Module 2 - Surgical Wound Care Flashcards
Healing process of Surgical Incisions
Primary Intention, Secondary Intention and Tertiary intention
Primary Intention
Edges are approximated, low infection risk, quick healing, minimal scar
Secondary Intention
Edges are not well approximated, longer healing time, higher risk of infection, risk of large scar
Tertiary Intention
Edges approximated after wound is cleaned, wound left open due to possible contamination, requires observation
Phases of Wound Healing
1) Inflammatory phase
2) Proliferation phase - collagen building, granulation tissue
3) Maturation phase - early - raised scar formation
4) Maturation phase - later - thin scar
Assessments prior to surgical dressing change
Pain Assessment Client discomfort/tenderness Checking clients care plan Mobility issues Continence Presence of wound
Wound Assessments during a surgical dressing change
Skin Assessment Wound Assessment - REEDA Wound Drainage - TACO Staples, Sutures or Tape quality Palpation of wound for temperature/tenderness/pain
Dressing Removal Steps
Assessment of Client
Put on clean disposable gloves - Hand Hygiene
Remove tape, pulling parallel to skin toward dressing, remove remaining adhesive
Remove gauze one layer at a time
Observe drainage (TACO)
Observe Wound (REEDA)
Throw away soiled dressing in bio hazard
Wound Cleansing Steps
Sterile technique
Clean gloves
Use only noncytotoxic solution (Saline or 0.9% NACI)
Cleanse in direction from least contaminated to most contaminated (inside to out)
Irrigate - removing exudation
Debridement - removes necrotic tissue
Suture/Staple Removal Steps
Read MD order
Count staples/sutures
Clean from least contaminated to most contaminated (inside to outside) - depends on policy
Use appropriate tools
Remove every other suture/staple depending on order
Never pull the suture through tissue - cut at knot and pull from there
Place remover under suture, pinch, wiggle(back and forth) and gently pull
Place steri-stripes on areas with no staples/sutures
New Dressing Steps
Apply with new gloves Assess wound and surrounding skin Dry wound edges with gauze Apply appropriate dressing Window formation with tape Initial and Date tape and place over new dressing
Intermittent Suture
Surgeons ties individual sutures made in skin
Continuous Suture
Series of sutures with only two knots, one at beginning and one at the end
Blanket Suture
A continuous suture that has a lock stitch used to pull together the skin of the wound
Absorbable Sutures
Disappear over time, no need for removal, used on internal tissues
Non-Absorabable Sutures
Must be removed after a few weeks, used on superficial tissues or at times internal if absorbable sutures cannot
Deep Sutures
Placed in the dermal layer to reduce tension
Superficial Sutures
Placed in the epidermis skin layer
Purpose of Skin Closures
- minimize scar formation
- reduces bleeding
- minimal trauma
- less tension on tissues
- keeps edges approximated
Assessment prior to Suture/Staple removal
- client history of suture/staple removal
- site of surgery - REEDA, Skin Assessment
- tissues involved
- purpose of removal
Supplies required for Suture/Staple Removal
- Special scissors with curved tip - Sutures
- Tweezers
- Special scissors for staples
- Steri strips
Sutures vs Staples
Sutures are absorbable or non-absorbable, sewn into tissues by intermittent, continuous or blanket continuous. Minimal scar tissue and precise, available in different materials.
Staples are quicker to use, used on outer tissue and cause less trauma and also stronger than sutures. Not as precise and create round wound edges that may lead to abnormal scar formation
Process of applying Steri-Stripes
Steri-strips are applied over the areas where the sutures/staples were removed, this keeps edges closed and support the wound eliminating scarring.
Potential complications of Suture/Staple Removal
- Skin Trauma - Incision separates
- Unable to remove
- Pain
