LO6 Wound Care Flashcards
4 stages of wound healing
- Hemostasis
- inflammation
- proliferation
- maturation
hemostasis stage of healing
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.
inflammation stage of healing
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.
Neutrophils
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
Macrophages
continue the process of phagocytosis
proliferation stage of healing
The phase of proliferation overlaps inflammation.
The key cells of this phase of healing are the fibroblasts and myofibroblasts.
fibroblasts and collagen synthesis
Fibroblasts secrete a loose extracellular matrix that is rich in collagen.
Collagen synthesis peaks 5–7 days post injury.
Wound contraction
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.
Angiogenesis
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.
maturation stage of wound healing
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
Factors Affecting Wound Healing
Metabolic Disorders Nutrition Medications Ischemia Infection Treatment regimes Psychosocial well being Aging Smoking
Sanguineous fluid
blood, hemorrhage
Fresh—bright red
Old—dark brown
Serous fluid
clear, light, straw-colored
Serosanguineous fluid
clear, pinkish color
Purulent
thick, curdy, yellow, green, white, foul-smelling “pus”
Goals of Wound Closure
To restore function
To prevent infection
To promote healing by primary intention
To prevent further damage and minimize scarring
Prophylactic antibiotics such as cloxacillin or penicillin should be prescribed if:
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.
Clinical indicators of wound infection include:
Wound tenderness
Erythema greater than one cm from wound edge
Wound purulence
Wound dehiscence
Regional lymphangitis
Wound Closure Principles
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.
Care of Wound after Suturing
Simple wound
lace gauze over suture line and cover with an occlusive dressing for 72 hours.
Care of Wound after Suturing
Complex wound
Immobilize the injured body part for 72 hours and apply a bulky dressing. Wounds overjoints should be immobilized by the use of a splint.
Patient Education
Instruct the patient:
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.
Suture Removal
As a general guideline:
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.
Staples
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
