term
Other examples of periop factors that affect wound healing:
Definition
• adherence to appropriate skin preparation and sterile techniques
• duration of surgery
• amount of traffic in the OR
Term
Select the factors that are responsible for slower healing and postsurgical complications:
• Diabetes
• Rhinitis
• Obesity
• Ear wax
Definition
Answer:

Diabetes

Obesity
Term
48. Based on what you have learned about the preoperative factors that affect wound healing. Identify the nutritional component that supports collagen formation and increases capillary formation:
• Vitamin A
• Vitamin B
• Vitamin C
• Zinc
• Protein
Definition
Answer:

VITAMIN C
Term
From the list of wound examples, list the wound type:

Colon resection
Definition
Class II clean contaminated wounds
Term
From the list of wound examples, list the wound type:

Ruptured appendix
Definition
Class IV Dirty or infected wounds
Term
From the list of wound examples, list the wound type:

Fresh surgical incision
Definition
Class III contaminated
Term
From the list of wound examples, list the wound type:

open leg wound from a car accident
Definition
Class III Contaminated wounds
Term
Methods used to stop bleeding. Examples of hemostatic products include
Definition
Fibrin Sealants:
• These products promote blood clotting by increasing the amounts of fibrinogen and thrombin at a bleeding site. The fibrin in these products is derived from pooled or individual human plasma, equine or bovine collagen and bovine thrombin.
• Synthetic sealants are also available.
• Examples:
• Tisseel, Tachosil, Vitgel, Coseal, Duraseal, Progel, Bioglue, Omnex.
Term
Methods used to stop bleeding. Examples of hemostatic products include:
Definition
Flowables
• These are combinations of passive and active hemostatic agents. They work by mechanically obstructing the flow of blood and converting fibrinogen into fibrin at the bleeding site. They do not contain fibrinogen and require direct contact with blood to make this conversion work.
• Examples:
• Floseal and Surgiflo.
Term
Methods used to stop bleeding.

Active Hemostatic Agents:
Definition
• These agents contain thrombin and products mixed with thrombin. They Enhance clotting at the bleeding site.
• Examples:
• Thrombin, topical, bovine origin
• Thrombin, topical, human
• Thrombin, topical recombinant
Term
Methods used to stop bleeding:

Passive or mechanical hemostatic agents
Definition
• These agents are applied at the bleeding site and provide a barrier to stop blood flow.
• Collagens: Avitene, Ultrafoam, Helistat, Helitene and Instat
• Cellulose: Surgical and Nu-Knit
• Gelatins: gelfoam and Surgifoam
• Polysaccharide spheres: Aristak, hemostase & Vitsuire
Term
Always clean open wounds with:

Sterile water

Iodine

Alcohol

Chlorhexidin gluconate
Definition
Answer: STERILE WATER

some antiseptic solutions are suitable for healthy unbroken skin but are too caustic for an open wound
Term
During which phase of wound healing does contraction occur?

Epithelialization

Inflammation

Proliferation

Remodeling
Definition
Answer: PROLIFERATION
Term
Identify the proper sequence of events in the body’s defense mechanism:
Definition
Hemostasis
Cleaning up the pathogens
Wound sealing
Regeneration of epidermal covering
Repairing deeper tissue damage
Term
At what point in the healing process do most wound disruptions occur?

Beginning of Proliferative
End of Proliferative
Beginning of motivation phase
End of maturation phase
Definition
Beginning of Proliferative
Term
Clean wound
Definition
Thyroidectomy
Term
Clean contaminated
Definition
Colon resection
Term
Contaminated wounds
Definition
Open or fresh traumatic wound
Term
Dirty wounds
Definition
ruptured appendix
Term
Prolonged high dosages of steroids preoperatively delay

Hemoglobin formation
Site production
Insulin production
Collagen formation
Definition
Answer: COLLAGEN FORMATION
Term
The CDC’s classification of surgical wounds system is intended to:
Definition
Monitor postoperative infections and suggest steps to take to decrease these infections.
Term
Select the intraoperative factors that negatively affect wound healing:

Surgical complication

Failure to eliminate dead space when closing the incision

Implantation of orthopedic hardware

Surgical incisions in an area of high mobility.
Definition
Surgical complication

Failure to eliminate dead space when closing the incision

Implantation of orthopedic hardware

Surgical incisions in an area of high mobility.
Term
Passive
Definition
Provides a barrier
Term
Flowable
Definition
Mechanically obstructs the flow of blood
Term
Fibrin Sealants
Definition
Increases amount of fibrinogen at site
Term
Active
Definition
Enhanced clotting
Term
Methods of producing hemostasis include the following:

Administering blood
Applying pressure
Electrocautery

Irrigating with large amounts of sterile saline

Use of antiseptic solution containing alcohol
Use of topical hemostatic agents
Definition
Administering blood

Applying pressure

Electrocautery

Use of topical hemostatic agents
Term
The process of digestion of pathogens by neutrophils and macrophages is known as

Epithelialization

Hemostasis

Oedema formation

Phagocytosis

Proliferation
Definition
Phagocytosis
Term

Matching

Gastrointestinal surgery 

Definition
Gastrointestinal surgery - ostomy placement
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