healing by wound type

Question 1

What are the types of wounds?

Answer 1

-surgical, venous stasis ulcers, arterial ulcers, pressure ulcers

Question 2

Surgical wound overview

Answer 2

• heald by primary intention–> would edges are approximated and closed
• Healing involved the interaction b/t extrinsic and intrinsic factors

Question 3

What are the extrinsic factors of surgical wounds?

Answer 3

• physical envrionment before and during surgery: surgical prep, techniques, types of sutures used
• infections are major source of failure to heal

Question 4

Describe the preoperative period and intraoperative period

Answer 4

• pre: length of time the pt spends in hosptial prior to surgery influcences the rate of infection
• Intra: type of surgery & technique (GI or respiratory tract, Pus encountered, devitalized tissue encountered); condition of pt–> obesity (tension on suture site), vascular supply

Question 5

Postoperative pahse of surgical wounds

Answer 5

• stress response: high amounts of circulating catecholamine causes vasconstriction
• maximize wound healing: keeping pt warm, well hydrated, pain free, well oxygenated

Question 6

What are the intrinsic factors of surgical wounds?

Answer 6

Age, concomitant conditions (diseases, treatments), oxygen & perfusion

Question 7

Assessment of the surgical wound

Answer 7

• involvoes physical examination of wound site and the surrounding wound tissue
• wound healing processes aren’t always visible–> standars is base on time since surgery, wound progress can be measured agaisnt standard

Question 8

Inflammatory phase of surgical wounds

Answer 8

• normal/expected first 4 days–> incision may feel warm, edema present, no inflammation may be abnormal
• surgical site is re-epithelialized w/in first 72 hours

Question 9

Proliferative phase of surgical wounds

Answer 9

• palpation of site will reveal collagen deposition
• firmness along the incision is known as the healing ridge (palapate day 5-9)
• observe for edema (hinder healing)
• skin color changes (brusing, infection, warmth, pain)
• sutures removed 7-10 days

Question 10

Drainage

Answer 10

• Bloody (48 hours)
• Serosanguineous
• serous
• increased–> possible infection
• new drainage from healed incision: dehiscence, infection

Question 11

Describe color change of remodeling

Answer 11

• slow change in color over time

- bright pink–> pale

Question 12

Dressings

Answer 12

Primary layer: absorbs exudate——> Telfa pad or Hydrofiber

Secondary layer: provides absorption, protection, and hols primary dressing in place

Question 13

Venous Insufficiency Ulcers

Answer 13

-Compression must be added!!

Dressings

• select dressing that will maintain proper wound moisture balance
• varies based on size and amount of exudate
• tend to be moist–> foam, Alginate, Hydrofiber
• where significant fibrin deposition is present: Hydrocolloid; autolytic debridment

Exercise: ankle ROM, walking/stretching program, strengthening

Question 14

Arterial Ulcers

Answer 14

• Deprived of O2: Pale, dry, little drainage/eschar
• clearly demarcated or punched out margins
• generally deeper than venous wounds
  
  • structures turn dusky as they become ischemic

Compression

ABI > 0.8 okay for compression
0.6-0.8 light compression
< 0.5 absolute contraindication for compression

Question 15

Treatment of Arterial Ulcers

Answer 15

• wound bed prep
• proper dressing selection
• limb protection
• surgical, medical, Nutritional

Question 16

Arterial Ulcer wound bed prep

Answer 16

• remove necrotic tissue- not stable eschar, unless healing potential and local perfusion are confirmed
• cleansing and irrigation
• dressings

Look at slide 24

Question 17

Dressings for Arterial Ulcers

Answer 17

• hydrogels, hydrogel sheets
• Alginates or hydrofibers pre-moistened with saline or sterile water
• be careful and avoid harsh adhesives to prevent damage to the periwound
• frequent dressing changes may be necessary as changes can occur quickly

Question 18

Arterial Ulcer infection and surgical options

Answer 18

-infection is common: inc necrotic tissue –> inc risk of infection. Dec O2 provides an environment for aerobic and anaerobic bacteria

Surgical options

• Revascularization–> bypass grafting, stenting, angioplasty
• Amputation

Question 19

Pressure Ulcers

Answer 19

• REMOVE THE PRESSURE
• thin flexible dressings–> conform better to bony prominences and are less likely to fold or curl
• Must fill undermined or tunneled areas loosely to prevent Pressure
• barrier creams may be necessary around groin or buttocks as urine/POOP can irritate the skin/ infection

Question 20

Pressure Ulcer Dressings

Answer 20

Dressings with smooth/slippery surfaces are easier to pull clothes over w/o disrupting the dressing and will stay in place during reposition

-dressings that adhere to the skin, but can easily be removed w/o stripping skin are preferred