Skin & Wound Healing Flashcards
What is the skin?
Skin is the largest organ of the body and the first defence line.
What is the epidermis?
The outer layer that is continuously replaced
Protects against the environment and infection, and prevents excess water loss.
What is the dermis?
- The firm part of your skin (above the fat)
- Blood vessels deliver nutrients and regulate temperature → vasoconstriction and vasodilation
Nerve receptors sense touch, temperature, pain, pressure etc
What are the four stages of wound healing?
- Inflammation
- Destruction
- Proliferation
- Maturation
What is inflammation?
Starts immediately after the injury is caused and lasts 0-3 days.
Vasoconstriction, which results in a blood clot or scab
Once bleeding stops, the blood vessels within the wound dilate to allow fluid carrying the cells necessary for healing to enter the wound.
Around 10-15 minutes after the injury has occurred - wound appears red, heat, swelling and pain (result of histamine and prostaglandin).
What is destruction?
Lasts 1-6 days
To prevent infection, clean and dry the wound and provide the best conditions for healing
White blood cells cleanse the wound by releasing chemicals that digest any bacteria or tissue debris
Once this is complete, the white cells die off and can be seen as moist, sticky tissue, known as slough.
What is Proliferation?
Lasts 3-24 days
New blood vessels, collagen and other connective tissue are developed by fibroblasts-
New capillaries join together in a scaffold which develop into granulation tissue within the wound from the bottom up
Granulation tissue is pale pink but becomes bright red as more new blood vessels develop
What is Maturation?
Lasts between 21 days and two years
Epithelial cells move over the newly formed granulation tissue and reduce the size of the wound by contracting, thereby pulling the edges together
Macrophages re-organise the collagen to form scar tissue, which will fade from red to white over time
Healed skin only regains 80% of the strength of non-injured skin.
What differences occur to the skin in pregnancy?
Hyper-pigmentation
Striae gravidarum: stretch marks- as the skin appears to tear as it stretches to accommodate pregnancy
Spider nevi: capillaries
Varicosities: the veins are more noticeable within the skin
Non-pitting oedema: collection of fluid and is associated with eclampsia and pre eclampsia which can be seen on feet.
Pruritus: itching
What is hyperpigmentation?
Hyperpigmentation: this is due to increase circulating hormones
Dark spots
Linea nigra: may fade between pregnancies but become darker again during each subsequent pregnancies.
Melasma
Cholasma: may develop on the face often a butterfly shape around nose and cheeks. This is due to the increased production of melanocyte-stimulating hormone from the anterior pituitary gland
What are pressure ulcers?
Can occur during labour occur over bony prominences - sacrum, heels, ankles, knees, hips and elbows
Causes
• Shearing forces: moving women up and down the bed
• Friction
• Moisture - amniotic fluid or lochia
How can a women prevent perineal trauma?
Antenatal perineal massage for reducing perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain
The use of warm compresses on the perineum is associated with a decreased occurrence of perineal trauma
• In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
What care does a CS women need?
Prophylactic antibiotics Pain relief Dressing removal around 24 hours if appropriate Advice on wound care Removal of sutures if needed
What is considered as breast wound?
Sore nipples, cracked nipples, baby bite, or milk blister
Engorgement, blocked ducts, mastitis, abscess
Treatment for mastitis?
Paracetamol – pain relief & reduce temperature
Ibuprofen - pain relief, reduce temperature & reduce inflammation
Antibiotics
