AFAMS Wound Management مراقبت جرحه 01/11/2012. AFAMS Wound Management مراقبت جرحه Learning Objective: Physical Therapy Technicians will gain an understanding

AFAMS

Wound Managementجرحه مراقبت

01/11/2012

AFAMS


Learning Objective: Physical Therapy Technicians will gain an understanding of wound management.

Estimated Time to Complete: 240 minutes. : لکچر تکمیل برای شده تعین دقیقه 240 وقت

AFAMS

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Enabling Learning Objectiveآموزش توانائی اهداف

• Define key terms related to wound management.

• Identify three stages of wound healing.

• Describe the process of wound healing and factors that may impair the healing process.

• Identify common complications of wound healing.

کلیدی • اصطالحات تعریفجرحه مراقبت به مربوط

میگردد.چهار • نمودن مشخص

. جرحه التیام مرحلهالتیام • های پروسه شرح

که های فکتور و جرحههای پروسه تخریب سبب

. میگردد التیاماختالطات • نمودن مشخص

. جرحه التیام معمول

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Infection - The invasions and multiplication of infective agents in body

Closed Wounds

• Contusion

• Crush Injury

یک انتان - تکثیر و حمله. عضویت در انتانی عامل

بسته جروحاتکوفتگی •تصادم • از ناشی جروحات

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Open Wounds

• Abrasions

• Lacerations

• Avulsion

• Amputations

• Punctures

• Bite

باز جروحات

گی • خراشیدهگی • پارهگی • شده جداگی • شده قطعگی • شده سوراخزدن / • چک گی گزیده

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Wounds

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Wounds

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Wounds

• Customize

• Shotgun approach not acceptable

• No two patients OR wounds are identical

58y DM, Neuropathy: unaware of R foot gangrene

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Review of Wound Healing

• Three basic types of healing– Primary– Delayed

Primary– Secondary

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Types of Wound Healingجرحه انواع

Primary Intention• When wound edges are

directly next to one another• Little tissue loss• Minimal scarring occurs• Most surgical wounds heal

by first intention healing• Wound closure is

performed with sutures, staples, or adhesive at the time of initial evaluation

: ابتدائی هدفجرحه • کنارهای زمانیکه

هم پهلوی مستقیمأدیگرباشند.

انساج • اندکی ضیاعندبه • ناچیز وقوعاز • بسیاری التیام

بواسطه جراحی جروحاتپروسه ابتدایی اقدام. میگیرد صورت التیام

توسط • جرحه نزدیکی , , ویا ستپل ها خیاطه

زمان در چسپ توسطاجراء ابتدایی ارزیابی

میگرد.

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Types of Wound Healingجرحه التیام انواع

Secondary Intention

• The wound is allowed to granulate

• May be packed a wound with gauze or use a drainage system

• Results in a broader scar

• Healing process is slow

• Wound care must be performed daily

: ثانوی هدفتا • میدهد موقع جرحه به

. نماید گرانولیتبسته • گاز با جرحه ممکن

دریناژ سیستم از ویا شدهگردد استفاده

وسیع • ندبه تشکلپروسه • شدن آهسته

التیام باید • جرحه از مراقبت

گردد انجام روزانه

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Types of Wound Healingجرحه التیام انواع

Delayed primary closure: (Tertiary Intention)

• The wound is initially cleaned, debrided and observed, typically 4 or 5 days) before closure

• The wound is purposely left open

هدف :( شروع در تاخیرثالثی)

جرحه • شدن بسته از قبل , پاک روز پنج تا چهار ابتدأ

. گردد مالحظه و تطهیر

جرحه • هدفی اساسی به. میشود نگهداشته باز

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Wounds

• Reconstructive Ladder– Simple to

ComplexFormal Debridement, Elevation/ABI’sAppropriate IV ABX, Wound Vac, Skin Graft

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Primary

• Wound surfaces opposed

• Healing without complications

• Minimal new tissue

• Results optional

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Delayed Primary

• Left open initially• Edges approximated 4-6 days later

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Secondary

• Surfaces not approximated

• Defect filled by granulation

• Covered with epithelium

• Less functional• More sensitive to

thermal and mechanical injury

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Secondary Wound Healing

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Phases of Wound Healing

• Inflammatory Phase• Proliferative Phase

– Begins when wound is covered by epithelium– Production of collagen is hallmark– 7 days to 6 weeks

• Remodeling Phase (Maturation Phase)

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Inflammatory Phase

• Hemostasis and Inflammation

• Days 4 - 6

• Exposed collagen activates clotting cascade and inflammatory phase

• Fibrin clot = scaffolding and concentrate cytokines and growth factors

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Inflammatory Phase

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Inflammatory: Granulocytes

• First 48 hours• Attracted by

inflammatory mediators

• Oxygen-derived free radicals

• Non-specific

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Inflammatory Phase

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Inflammatory: Macrophages

• Monocytes– attracted to area by

complement– Activated by:

• fibrin• foreign body

material • exposure to hypoxic

and acidotic environment

• Reached maximum after 24 hours

• Remain for weeks

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Inflammatory: Macrophages

• Activated Macrophage:– Essential for

progression onto Proliferative Phase

– Mediate:• Angiogenesis:

FGF, PDGF, TGF-a&b and TNF-a

• Fibroplasia: IL’s, EGF and TNF

– Synthesize NO – Secrete collagenases

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Inflammatory Phase

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Phases of Wound Healing

• Inflammatory Phase

• Proliferative Phase

• Remodeling Phase

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Proliferative Phase

• Epithelization, Angiogenesis and Provisional Matrix Formation

– Begins when wound is covered by epithelium

• Day 4 through 14

• Production of collagen is hallmark

• 7 days to 6 weeks

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Proliferative Phase

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EpithelializationEpithelialization

Basal epithelial cells at the wound margin flatten (mobilize) and migrate into the open wound

Basal cells at margin multiply (mitosis) in horizontal direction

Basal cells behind margin undergo vertical growth (differentiation))

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Proliferative: Fibroblast

• Work horse of wound repair• Produce Granulation

Tissue:– Main signals are PDGF

and EGF– Collagen type III– Glycosaminoglycans– Fibronectin – Elastin fibers

• Tissue fibroblasts become myofibroblasts induced by TGF-b1

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Wound Contraction

• Actual contraction with pulling of edges toward center making wounds smaller

• Myofibroblast: contractile properties

• Surrounding skin stretched, thinned

• Original dermal thickness maintained

• No hair follicles, sweat glands

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Epithelialization/ContractionEpithelialization/Contraction

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EpithelializationEpithelialization

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Collagen Homeostasis

• After Wounding (Optimal Healing)

– Days 3 - 7 week• Collagen production

begins– Days 7 – 42

• Synthesis with a net GAIN of collagen

• Initial increase in tensile strength due to increase amount of collagen

– Days 42+• Remodeling with No

net collagen gain

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Three Phases of Wound Healing

• Inflammatory Phase• Proliferative Phase• Remodeling Phase

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Maturation Phase

• Random to organized fibrils • Day 8 through years• Type III replaced by type I• Wound may increase in

strength for up to 2 years after injury– Collagen organization– Cross linking of collagen

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Maturation Phase

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Factors that Complicate the Wound Healing Process

را جرحه التیام پروسه که های فکتورمیسازد اختالطی

• Extent of the Injury

• Type of Injury

• Patient's Nutritional Status

• Age of patient

• Obesity

جرحه • وسعتجرحه • نوعمریض • تغذیه حالتمریض • سنچاقی •

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Factors that Complicate the Wound Healing Process

را جرحه التیام پروسه که های فکتورمیسازد • اختالطی Infection

• Drugs

• Diabetes Mellitus

• Smoking

انتان •ادویه •میالتوس • مرضشکرگشیدن • سگرت

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Impaired Wound Healing

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Wound Complicationsجرحه اختالطات

• Abscess • Adhesion • Cellulitis • Dehiscence • Evisceration • Extravasations • Hematoma • Compartment Syndrome

ها • آبسهالتصاقات •سیلوالیتس •جرحه • پارهگیجراحی •اکستراوزیشن•زهیماتوما •کمپارتمنت • سندروم

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Compartment Syndromeسندروم کمپارتمنت

• A progressive degeneration of tissue and muscle

• A severe interruption of blood flow.

• Signs and symptoms include:– Pain with pressure – Diminished sensation

distal to the compartment area.

– Diminished to absent extremity pulses distal to the injury

انحطاط • یک از عبارتو انساج در پیشرفته

میباشد عضالتدر • شدید اختالط یک

میباشد خون دورانعالیم • اعراضو

شامل ....فشار • با توأم دردبعیده • کاهشحسیت

کمپارتمنت نواحی درعدم • یا کاهش

نبضان موجودیتناحیه در بعیده نهایات

. دیده صدمه

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Wound Healing

• To treat the wound, you have to treat the patient

• Optimize the patient– Circulatory– Pulmonary– Nutrition– Associated diseases

or conditions

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• Oxygen

– Fibroblasts are oxygen-sensitive– PO2 < 40 mmHg collagen synthesis cannot take

place – Decreased PO2: most common cause of wound

infection– Healing is Energy Dependent– Proliferative Phase has greatly increased

metabolism and protein synthesis

Wound Healing

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• Hypoxia:

– Endothelium responds with vasodilation

– Capillary leak– Fibrin deposition– TNF-a induction

and apoptosis

Wound Healing

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• Edema

– Increased tissue pressure

– Compromise perfusion

– Cell death and tissue ulceration

Wound Healing

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• Infection

– Decreased tissue PO2 and prolongs the inflammatory phase

– Impaired angiogenesis and epithelialization

– Increased collagenase activity

Wound Healing

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• Nutrition– Low protein levels

prolonged inflammatory phase

– impaired fibroplasia– Of the essential amino

• Methionine is critical

• Hydration– A well hydrated wound

will epithelialize faster than a dry one

– Occlusive wound dressings hasten epithelial repair and control the proliferation of granulation tissue

Wound Healing

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• Temperature– Wound healing is

accelerated at environmental temperatures of 30°C

– Tensile strength decreases by 20% in a cold (12°C) wound environment

• Denervation– Denervation has no effect

on either wound contraction or epithelialization

Wound Healing

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• Diabetes Mellitus– Larger arteries, rather than the

arterioles, are typically affected • Sorbitol accumulation• Increased dermal vascular

permeability and pericapillary albumin deposition

• Impaired oxygen and nutrient delivery

– Stiffened red blood cells and increased blood viscosity

– affinity of glycosylated hemoglobin for oxygen contributing to low O2 delivery

– impaired phagocytosis and bacterial killing

– neuropathy

Wound Healing

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• Radiation Therapy– Acute radiation injury

• stasis and occlusion of small vessels

• fibrosis and necrosis of capillaries

• decrease in wound tensile strength

• direct, permanent, adverse effect on fibroblast

• may be progressive• fibroblast defects are the central

problem in the healing of chronic radiation injury

Wound Healing

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• Medications– Steroids

• Stabilize lysosomes and arrest of inflammation response

• inhibit both macrophages and neutrophils

• interferes with fibrogenesis, angiogenesis, and wound contraction

• Also direct effect on Fibroblasts– Minimal endoplasmic

reticulum• vitamin A

– oral ingestion of 25,000 IU per day pre op and 3d post op (not to pregnant women)

– Restores inflammatory response and promotes epithelializaton

– Does not reverse detrimental effects on contraction and infection

Wound Healing

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• Nutritional Supplements

– Vitamin C ( Ascorbic Acid)• is an essential cofactor in the

synthesis of collagen• excessive concentrations of

ascorbic acid do not promote supranormal healing

– Vitamin E• therapeutic efficacy and

indications remain to be defined

• large doses of vitamin E inhibit healing

• increase the breaking strength of wounds exposed to preoperative irradiation

Wound Healing

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Factors in Wound Healing

• Smoking

– 1ppd = 3x freq of flap necrosis

– 2ppd = 6x freq of flap necrosis

– Nicotine acts via the sympathetic system

• vasoconstriction and limit distal perfusion

– 1 cigarette = vasoconstriction > 90 min

• Decrease proliferation of erythrocytes, macrophages and fibroblasts

– Smoke contains high levels of carbon monoxide

• shifts the oxygen-hemoglobin curve to the left

• decreased tissue oxygen delivery

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Syndromes Associated with Abnormal Wound Healing

• Ehlers-Danlos Syndrome– Connective tissue abnormalities due to defects:

• Inherent strength• Elasticity• Integrity• Healing properties

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Syndromes Associated with Abnormal Wound Healing

• Ehlers-Danlos Syndrome

– Four major clinical features

• Skin hyper-extensibility

• Joint hyper-mobility

• Tissue fragility

• Poor wound healing

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Electrostimulation• Electrical current

applied to wounds

– Increases migration of cells

– 109% increase in collagen

– 40% increase in tensile strength

– 1 to 50 mA direct or pulsed based on wound

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Excessive Healing

• Hypertrophic Scars• Keloids

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Hypertropic Scar

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Keloids

• Extends beyond original bounds• Raised and firm• Rarely occur distal to wrist or knee• Predilection for sternum, mandible and deltoid• Rate of collagen synthesis increased • Water content higher• Increased glycosaminoglycans

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Keloid Treatment

• Triamcinolone injections• 3-4 weeks• Cross linking modulated• Injections continued until no excess abnormal

collagen• Excise• Prevention during healing – pressure and injection

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Keloid

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Keloid

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Keloid Scar

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Keloid Scar

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Wound Bleedingجرحه خونریزی

• Slipped suture

• Dislodged clot

• Coagulation problem

• Trauma

• Inspection aids in detecting an increase in drainage and color changes

لغزشخیاطه •علقه • نمودن دورخون • تحثری مشکالتترضیضات •دریافت • تفتیشجهت

افزایش و رنگ در تغیراتجرحه دریناژ

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Bleeding Internallyداخلی خونریزی

• Dressing may remain dry • Increase thirst• Restlessness• Rapid, thready pulse• Decreased blood pressure• Decreased urinary output• Cool clammy skin• Abdomen rigid and

distended• Hypovolemic shock

خشک • ممکن پانسمانبماند باقی

افزائشتشنگی •مریض • بیقراریخفیف • و نبضسریعخون • کاهشفشارادرار • کاهشدهنهمرطوب • و سرد جلدبطنی • شخی و توسعپو • ها شاک موجودیت

والمیک

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Complication Management اختالطات مراقبت

Dishiscence

• Patient should remain in bed

• Kept NPO

• Told not to cough

• Reassure patient

• Place sterile dressing over area

جرحه پارگی

با • بستر در باید مریضبماند قی

حالت • در را NOPمریضنگهدارید

سرفه • که بگوئید را مریضننماید

اطمنان • دوباره را مریضدهید

باالی • را معقم پانسمان . بگذارید جرحه ناحیه

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Complication Managementاختالطات مراقبت

Evisceration

Patient is to remain in bed

Cover Wound and contents with warm, sterile saline dressings

Surgeon is notified immediately - this is a medical emergency

عضو برداشتننگهداری بستر در مریض

نمائید گرم پانسمان بایک را جرحه

سودیم از حاوی که. بپوشانید باشد کلوراید

که دهید اطالع d فورا را جراحطبی عاجل حالت یک این

میباشد

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Wound Infection• Purulent (pus) drainage

• Foul odor • Brown, yellow or green

• Fever• Tenderness • Pain • Edema• Elevated WBC

جرحه انتانات

• ) دار ) چرکه قیحی دریناژبد • بویسبز • یا زرد نصواری رنگتب •حساسیت •درد •اذیما •سفید • کرویات افزائش

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Care of Incisionجراحی شق مراقبت

• Assemble equipment needed

• Use a sterile technique

• Apply ointment as ordered by MD or other topical agent as needed

• Redress wound

• Document the procedure

را • ضرورت مورد وسائلنمایید اوری جمع

سازی • معقم های تخنیکنمائید استفاده را

از • داکتر هدایت به نظردیگر عامل ویا مرهماستفاده را موضعی

نمایید.پانسمان • دوباره را جرحه

نماییدانجام • های پروسیجر تمام

دوسیه درج را شده . نمائید مریض

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Wet to Dry Dressingsمرطوب الی خشک پانسمان

• Dressings are changed per doctor's orders, or when the wound requires

– Assessment

– Care

– Loose

– Saturated

نظر • پانسمان تبدیلییا و داکتر هدایت به

ضرورت به نطرمیباشد جرحه

ارزیابی−مراقبت −آزاد − و سست

نمودن پانسمانجرحه − ساختن مشبوع

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• Assemble required equipment

• Use sterile technique• Remove the dressing• Do not to tear the wound or

dislodge drains• Sterile saline to moisten

dressing sticking • Assess old dressing• Assess the wound bed

tissue• Irrigating and clean

prescribed

دارد • لوازم به ضرورت ارزیابیاستفاده • معقم های تخنیک از

نماییدنمایید • دور را پانسمانننمائید • پاره جرحه و بیجا را درینکلوراید • سودیم از استفاده با

را چسپنده های پانسمان ، معقمسازید مرطوب

نمایید • ارزیابی را گهنه پانسمانارزیابی • را جرحه انساج طبقه

نماییدنمایید • توصیه را پاکاری و شستشو

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• The dressings that touch the wound directly will be dampened

• Never allow to dry out

• The outer dressings are applied dry

• Never form a constricting band WITH TAPE

باالی • مستقیم پانسمانکهمیشود داده قرار جرحه

. باشد مرطوب بایداجازه • را پانسمان هیچگاه

. گردد خشک که ندهیدخارج • طبقه پانسمان

گردد تطبیق خشکرا • محکم بند یک هیچگاه

تیپ رابر یا عوضچسپ . ننمایید استفاده

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• Examples of uses:

– Abdominal evisceration

– Dehiscence

– Infected open wounds

– Pressure ulcers

– Diabetic foot ulcers

مورد • های مثالاستفاده

داخل − احشائی برداشتنبطنی

گی − پارهمنتن − باز جرحهفشاری − قرحهقدم − دیابتیک قرحه

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Wound Drainage دریناژجرحه

• Drain

• Exudate

• Types of Drainage (Exudate):

– Serous

– Sanguineous

– Serosanguineous

– Purulence

درین •اگزودات •دریناژ • انواع

) اگزودات)سیروزا −الود − خونسیروسنگیونوس −تقیحی −

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Wound Drainageجرحه دریناژ

• Exudate/drainage greater than 300 ml in the first 24 hours is abnormal

• A slight increase in drainage may occur with ambulation

• Not all surgical wounds drain

تر دریناژ • اضافه اگزوداتدر 300از سی 24سی

نارمل غیر اول ساعتمیباشد.

دریناژ • در جزیی ازدیادآهسته حرکت با ممکن

گردد ایجادجراحی • جروحات تمام

. نمیگردند درین

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Wound Drainage Systemsدریناژجرحه های سیستم

Open Drains:

• Drainage passes through an open-ended tube into a receptacle or out onto the dressing

Penrose Drain

: باز های درینیک • به مستقیمأ دریناژ

یک به وبالخره باز تیوپپانسمان از خارج یا ظرف

. میشود داده عبور

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Wound Drainage Systemsدریناژحرحه های سیستم

Closed/Suction Drains:

• Self-contained suction units

• More effective than open drains

• Creating a vacuum or negative pressure

• Prevents environmental contaminants

جرحه • سکشن یا درینبسته

از • حاوی های یونتخودبخودی سکشن

باز • های درین به نظر. میگردد موثرتمام بیشتر

یا • خالء آمدن بوجود باعت. میگردد منفی فشار

مریض • محیط ملوثیت از . میگردد گیری جلو

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Wound Drainage Systemsدریناژحرحه های سیستم

• Two types of drainage devices

– Jackson-Pratt drain - used when small amounts (100-200 ml) of drainage anticipated

– Hemovac drainage system used for larger amounts (up to 500 ml)of drainage

دریناژ • وسائل دونوعمیباشد موجود

زمانیکه- Jackson-Prattدرن •یعن ) کم ( ml 200-100مقدار

استفاده باشد موجود دریناژمیگردد

دریناژ • برای Hemovacسیستمتا ) زیاد های سی 500مقدار

میگردد ( استفاده سی

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Evaluation of Wound Healingجرحه التیام ارزیابی

• Checked after:

– Each dressing change

– Application of heat and cold therapies

– Wound Irrigation

– Stress to the wound site

ذیل • موارد از بعد ارزیابی

پانسمان − هر تبدیلیو − سرد های تداوی تطبیق

گرم جرحه − شستشویساحه − به دادن فشار

جرحه

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Evaluation Measuresالتیام درجه ارزیابی

• Assess condition of the wound and dressing

• Discomfort during dressing change

• Inspect condition of dressings at least every shift

چگونگی • حالت ارزیابیپانسمان و جرحه

مریض • حتی نارا احساسجرحه تبدیل جریان در

حد • را پانسمان چگونگیتبدیلی درهر اقل

تفتیش صحی پروسونلنمائید.

AFAMS

Documentationمریض دوسیه درجه

• Location

• Size (Length x Width x Depth)

• Drainage Type and Amount

• Odor

• Neurovascular Status

• Peripheral Vascular Status - depending on site of injury

موقیعت •طول ( • از جرحه xاندازه

جرحه xعرض عمقدریناژ • مقدار و نوعبوی •و • عصبی حالت چگونگی

عایی اوعیه • حالت چگونگی

میگردد وابسته محیطیجرحه . محل به

AFAMS


• Potential diagnosis for a patient requiring wound care

– Potential for infection related to alteration in skin integrity

– Alteration in comfort related to injury

– Knowledge deficit related wound care

نرسنگ • بالقوه تشخیصجرحه که مریضان برایمراقبت به ضرورت آنها

. دارندجلدی − تمامیت در تغیرات

انتانات برای را زمینه. میسازد مساعد بالقوه

مشو − آرا در تغیراتوابسته مریض راحتی

حالت چگونگی به میگردد. میباشد جرحه

ارتباط − دانش کمبودجرحه مراقبت به میگردد

AFAMS

1.CHECK ON LEARNINGآموزش ارزیابی

QUESTION:

How do you evaluate wound healing?

سوال:ارزیابی را جرحه التیام چطور

مینماییم.

AFAMS


QUESTION:

How do you evaluate wound healing?

ANSWER:

Reduced size

Depth

Increase in granulation tissue

Free of signs and symptoms

Relief of pain

سوال:ارزیابی را جرحه التیام چطور

مینماییم.

جواب:جرحه اندازه کاهش

جرحه عمقدر گرانولیشن انساج ازدیاد

جرحه اطرافعالیم اعراشو از عاری

درد تسکین

AFAMS

2.Check on Learningآموزشی ارزیابی

QUESTION:

Name three examples of open wound injuries?

سوال:رانام باز جروحات از مثال سه

بگیرید؟

AFAMS


QUESTION:

What are the three types of wound healing?

ANSWER:

Primary

Secondary

Delayed Primary

سوال: کدام جرحه التیام از نوع سه

اند؟ ها

جواب: ابتدائی

ثانوی شروع در تاخیر

AFAMS


QUESTION:

Which wound complication is a surgical emergency?

سوال: حالت یک جرحه اختالطات کدام

میباشد؟ طبی عاجل

AFAMS


QUESTION:

Which wound complication is a surgical emergency?

ANSWER:

Evisceration

سوال: حالت یک جرحه اختالطات کدام

میباشد؟ طبی عاجل

جواب:عضو جداشدن

AFAMS


QUESTION:

What supplies do you need to do a dry sterile dressing change?

سوال:پانسمان تبدیل جهت وسائل کدام

ضرورت معقم و خشکاست؟

AFAMS


QUESTION:

What supplies do you need to do a dry sterile dressing change?

ANSWER:

Gloves, gauze, tape, basin, NSS or SW, 30-60 ml syringe, pad

سوال:پانسمان تبدیل جهت وسائل کدام

ضرورت معقم و خشکاست؟

جواب: یا رابرتیب گازپنداژ، ، کش دستیا سلین نورمال جام، ، چسپ

سرینج معقم 60الی 30آبضرورت نرم الیه و سی سی

میباشد.

AFAMS

5.CHECK ON LEARNINGآموزشی ارزیابی

QUESTION:

What type of wound may require a wet to dry dressing?

سوال:تطبیق به ضرورت جرحه نوع کدام

خشک پانسمان الی مرطوب پانسمانمیباشد.

AFAMS


QUESTION:

What type of wound may require a wet to dry dressing?

ANSWER:

Abdominal evisceration

Dehiscence

Infected open wounds

Pressure ulcers

Diabetic foot ulcers

سوال:تطبیق به ضرورت جرحه نوع کدام

خشک پانسمان الی مرطوب پانسمانمیباشد.

جواب:بطنی داخل احشای برداشتن

گی پارهمنتن باز جرحه

فشاری قرحهقدم دیابتیک فرحه

AFAMS


QUESTION:

Give two examples of a closed drainage system?

سیستم: از مثل نوع دو سوالبگیرید؟ نام را بسته دریناژ

AFAMS


QUESTION:


ANSWER:

Jackson-Pratt

Hemovac


جوال:پرات جکسن و هیمووک

AFAMS


QUESTION:



بگیرید؟

AFAMS


QUESTION:


ANSWER:

Abrasions

Lacerations

Avulsion

Amputations

Punctures

Bite


بگیرید؟

جواب:گی- خراشیده

گی- پارهگی- شده جدا

گی- شده قطعگی- شده سوراخ

گی- گزیده

AFAMS


QUESTION:



AFAMS


QUESTION:


ANSWER:

Jackson-Pratt

Hemovac


جوال:پرات جکسن و هیمووک

AFAMS

• The proliferative phase of wound healing occurs how long after the injury?

A. 1 dayB. 2 daysC. 7 daysD. 14 days

9. CHECK ON LEARNINGآموزش ارزیابی

AFAMS

• The proliferative phase of wound healing occurs how long after the injury?

A. 1 dayB. 2 daysC. 7 daysD. 14 days


AFAMS

• Which type of collagen is most important in wound healing?

A. Type IIIB. Type VC. Type VIID. Type XI


AFAMS

• Which type of collagen is most important in wound healing?

A. Type IIIB. Type VC. Type VIID. Type XI


AFAMS

• The tensile strength of a wound reaches normal (pre-injury) levels:

A. 10 days after injuryB. 3 months after injuryC. 1 year after injuryD. never

CHECK ON LEARNINGآموزش ارزیابی

AFAMS

• Which of the following is commonly seen in Ehlers-Danlos syndrome?

A. Small bowel obstructionsB. Spontaneous thrombosisC. Direct hernia in childrenD. Abnormal scarring of the hands with contractures.


AFAMS

• Steroids impair wound healing by:

A. Decreasing angiogenesis and macrophage migration

B. Decreasing platelet plug integrity

C. Increasing release of lysosomal enzymes

D. Increasing fibrinolysis


AFAMS

• Supplementation of which of the following micronutrients improves wound healing in patients without micronutrient deficiency?

A. Vitamin C

B. Vitamin A

C. Selenium

D. Zinc


AFAMS

• Signs of malignant transformation in a chronic wound include:

A. Persistent granulation tissue with bleeding

B. Overturned wound edges

C. Non-healing after 2 weeks of therapy

D. Distal edema


AFAMS

• The treatment of choices for keloids is:

A. Excision alone

B. Excision with adjuvant therapy (e.g. radiation)

C. Pressure treatment

D. Intralesional injection of steroids


AFAMS

• The major cause of impaired wound healing is:

A. Anemia

B. Diabetes mellitus

C. Local tissue infection

D. Malnutrition


AFAMS

• Bradykinin, serotonin, and histamine in wounds are released from:

A. Lymphocytes

B. Mast cells

C. Polymorphonuclear leukocytes

D. Platelets


AFAMS

• Platelets in the wound form a hemostatic clot and release clotting factors to produce:

A. Fibrin

B. Fibrinogen

C. Thrombin

D. Thromboplastin


AFAMS

• In a healing wound, metalloproteinases are responsible for:

A. Establishing collagen cross-link

B. Glycosylation of collagen molecules

C. Incorporation of hydroxyproline into the collagen chain

D. Initiating collagen degradation


AFAMS

• Severe cases of hidradenitis suppurativa in the groin area are best managed by excision of the involved area and?

A. Closure by secondary intension

B. Delayed primary closure

C. Primary closure

D. Split thickness skin grafting


AFAMS

• All of the following statements about keloids are true except?

A. Keloids do not regress spontaneously

B. Keloids extend beyond the boundaries of the original wound

C. Keloids or hypertrophic scars are best managed by excision and careful reapproximation of the wound

D. Keloid tissue contains an abnormally large amount of collagen.


Documents

AFAMS Wound Management مراقبت جرحه 01/11/2012. AFAMS Wound Management مراقبت جرحه Learning Objective: Physical Therapy Technicians will gain an understanding