CH 14 Normal Wound Healing Flashcards
A process that is continuous while its phases are not entirely distinct
Wound healing
The number of days to complete each phase will vary by what factors?
Age, size of wound, comorbidities, continued trauma, nutrition, blood flow, medications, stress, infection
What phase is a NORMAL immune system reaction to injury?
Inflammation (Phase I)
What phase is the CENTRAL ACTIVITY in wound healing?
Inflammation (Phase I)
What phase is where temporary repair is initiated by coagulation (clotting factors, platelets) and SHORT-TERM DECREASED blood flow occurs?
Inflammation (Phase I)
What phase is where NECROSIS occurs after cells have been injured or destroyed?
Inflammation (Phase I)
What phase is where the spread of pathogens is slowed; debris and bacteria are attacked by a host of cells?
Inflammation (Phase I)
Fluid that accumulates at the injury site during the inflammation phase (phase I)?
Pus
If the wound is acute, what can be expected in the inflammation phase (phase I)?
Edema, erythema, and drainage
What phase has oxygen being delivered via INCREASED blood flow to keep the phagocytic cells alive and functioning?
Inflammation (Phase I)
What phase is where permanent repair is facilitated by creating a clean wound, SETTING THE STAGE for the next phase of healing; re-epithelialization can begin?
Inflammation (Phase I)
What phase has a time frame from day of injury to approx day 10?
Inflammation (Phase I)
What phase is when the RATE of inflammatory process if affected by the size of wound, blood supply, available nutrients, and extrinsic environment?
Inflammation (Phase I)
What happens when the inflammation phase is interrupted or delayed?
Chronic inflammation
What phase is where NEW TISSUE fills the wound as fibroblasts secrete collagen?
Proliferation (Phase II)
What phase is where skin integrity is restored by re-epithelialization and/or contraction?
Proliferation (Phase II)
What phase is where angiogenesis occurs; new blood vessel growth from endothelial cells and fragile capillary buds grow into the wound bed; new reddish, slightly bumpy tissue is called GRANULATION TISSUE?
Proliferation (Phase II)
What phase is where epithelial cells differentiate into Type I Collagen?
Proliferation (Phase II)
What phase is where COLLAGEN SYNTHESIS occurs but the resulting new scar tissue is fragile and must be protected; trauma during this phase may return the wound to the inflammatory phase?
Proliferation (Phase II)
What phase has a time frame from day 3 of injury to approx day 20?
Proliferation (Phase II)
What phase is when the RATE of proliferation is affected by the size of the wound, blood supply, available nutrients, and the extrinsic environment?
Proliferation (Phase II)
What phase may result in a chronic wound if interrupted or delayed?
Proliferation (Phase II)
What phase occurs when maturation or remodeling of new tissue begins while granulation tissue is forming during the prior phase?
Maturation/Remodeling (Phase III)
What phase is when epithelial cells continue to differentiate into type I collagen?
Maturation/Remodeling (Phase III)
What phase is when new skin has tensile strength that is 15% of normal; scar tissue is rebuilding but at best reaches 80% of original tensile strength?
Maturation/Remodeling (Phase III)
What phase is when underlying granulation tissue is replaced by less vascular tissue?
Maturation/Remodeling (Phase III)
What phase is when deep wounds have dermal appendages that are rarely repaired (hair follicles, sebaceous and sweat gland, nerves) but instead are replaced by fibrous tissue?
Maturation/Remodeling (Phase III)
What phase is when over time the scar tissue matures, changing from red to pink to white and from raised to rigid to flat and flexible?
Maturation/Remodeling (Phase III)
What phase has a time frame of approximately day 9 of injury up to 2 years?
Maturation/Remodeling (Phase III)
What is necessary to sustain life at the cellular and systemic level?
Oxygen in wound healing
What occurs when oxygenated blood flows to the tissues of the body?
Perfusion
What reaches the wound beds through blood flow to the area?
Oxygen (role in wound healing)
Wound contraction, collagen deposition, angiogenesis, and granulation are all examples of wound healing supported by what?
Oxygen perfusion
What is a sensitive indicator for the risk of post-operative infection?
Wound tissue oxygenation or perfusion (role in wound healing)
What would a decrease in oxygen availability lead to in wound healing?
Increases likelihood of infection
What are the two most common problems that limit perfusion?
Edema and necrosis
What are the procedural intervention components crucial to oxygen wound healing?
- Compression to reduce edema
- Debridement to remove necrotic tissue
When is compression and debridement contraindicated to oxygen wound healing?
Arterial disease
What are interventions that would increase oxygen for wound healing?
- Keeping wound area warm
- Avoiding smoking
- Hydrating
- Controlling pain
- Controlling anxiety
What nutritional factors have an impact on oxygenation because they are needed to enable RBC to carry oxygen to healing tissues?
- Hemoglobin
- Iron
- B12
- Folic acid
What is the modern wound management based on creating and maintaining?
A moist wound environment
What in wound healing can create an environment that is hostile to wound healing?
Dry wounds (role of moisture in wound healing)
What in wound healing allows the formation of eschar (scab) to inhibit migration of epithelial cells, provide food for pathogens, and affect blood flow to wound bed?
Dry wounds (role of moisture in wound healing)
In wound healing, what allows cooling of wound surface and slowing of healing?
Dry wounds (role of moisture in wound healing)
In wound healing, what can cause trauma to wound bed when removed and pain to individual?
Dry dressing, adhesion gauze
What type of dressing retains fluid on the wound bed?
Occlusive, moisture retention dressing
What occurs when moisture retention dressing softens wound scab and eschar then the body’s own enzymes will dissolve the eschar?
Autolytic Debridement
What occurs when maintaining a moist wound with an occlusive dressing during wound healing?
Holds appropriate amount of endogenous fluid on wound, preserving them for healing and keeping them in contact with wound bed
What are the basic principles of moist wound healing?
- Covering the wound with barrier (occlusive) to preserve adequate wound hydration
- limiting fluid loss from wound surface
- allowing gaseous exchange
- maintaining periwound integrity
- controlling heavy exudate
- removing dressing when exudate begins to leak out
What type of dressing helps to maintain appropriate wound surface temperature to prevent delays in healing and to protect wound surface from trauma, bacteria, and other contaminants?
Occlusive dressings (moisture in wound healing)
What is the most important external factor for optimal wound healing?
Adequate moisture
Wound hydration
What is commonly used to assist in the maintenance of adequate moisture of wounds?
Moisture retentive dressings
What nutrition is required for collagen synthesis, formation of new blood vessels and muscle tissue?
Protein
What vitamins are essential so RBC can deliever oxygen to tissues?
Iron
Vitamin B12
Folic acid
What vitamins are essential for tissue repair?
Vitamin C
Zinc
What vitamins are essential to stimulate collagen cross linking?
Vitamin A
What vitamins enhance healing and immune function?
Anginine
What intake provides the amino acids required to build new tissue?
Protein
What describes the physical appearance of the wound but may also provide clues to the cause of wound, phase of healing, and likelihood of closure?
Wound characteristics
What can provide valuable information needed to make sound clinical judgements about treatment?
Wound characteristics
What can indicate the progress or lack thereof toward closure and healing in documentation?
Wound characteristics
What should be identified during initial examination and then monitored at least weekly during the healing process?
Wound characteristics
What are the wound characteristics that should be tracked and documented through the process of wound healing?
-Location: where on the body
-Size: depth, width, length
-Shape: irregular v distinct
-Edges: condition, shape, premature healing
-Tunneling, undermining, sinus tracts: presence, depth
-Base: characteristics of wound base compared to sides and edges
Periwound area: edema, induration, maceration
-Pain
-Quantity of bacteria: amount present (bio-burden)
What are BASE wound characteristics that should be tracked and documented through the process of wound healing?
- Necrosis, eschar, slough: amount, color, texture, adherence to wound bed
- Exudate: amount, color, odor
- Granulation tissue: presence or absence, amount, location
- Epithelialization: presence or absence, premature or on schedule
- Exposed structures: color and condition of bone, tendon, ligament
What is the gold standard for obtaining a wound culture, but not used universally owing to cost, lack of lab facilities, and potential pain for patient?
Quantitative biopsy
What is limited to detecting surface contamination not tissue infection?
Swab culture
What type of wound closure occurs when a health care provider closes a wound by bringing the edges together?
Primary intention
What type of wound closure uses sutures, staples, glue, skin grafts, or skin flaps?
Primary intention
What type of wound closure still passes through the phases of healing but usually in a shorter time span?
Primary intention
What process occurs when a wound closed by primary intention later opens up again owing to maceration or infection?
Dehiscence
What type of wound closure occurs when a wound is left open to heal on its own?
Secondary intention
What are the mechanisms of healing by secondary intention?
- Contraction
- Re epithelialization
- Or combo of both
What type of wound close is often used after an infection or reopening of the wound by dehiscence?
Secondary intention
What occurs during secondary intention when growth factors trigger myofibroblasts to pull the edges of the wound inward?
Contraction
What occurs if contraction by secondary intention happens too rapidly?
Disfiguring scars
Impaired tissue function
What is the process of contraction by secondary intention?
- Existing tissue migrates pulling the wound edges toward the center
- Forms no new tissue
What occurs if tissue elongation cannot keep up with contraction by secondary intention?
Functional and cosmetic deformity
What occurs during secondary intention when epithelial cells meet at the center of wound, covers with new skin, migration ends, and new cells stop dividing (contact inhibition)?
Epithelialization
What should be documented when a wound is closing and healing by secondary intention?
- Wound shape
- Wound depth
- Wound location
- Wound etiology
What type of wound shape would contract most rapidly?
Linear (surgical) wounds
What type of wound shape would contract slowly?
Circular wounds (pressure injuries)
What type of wound depth would close more quickly?
Shallow wounds with all things equal
What type of wound depth has a loss of epidermis and closes by re-epithelization?
Superficial wound depth
What type of wound depth has a loss of dermis and epidermis; closes primarily by re-epithelialization with minimal contraction?
Partial-thickness
What type of wound depth has a loss of all layers of epidermis, dermis, and deeper structures?
Full thickness
What type of wound depth closes by contraction and scar formation; however, epithelial cells will migrate from wound edges to assist in wound closure in environment is homeostatic?
Full thickness
What type of wound location will close more rapidly?
Areas with least pressure, most perfusion (face)
What type of wound location will close slower?
Areas with most pressure, least perfusion (sacrum, heel)
What type of wound etiology will close more rapidly?
Least traumatic (surgery)
What type of wound etiology will close slowly?
Most traumatic (pressure injury, burn_
As deeper wounds heal, what occurs?
Wound is filled with tissue but repair process does not replace lost muscle, fat, or dermis with those same types of tissues.
