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Lecture Notes For Wound Management: Principles and Practices, 4th Edition

Stay on top of your studies with Lecture Notes For Wound Management: Principles and Practices, 4th Edition, providing well-organized notes that summarize the essential topics.

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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 1 preview imageInstructor’s ManualforWound Management:Principles and Practice4thEditionBetsy A. Myers, DHS, MPT, OCS, CLT, CWSAssistant Professor of Physical Therapy,University of Tennessee at ChattanoogaChattanooga, TNandStaff Physical Therapist,Saint Francis Health SystemTulsa, OKLECTURE NOTES
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 2 preview image
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 3 preview imageiiiTABLE OF CONTENTSIntroduction1Chapter 1 Integumentary Anatomy2Chapter 2 Wound Healing6Chapter 3 Factors Affecting Wound Healing9Chapter 4 Examination of Patients with Open Wounds12Chapter 5 Debridement20Chapter 6 Management of Infection28Chapter 7 Dressing Selection and Bandaging36Chapter 8 Biophysical Agents43Chapter 9 Nutrition and Interdisciplinary Care51Chapter 10 Arterial Insufficiency Ulcers54Chapter 11 Venous Insufficiency Ulcers58Chapter 12 Pressure Injuries68Chapter 13 Neuropathic Ulcers74Chapter 14 Burns80Chapter 15 Lymphedema86Chapter 16 Miscellaneous Wounds92Chapter 17 Basic Dermatology96
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 4 preview image1INTRODUCTIONThis Instructor’s Resource Manual will save course instructors valuable time and allows forconsistent and inclusive presentation of material from the 4thedition ofWound Management:Principles and Practice. The manual includes a preview of chapter objectives, key terms, and achapter outline to quickly focus instructors on the material to be covered. Next, the manualprovides key discussion points for each chapter to spur student conversation and help studentslearn key points. Third, the manual provides teaching tips for instructors to help students masterchapter objectives. The manual also contains comprehensive laboratory activities. Studentlaboratory handouts contain step-by-step procedures for wound management techniques, writtenactivities to reinforce chapter material, as well as opportunities for guided practice of physicalskills both individually and in small groups. The instructor laboratory handout contains supplylists and answers to student laboratory activities. A separate infection control lab is included tohelp students learn operational definitions of key terms such as contamination, disinfect, clean,and sterile. Laboratory activities are made even easier by taking advantage of the many videosprovided in the accompanying website to watch complex skills such as pulsatile lavage withsuction, multilayer compression bandaging, and sterile procedures.Instructors can access MyHealthProfessionsKit to access many resources in an electronic format.It includes the complete test bank that allows instructors to design customized quizzes and exams.The MyTest wizard guides you through the steps to create a simple test with drag and-drop orpoint-and-click transfer. Instructors can select test questions either manually or randomly and useonline spell-checking and other tools to quickly polish their test content and presentation. Thequestion formats include multiple choice, fill-in-the-blank, true/false, and essay. Instructors cansave their tests in a variety of formats both locally and on a network, print up to 25 variations of asingle test, and publish tests in an online course.The instructor manual also includes aPowerPoint Lecturepackage that contains keydiscussion points, along with figures and tables, full color images of patients with open wounds,and video links for each chapter. This feature provides dynamic, fully designed, integratedlectures that are ready to use and allows instructors to customize the materials to meet theirspecific course needs.Anelectronicversion of this Instructor’s Resource Manual can be accessed.Of course, the manual also contains all of the updates of the 4thedition of the textbook includingthe latest information from the National Pressure Ulcer Advisory Panel on pressure injures,current data on biofilms and wound infections, new standards regarding circulation required fortissue healing, and contemporary evidence on neuropathy and the treatment of patients withneuropathic ulcers.
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 5 preview image2Chapter 1Integumentary AnatomyMULTIPLE CHOICE. Choose the one alternative that best completesthe statement or answers the question.1. All of the following are functions of the dermis EXCEPT:A.Provides sensation.B.Houses epidermal appendages.C.Assists with thermoregulation.D.Assists with vitamin D production.2. Cells that can be found in the dermis are:A.Merkel cells.B.fibroblasts.C.Langerhans' cells.D.melanocytes.3. The stratum corneum can be found in the:A.dermis.B.fascia.C.epidermis.D.adipose tissue.4. A full-thickness wound involves the following tissue layers:A.Epidermis.B.Dermis and subcutaneous tissue.C.Subcutaneous tissue.D.Epidermis, dermis, and subcutaneous tissue.5. A stage 2 pressure injury can also be described as a ______ lesion.A.Wagner grade 4.B.partial-thickness.C.superficial thickness.D.full-thickness.6. An abrasion most commonly involves ______ .A.the epidermis, dermis, and subcutaneous tissue.B.fascia but not adipose tissue.C.the epidermis.D.the epidermis and dermis.
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 6 preview image37. A callus is caused by a build-up of cells within the stratum basale.A.True.B.False.8. The number of melanocytes determines an individual's skin color.A.True.B.False.9. Mast cells produce the following substances:A.collagen.B.keratin.C.histamine.D.sebum.10. Sudoriferous glands are present everywhere EXCEPT:A.the lips.B.the hands and feet.C.the feet.D.the hands.11. Which of the following is true regarding hair follicles?A.They assist with infection control.B.They are located in the subcutaneous tissue.C.They are present everywhere except the palms and soles.D.They are composed of hard collagen.12. When examining a patient's wound, you notice regularly arranged white fibrous tissue.What do you suspect this structure is?A.Muscle.B.Bone.C.Joint capsule.D.Tendon.13. When examining a patient's wound, you notice gray-black, dry, leathery appearingirregular fibrous tissue. What do you suspect this structure is?A.Healthy tendon.B.Healthy muscle.C.Nonviable joint capsule.D.Nonviable bone.14. When examining a patient's pressure injury, you are able to identify the patient's greatertrochanter within the wound bed. How would you classify the extent of woundinvolvement?A.Superficial.B.Partial-thickness.
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 7 preview image4C.Full-thickness.D.Unable to determine from the information provided.15. When examining a patient's wound, you notice regularly arranged red tissue. What doyou suspect this structure is?A.Joint capsule.B.Bone.C.Tendon.D.Muscle.16. A blister occurs:A.between the papillary and reticular dermis.B.at the junction between the epidermis and dermis.C.at the junction between the dermis and subcutaneous tissue.D.between the stratum basale and the stratum corneum.17. The subcutaneous tissue consists of:A.keratin and adipose tissue.B.sudoriferous and sebaceous glands.C.adipose tissue and fascia.D.the epidermis and dermis.ESSAY. Write your answer in the space provided or on a separate sheet of paper.18. List five functions of the epidermis.19. List three functions of the dermis.20. What is the function of the basement membrane?1) B2) D3) C4) D5) B6) C7) B8) B9) C10) A11) C12) D13) C14) C
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 8 preview image515) D16) B17) C18) Correct answers should include five of the following possible choices:* Provides a physical and chemical barrier.* Regulates fluid.* Provides light touch sensation.* Assists with thermoregulation.* Assists with excretion.* Assists with endogenous vitamin D production.* Contributes to cosmesis.19) Correct answers should include three of the following possible choices:* Supports and nourishes the epidermis.* Houses epidermal appendages.* Assists with thermoregulation.* Provides sensation.20) Correct answers should include the following key points:* Serves as a scaffolding for the epidermis.* Selective filter for substances moving between the epidermis and dermis.
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 9 preview image6Chapter 2Wound HealingCHAPTEROBJECTIVES1. Describe the vascular response of inflammation.2. State the cells involved in the inflammatory phase and describe their functions.3. Describe the proliferative phase of wound healing.4. State the cells involved in the proliferative phase and describe their functions.5. Describe the maturation and remodeling phase of wound healing.6. Differentiate between wound closure by primary, secondary, and delayed primary woundclosure.7. Compare and contrast absence of inflammation and chronic inflammation.8. Explain why absence of inflammation and chronic inflammation occur and interventions thatmay improve wound healing.9. Compare and contrast hypogranulation and hypergranulation.10. Explain why hypogranulation and hypergranulation occur and interventions that mayimprove wound healing.11. Compare and contrast hypertrophic scarring, keloids, contractures, and wound dehiscence.12. Explain why hypertrophic scarring, keloids, contractures, and wound dehiscence may occurand interventions that may improve wound healing.KEYTERMSAbrasionAngioblastsAngiogenesisChemotactic agentsChemotaxisClosed woundCollagenasesContractureCurrent of injuryCytokinesCytotoxic agentsDehiscenceDelayed primary closureDiapedesisEpiboleEpithelializationExudateFibroblastGranulation tissueGrowth factorsHealed woundHypergranulationHypertrophic scarringHypogranularInflammationIntegrinsKeloidsMacrophagesMarginationMast cellsMatrix metalloproteases (MMPs)Maturation/remodelingMyofibroblastsPlatelets
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 10 preview image7Polymorphonuclear neutrophils (PMNs)Primary closureProliferationProstaglandinsScabSecondary closureTissue inhibitors of matrix metalloproteases(TIMPs)TransudateWound contractionCHAPTEROUTLINEI.IntroductionII.Phases of Wound HealingA.Inflammation1.Vascular response2.Cellular responseB.Proliferation1.Angiogenesis2.Granulation tissue formation3.Wound contraction4.EpithelializationC.Maturation and remodelingIII. Types of Wound ClosureA.Primary closureB.Secondary closureC.Delayed primary closureIV. Abnormal Wound HealingA.Absence of inflammationB.Chronic inflammationC.Hypogranulation or nonadvancing wound edgeD.HypergranulationE.Hypertrophic scarringF.KeloidsG.ContracturesH.DehiscenceDISCUSSIONPOINTS1.Why is a wound likely to recur in the same location as a previous ulcer?2.How can inflammation be both beneficial and problematic?3.Why are inflamed wounds characterized by local redness, heat, swelling, pain, and decreasedfunction?4.When looking at an open wound, how might you be able to tell that the wound is primarily inthe proliferative phase of wound healing?
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 11 preview image85.You have been working with a 6-year-old patient with deeply pigmented skin who sustaineda full-thickness burn covering 75% of his upper extremity. The burn wound is now closed.What information would you provide to an insurer about the patient’s wound healing andimpairments to justify the patient’s requirement for continued physical therapy?6.How are chronic wounds different from acute wounds?TEACHINGTIPS1.Using some of the images of patients with open wounds, have the students determine theprimary phase of wound healing for each wound. Ensure that the students describe particularcharacteristics, such as the presence of granular budding or epithelialization.2.Make a list of all of the cells involved in wound healing. Ask the students to describe theirkey functions and what phase(s) these functions occur in.3.Have students group the various types of abnormal wound healing listed within the chapterby the phase of inflammation.4.Have students use the chapter objectives to assess their understanding of the informationprovided.5.Have students define a sampling of the key terms provided. Students may check theiranswers either within the chapter or by using the Glossary in Appendix A.
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 12 preview image9Chapter 3Factors Affecting Wound HealingCHAPTEROBJECTIVES1. State the difference between an acute and a chronic wound.2. Describe wound characteristics associated with delayed wound healing.3. Compare and contrast colonization and infection.4. Describe local factors associated with delayed wound healing.5. Describe systemic factors associated with delayed wound healing.6. Identify potential barriers and methods to facilitate patient adherence.7. Identify and prevent common inappropriate wound management practices which can delaywound healing.KEYTERMSAcute woundAdherenceChronic woundColonizationInfectionMaceratedNecrotic tissueCHAPTEROUTLINEI.IntroductionII.Wound CharacteristicsA.Mechanism of onsetB.Times since onsetC.Wound locationD.Wound dimensionsE.TemperatureF.Wound hydrationG.InfectionH.Necrotic tissue or foreign bodiesI.Changes in chronic woundsIII. Local FactorsA.CirculationB.SensationC.Mechanical stress
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 13 preview image10IV. Systemic FactorsA.AgeB.Inadequate nutritionC.ComorbiditiesD.MedicationE.Lifestyle choicesV.Patient AdherenceA.Understanding and Enhancing Adherence1.Patient characteristics2.Task characteristics3.Health care provider characteristicsVI. Inappropriate Wound ManagementDISCUSSIONPOINTS1. Certain wound characteristics are known to affect the rate of wound healing. List some ofthese characteristics and describe what interventions can be used to address these factors tofacilitate wound healing.2. Now that you know more about normal wound healing and factors that can affect woundhealing, how are chronic wounds different from acute wounds?3. In what ways are matrix metalloproteases (MMPs) beneficial? In what ways are theydetrimental?4. Circulation, sensation, and mechanical stress are local factors that affect wound healing. Thischapter provides some ways in which clinicians can assist with improving circulation.a.How might a physical therapist address loss of sensation as a risk factor for delayedwound healing?b.How might a physical therapist address adverse mechanical stresses in a patient who isnonambulatory?TEACHINGTIPS1. Many times, in physical therapy, the terms acute and chronic are incorrectly used to denotearbitrary time frames for a rehabilitation program, such as acute, subacute, and chronicphases. Help the students clarify the proper use of the terms of acute wounds and chronicwounds using the definitions provided in the chapter.2. Provide a scrambled list of factors known to affect wound healing. Have the students groupthese factors into the following categories:a.Wound characteristicsb.Local factorsc.Systemic factorsd.Factors that can be modified with physical therapy interventions
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 14 preview image11e.Factors that can be modified with medical interventionsf.Factors that cannot be modified3. If students are having difficulty understanding what macerated tissue looks like, try havingthem put an adhesive bandage (e.g., a Band-Aid) on a finger, then soak the finger in a cup ofwater during the lecture portion of the class.4. Integrate information from students’ previous or current coursework regarding thepsychosocial aspects of disability and impairments with methods to enhance patientadherence.5. Have the students use the chapter objectives to assess their understanding of the informationprovided.6. Have the students define a sampling of the key terms provided. Students may check theiranswers either within the chapter or by using the Glossary in Appendix A.
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 15 preview image12Chapter 4Examination of Patients with Open WoundsCHAPTEROBJECTIVES1. Describe the four aspects of obtaining the history of patients with open wounds.2. State the key components of the systems review for patients with open wounds.3. Identify and document wound characteristics.4. Identify and document periwound and associated skin characteristics.5. Assess and document circulation.6. Assess and document sensory integrity.7. Classify open wounds based on extent of tissue damage.8. Document goals for patients with open wounds.KEYTERMSCapillary refillEscharIndurationPitting edemaSemmes–Weinstein monofilamentsSinus tractSloughTunnelingUnderminingCHAPTEROUTLINEI.IntroductionII.ExaminationA.History1.Review of systems2.General demographics3.Lifestyle and functional status4.Past and current general medical history5.Past and current wound historyB.Systems review1.Cardiovascular/pulmonary system2.Musculoskeletal system3.Neuromuscular system4.Integumentary systemC.Tests and measures1.Integumentary integritya.Wound characteristics
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Lecture Notes For Wound Management: Principles and Practices, 4th Edition - Page 16 preview image13i.Wound locationiiWound sizeiii Tunneling/underminingivWound bedvWound edgesviWound drainagevii Wound odorb.Periwound and associated skin characteristicsi.Structure and qualityii. Coloriii Epithelial appendagesiv. Edemav.Temperature3.Circulation4.Sensory integrityIII. Clinical Decision MakingA.DiagnosisB.PrognosisC.InterventionsD.Goals and outcomesDISCUSSIONPOINTS1. Obtaining a medical history and performing a systems review are vital parts of the physicaltherapy examination. List some medical conditions that can adversely affect wound healingand describe why healing may be compromised.2. Why might it be important to assess motor function and range of motion in a patient with anopen wound?3. What are some of the benefits and limitations of using direct measurement to determinewound size?4. When assessing a patient’s wound bed, it is important to estimate what percentage of thewound bed is granular and what percentage is necrotic. Describe ways you might improvethe reliability of your estimation.5. When assessing a patient’s open wound, you notice minimal wound drainage. Is thisdesirable or problematic? Why?TEACHINGTIPS1. Many times, students and clinicians are under the mistaken belief that the examinationof patients with open wounds is vastly different from the examination of patients that areclassified within other practice patterns. Have the students note the similarities acrosspractice patterns in the following portions of a physical therapy examination:
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