healing by wound type Flashcards
What are the types of wounds?
-surgical, venous stasis ulcers, arterial ulcers, pressure ulcers
Surgical wound overview
- heald by primary intention–> would edges are approximated and closed
- Healing involved the interaction b/t extrinsic and intrinsic factors
What are the extrinsic factors of surgical wounds?
- physical envrionment before and during surgery: surgical prep, techniques, types of sutures used
- infections are major source of failure to heal
Describe the preoperative period and intraoperative period
- 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
Postoperative pahse of surgical wounds
- stress response: high amounts of circulating catecholamine causes vasconstriction
- maximize wound healing: keeping pt warm, well hydrated, pain free, well oxygenated
What are the intrinsic factors of surgical wounds?
Age, concomitant conditions (diseases, treatments), oxygen & perfusion
Assessment of the surgical wound
- 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
Inflammatory phase of surgical wounds
- 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
Proliferative phase of surgical wounds
- 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
Drainage
- Bloody (48 hours)
- Serosanguineous
- serous
- increased–> possible infection
- new drainage from healed incision: dehiscence, infection
Describe color change of remodeling
- slow change in color over time
- bright pink–> pale
Dressings
Primary layer: absorbs exudate——> Telfa pad or Hydrofiber
Secondary layer: provides absorption, protection, and hols primary dressing in place
Venous Insufficiency Ulcers
-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
Arterial Ulcers
- 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
Treatment of Arterial Ulcers
- wound bed prep
- proper dressing selection
- limb protection
- surgical, medical, Nutritional
