CH 14 Normal Wound Healing Flashcards

1
Q

A process that is continuous while its phases are not entirely distinct

A

Wound healing

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2
Q

The number of days to complete each phase will vary by what factors?

A

Age, size of wound, comorbidities, continued trauma, nutrition, blood flow, medications, stress, infection

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3
Q

What phase is a NORMAL immune system reaction to injury?

A

Inflammation (Phase I)

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4
Q

What phase is the CENTRAL ACTIVITY in wound healing?

A

Inflammation (Phase I)

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5
Q

What phase is where temporary repair is initiated by coagulation (clotting factors, platelets) and SHORT-TERM DECREASED blood flow occurs?

A

Inflammation (Phase I)

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6
Q

What phase is where NECROSIS occurs after cells have been injured or destroyed?

A

Inflammation (Phase I)

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7
Q

What phase is where the spread of pathogens is slowed; debris and bacteria are attacked by a host of cells?

A

Inflammation (Phase I)

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8
Q

Fluid that accumulates at the injury site during the inflammation phase (phase I)?

A

Pus

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9
Q

If the wound is acute, what can be expected in the inflammation phase (phase I)?

A

Edema, erythema, and drainage

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10
Q

What phase has oxygen being delivered via INCREASED blood flow to keep the phagocytic cells alive and functioning?

A

Inflammation (Phase I)

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11
Q

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?

A

Inflammation (Phase I)

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12
Q

What phase has a time frame from day of injury to approx day 10?

A

Inflammation (Phase I)

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13
Q

What phase is when the RATE of inflammatory process if affected by the size of wound, blood supply, available nutrients, and extrinsic environment?

A

Inflammation (Phase I)

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14
Q

What happens when the inflammation phase is interrupted or delayed?

A

Chronic inflammation

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15
Q

What phase is where NEW TISSUE fills the wound as fibroblasts secrete collagen?

A

Proliferation (Phase II)

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16
Q

What phase is where skin integrity is restored by re-epithelialization and/or contraction?

A

Proliferation (Phase II)

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17
Q

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?

A

Proliferation (Phase II)

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18
Q

What phase is where epithelial cells differentiate into Type I Collagen?

A

Proliferation (Phase II)

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19
Q

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?

A

Proliferation (Phase II)

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20
Q

What phase has a time frame from day 3 of injury to approx day 20?

A

Proliferation (Phase II)

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21
Q

What phase is when the RATE of proliferation is affected by the size of the wound, blood supply, available nutrients, and the extrinsic environment?

A

Proliferation (Phase II)

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22
Q

What phase may result in a chronic wound if interrupted or delayed?

A

Proliferation (Phase II)

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23
Q

What phase occurs when maturation or remodeling of new tissue begins while granulation tissue is forming during the prior phase?

A

Maturation/Remodeling (Phase III)

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24
Q

What phase is when epithelial cells continue to differentiate into type I collagen?

A

Maturation/Remodeling (Phase III)

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25
Q

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?

A

Maturation/Remodeling (Phase III)

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26
Q

What phase is when underlying granulation tissue is replaced by less vascular tissue?

A

Maturation/Remodeling (Phase III)

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27
Q

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?

A

Maturation/Remodeling (Phase III)

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28
Q

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?

A

Maturation/Remodeling (Phase III)

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29
Q

What phase has a time frame of approximately day 9 of injury up to 2 years?

A

Maturation/Remodeling (Phase III)

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30
Q

What is necessary to sustain life at the cellular and systemic level?

A

Oxygen in wound healing

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31
Q

What occurs when oxygenated blood flows to the tissues of the body?

A

Perfusion

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32
Q

What reaches the wound beds through blood flow to the area?

A

Oxygen (role in wound healing)

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33
Q

Wound contraction, collagen deposition, angiogenesis, and granulation are all examples of wound healing supported by what?

A

Oxygen perfusion

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34
Q

What is a sensitive indicator for the risk of post-operative infection?

A

Wound tissue oxygenation or perfusion (role in wound healing)

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35
Q

What would a decrease in oxygen availability lead to in wound healing?

A

Increases likelihood of infection

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36
Q

What are the two most common problems that limit perfusion?

A

Edema and necrosis

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37
Q

What are the procedural intervention components crucial to oxygen wound healing?

A
  • Compression to reduce edema

- Debridement to remove necrotic tissue

38
Q

When is compression and debridement contraindicated to oxygen wound healing?

A

Arterial disease

39
Q

What are interventions that would increase oxygen for wound healing?

A
  • Keeping wound area warm
  • Avoiding smoking
  • Hydrating
  • Controlling pain
  • Controlling anxiety
40
Q

What nutritional factors have an impact on oxygenation because they are needed to enable RBC to carry oxygen to healing tissues?

A
  • Hemoglobin
  • Iron
  • B12
  • Folic acid
41
Q

What is the modern wound management based on creating and maintaining?

A

A moist wound environment

42
Q

What in wound healing can create an environment that is hostile to wound healing?

A

Dry wounds (role of moisture in wound healing)

43
Q

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?

A

Dry wounds (role of moisture in wound healing)

44
Q

In wound healing, what allows cooling of wound surface and slowing of healing?

A

Dry wounds (role of moisture in wound healing)

45
Q

In wound healing, what can cause trauma to wound bed when removed and pain to individual?

A

Dry dressing, adhesion gauze

46
Q

What type of dressing retains fluid on the wound bed?

A

Occlusive, moisture retention dressing

47
Q

What occurs when moisture retention dressing softens wound scab and eschar then the body’s own enzymes will dissolve the eschar?

A

Autolytic Debridement

48
Q

What occurs when maintaining a moist wound with an occlusive dressing during wound healing?

A

Holds appropriate amount of endogenous fluid on wound, preserving them for healing and keeping them in contact with wound bed

49
Q

What are the basic principles of moist wound healing?

A
  • 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
50
Q

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?

A

Occlusive dressings (moisture in wound healing)

51
Q

What is the most important external factor for optimal wound healing?

A

Adequate moisture

Wound hydration

52
Q

What is commonly used to assist in the maintenance of adequate moisture of wounds?

A

Moisture retentive dressings

53
Q

What nutrition is required for collagen synthesis, formation of new blood vessels and muscle tissue?

A

Protein

54
Q

What vitamins are essential so RBC can deliever oxygen to tissues?

A

Iron
Vitamin B12
Folic acid

55
Q

What vitamins are essential for tissue repair?

A

Vitamin C

Zinc

56
Q

What vitamins are essential to stimulate collagen cross linking?

A

Vitamin A

57
Q

What vitamins enhance healing and immune function?

A

Anginine

58
Q

What intake provides the amino acids required to build new tissue?

A

Protein

59
Q

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?

A

Wound characteristics

60
Q

What can provide valuable information needed to make sound clinical judgements about treatment?

A

Wound characteristics

61
Q

What can indicate the progress or lack thereof toward closure and healing in documentation?

A

Wound characteristics

62
Q

What should be identified during initial examination and then monitored at least weekly during the healing process?

A

Wound characteristics

63
Q

What are the wound characteristics that should be tracked and documented through the process of wound healing?

A

-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)

64
Q

What are BASE wound characteristics that should be tracked and documented through the process of wound healing?

A
  • 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
65
Q

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?

A

Quantitative biopsy

66
Q

What is limited to detecting surface contamination not tissue infection?

A

Swab culture

67
Q

What type of wound closure occurs when a health care provider closes a wound by bringing the edges together?

A

Primary intention

68
Q

What type of wound closure uses sutures, staples, glue, skin grafts, or skin flaps?

A

Primary intention

69
Q

What type of wound closure still passes through the phases of healing but usually in a shorter time span?

A

Primary intention

70
Q

What process occurs when a wound closed by primary intention later opens up again owing to maceration or infection?

A

Dehiscence

71
Q

What type of wound closure occurs when a wound is left open to heal on its own?

A

Secondary intention

72
Q

What are the mechanisms of healing by secondary intention?

A
  • Contraction
  • Re epithelialization
  • Or combo of both
73
Q

What type of wound close is often used after an infection or reopening of the wound by dehiscence?

A

Secondary intention

74
Q

What occurs during secondary intention when growth factors trigger myofibroblasts to pull the edges of the wound inward?

A

Contraction

75
Q

What occurs if contraction by secondary intention happens too rapidly?

A

Disfiguring scars

Impaired tissue function

76
Q

What is the process of contraction by secondary intention?

A
  • Existing tissue migrates pulling the wound edges toward the center
  • Forms no new tissue
77
Q

What occurs if tissue elongation cannot keep up with contraction by secondary intention?

A

Functional and cosmetic deformity

78
Q

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)?

A

Epithelialization

79
Q

What should be documented when a wound is closing and healing by secondary intention?

A
  • Wound shape
  • Wound depth
  • Wound location
  • Wound etiology
80
Q

What type of wound shape would contract most rapidly?

A

Linear (surgical) wounds

81
Q

What type of wound shape would contract slowly?

A

Circular wounds (pressure injuries)

82
Q

What type of wound depth would close more quickly?

A

Shallow wounds with all things equal

83
Q

What type of wound depth has a loss of epidermis and closes by re-epithelization?

A

Superficial wound depth

84
Q

What type of wound depth has a loss of dermis and epidermis; closes primarily by re-epithelialization with minimal contraction?

A

Partial-thickness

85
Q

What type of wound depth has a loss of all layers of epidermis, dermis, and deeper structures?

A

Full thickness

86
Q

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?

A

Full thickness

87
Q

What type of wound location will close more rapidly?

A

Areas with least pressure, most perfusion (face)

88
Q

What type of wound location will close slower?

A

Areas with most pressure, least perfusion (sacrum, heel)

89
Q

What type of wound etiology will close more rapidly?

A

Least traumatic (surgery)

90
Q

What type of wound etiology will close slowly?

A

Most traumatic (pressure injury, burn_

91
Q

As deeper wounds heal, what occurs?

A

Wound is filled with tissue but repair process does not replace lost muscle, fat, or dermis with those same types of tissues.