LO6 Wound Care

Question 1

4 stages of wound healing

Answer 1

1. Hemostasis
2. inflammation
3. proliferation
4. maturation

Question 2

hemostasis stage of healing

Answer 2

Hemostasis is characterized by clot formation resulting in cessation of bleeding.

This process is enhanced by a 5–10 minute phase of vasoconstriction.

Medical conditions or medications that alter the body’s ability to clot will slow down the initiation of healing.

Question 3

inflammation stage of healing

Answer 3

This is the body’s defense mechanism against bacterial invasion.

Neutrophils and monocytes are attracted at the same time to the wound site

the later phases of inflammation are characterized by conversion of monocytes to macrophages.

Any medical conditions (autoimmune diseases) or anti-inflammatory medications will alter this phase and delay healing.

Question 4

Neutrophils

Answer 4

migrate through the blood vessels to accumulate in the periphery of the wounded tissue.

The main function of these cells is to phagocytose local bacteria and debris

Question 5

Macrophages

Answer 5

continue the process of phagocytosis

Question 6

proliferation stage of healing

Answer 6

The phase of proliferation overlaps inflammation.

The key cells of this phase of healing are the fibroblasts and myofibroblasts.

Question 7

fibroblasts and collagen synthesis

Answer 7

Fibroblasts secrete a loose extracellular matrix that is rich in collagen.

Collagen synthesis peaks 5–7 days post injury.

Question 8

Wound contraction

Answer 8

is the reduction of a tissue defected by the centripedal movement of the surrounding skin.

This process of contraction will peak at approximately two weeks after the injury and varies in its ability to reduce wound size by the depth of the wound and the tension of the surrounding tissue.

Question 9

Angiogenesis

Answer 9

the formation of new blood cells occurs simultaneously with the above two cellular processes.

This is the process where capillaries bud from pre-existing small vessels found in close proximity to the wound to form granulation tissue.

Question 10

maturation stage of wound healing

Answer 10

Remodeling of the immature tissue occurs at the same time as granulation tissue formation.

This process occurs for a period of months or years after initial wound closure

Question 11

Factors Affecting Wound Healing

Answer 11

Metabolic Disorders  
Nutrition  
Medications  
Ischemia  
Infection  
Treatment regimes  
Psychosocial well being  
Aging  
Smoking

Question 12

Sanguineous fluid

Answer 12

blood, hemorrhage
Fresh—bright red
Old—dark brown

Question 13

Serous fluid

Answer 13

clear, light, straw-colored

Question 14

Serosanguineous fluid

Answer 14

clear, pinkish color

Question 15

Purulent

Answer 15

thick, curdy, yellow, green, white, foul-smelling “pus”

Question 16

Goals of Wound Closure

Answer 16

To restore function
To prevent infection
To promote healing by primary intention
To prevent further damage and minimize scarring

Question 17

Prophylactic antibiotics such as cloxacillin or penicillin should be prescribed if:

Answer 17

The wound is more than six hours old.

The wound is as a result of human or cat bites.

It is a crushing wound.

It is a contaminated wound.

Question 18

Clinical indicators of wound infection include:

Answer 18

Wound tenderness

Erythema greater than one cm from wound edge

Wound purulence

Wound dehiscence

Regional lymphangitis

Question 19

Wound Closure Principles

Answer 19

Avoid excessive suture tension which can lead to ischemia.

Close wound in layers to eliminate dead space except in contaminated wounds.

To obtain a satisfactory scar evert the wound edges. This is achieved when sutures are
placed so that the depth of each bite exceeds its width.

Before suturing be sure to clean the wound and debride as necessary. When debriding, trim
as little skin as possible.

Control bleeding by using direct pressure.

Question 20

Care of Wound after Suturing

Simple wound

Answer 20

lace gauze over suture line and cover with an occlusive dressing for 72 hours.

Question 21

Care of Wound after Suturing

Complex wound

Answer 21

Immobilize the injured body part for 72 hours and apply a bulky dressing. Wounds overjoints should be immobilized by the use of a splint.

Question 22

Patient Education

Instruct the patient:

Answer 22

o keep the wound clean and dry for at least 72 hours.
To return if signs and symptoms of infection appear, a red streak develops or there is increased pain.
That all trauma wounds heal with scarring. If the client is concerned about scarring, inform them that scar can revise after 6 months.

Question 23

Suture Removal

As a general guideline:

Answer 23

facial wounds in for 5 days,

extensor surfaces for 14 days

all other wounds for 7 days.

Keeping sutures in longer than 8 days is avoided as it leads to suture scars.

Question 24

Staples

Answer 24

most commonly to close lacerations on the scalp or to close the outer layers of skin in orthopedic procedures.

They cannot be used on the face, hand, or other areas of the body where tendons and nerves lie close to the surface.

removed seven to 10 days after surgery

Question 25

dehiscence

Answer 25

separation of the edges of the wound