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MIDW1002 Scientific Underpinnings of Midwifery Care > The Skin and Wound Healing > Flashcards

The Skin and Wound Healing Flashcards

1
Q

Describe the basic anatomy and physiology of the skin

A
  • it is the largest organ of the body
  • it receives 1/3 of all circulating blood volume
  • it makes up about 10% of total body weight
  • it varies in thickness
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2
Q

Describe the structure of the skin

A
  • epidermis
    - -> outermost layer
    - -> avascular
    - -> regenerates every 4-6 weeks
    - -> functions as a protective barrier preventing environmental damage and microorganism invasion
    - -> thickness varies, thicker on palms of hands and soles of feet
  • dermis
    - -> provides support and transport of nutrients to epidermis
    - -> contains blood and lymphatic vessels, swear and oil glands and hair follicles
    - -> it is made up of collagen, fibroblasts, elastin and other extra cellular proteins
    - -> the connective tissue within the dermis is highly elastic and its strength helps maintain the skins integrity
  • hypodermis
    - -> subcutaneous adipose fatty tissue
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3
Q

What are the functions of the skin?

A
  • outer boundary for the body and helps preserve the balance within
  • protection barrier against microorganisms, radiation, chemicals, mechanical impacts and pressure
  • thermoregulation
    - -> it is sensitive to fluctuations in temperate, perspiration, shivering and peripheral circulation
  • metabolism
  • synthesis of vitamin D from sunlight
  • secretion
  • excretion
  • cosmetic
  • non-verbal communication
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4
Q

What is the definition of a wound?

A
  • an injury to living tissue
  • a discount intuit in epithelium - may also involve connective tissue
  • a breakdown in protective function
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5
Q

What are the causes of wounds?

A
  • contusion (bruise)
  • abrasion (graze/friction)
  • laceration (tear)
  • incision (cut/surgical insult)
  • puncture (stab)
  • burn (heat, cold, chemical)
  • pressure
  • disease
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6
Q

List the common wounds that occur in perinatal women

A
  • abrasions to nipples
  • tears to genital tract
  • episiotomy
  • LSCS wound site
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7
Q

What is wound healing?

A
  • it is a physiological process by which the body replaces and restores function to damaged tissue
  • it is a cellular and biochemical process which relies on the inflammatory process
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8
Q

What are the objectives of wound healing?

A
  • to control bleeding
  • to prevent infection
  • regeneration and repair
  • to replace devitalised and missing cellular structures and tissue layers
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9
Q

What are the objectives of wound management?

A
  • to heal the wound in the shortest time possible with minimal pain, discomfort and scarring
  • form a flexible and fine scar with high tensile strength
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10
Q

Describe the phases of healing (Haemostasis)

A
  • its aim is to have minimal blood loss and no haemotoma formation
  • constriction of blood supply (vasoconstriction) in wound bed within a few seconds of injury
  • platelets begin clotting
    • -> they adhere to vessel walls in the wound site
    • -> and change to an amorphous shape suitable for clotting
    • -> they have the ability to aggregate and release chemical messengers that stimulate a clotting cascade when in contact with exposed collagen
  • scab formation
    • -> activated fibrin and fibronectin form a plug
    • -> it also acts a structural support matrix for the wound until collagen is deposited
    • -> bleeding ceases when the blood vessels thrombolise (5-10 mins).
    • -> assisted by ligation, alignment optimises healing
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11
Q

Describe the phases of wound healing (inflammatory phase)

A
  • occurs between 1 and 5 days
  • the normal inflammatory response isolates the damaged tissue decreasing the risk of infection
  • the clot and wound tissue releases pro-inflammatory cytokines and growth factors
  • with the activation of clotting factors comes the release of histamine
    - -> vasodilation begins
  • due to increased permeability of the capillary walls - plasma, proteins, leucocytes, antibodies and electrolytes exude into the surrounding tissues
  • the wound appears red, swollen and hot which can be mistaken for infection
  • an open blood supply cleanses the wound
    • -> chemicals attract essential cells (WBC, macrophages, antibodies, enzymes, growth factors and nutrients) to reach wounded area
    • -> leucocytes maintain host response by destroying bacteria and pathogens
    • -> macrophages engulf and ingest invading bacteria, cleanse the wound of devitalised necrotic tissue, damaged cells and cellular debris
    • -> platelet derived growth factors are released which intimate proliferative phase
  • signs (erythema, heat, oedema, pain and functional disturbance)
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12
Q

Describe the phases of healing (proliferation and reconstructive)

A
  • 4-24 days, growth of new tissue
  • growth factors induce cellular migration, division and proliferation
  • fibroblasts enlarge and migrate
  • fibronectin and collagen form provisional matrix
  • new collagen is laid down
  • granulation tissue, formation, rebuilds viable tissue (granules, uneven, pink/red, doesn’t bleed)
  • myofibroblasts grip matrix edges and contract wound
  • epithelial cells proliferate over moist surface, climbing over one another to migrate, resurfacing the wound site and providing cover for new tissue
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13
Q

Describe the phases of wound healing (maturation/remodelling phase)

A
  • 21 days to 1 year
  • final phase once wound is closed
  • collagen fibres enlarge and re orientate along lines of tension in the wound
  • cellular activity is reduced
    • -> redundant cells have programmed cell death and removal
  • the number of blood vessels in wounded areas regress and decrease
  • max tensile strength is reached from approximately 3 months although the scar will only achieve 70-80% of normal skin strength
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14
Q

Explain what is meant by healing by primary intention

A
  • surgically incised (aseptic conditions)
  • surgically clean margins (uncontaminated, uninfected)
  • close approximation by surgical ligatures
  • minimal epithelial cell mortality - small gap to bridge
  • contraction plays a minor role
  • healing occurs with minimal granulation tissue
  • rapid in growth of wound healing cell (macrophages, fibroblasts)
  • rapid skin regeneration - short healing period
  • edges united by 2 weeks
  • dense scar tissue by 1 month
  • minimal scar tissue, neat hairline scar
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15
Q

Explain what is meant by healing by secondary intention

A
  • significant sub-epithelial damage and loss
  • dead space
    • -> open gaping wound with large blood clot, inability to directly bridge gap between separated edges
  • irregular margins (jagged edge)
  • unclean, contaminated, infected
  • no surgical intervention
  • larger scab
  • granulates filling area, from bottom to surface of wound site
  • protracted healing process
    • -> increased potential for infection and other complications
  • the wound edges are not brought together, healing occurs by contraction and epithelialization
  • large amount of scar tissue
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16
Q

Explain what is meant by healing by tertiary intention

A
  • surgical incision
  • wound edges not re-approximated initially, they are left open for a few days to permit drainage of oedema, blood, contamination or infection
  • wound debrided and devitalised tissue removed
  • late surgical closure but within few days
  • increased granulation
  • wide scar
17
Q

What are some of the local factors that can affect wound healing?

A
  • size of wound
  • surgical apposition (poor surgical technique)
  • skin tension
  • vascular supply
  • venous drainage
  • chronic excessive exudate (fluid from tissue damage)
  • location and mobility
  • poorly applied dressing
  • presence of foreign body or localised reaction to it
  • present of microorganisms or infection
  • UV light
  • radiation
18
Q

What are some of the systemic factors that can affect wound healing?

A
  • cold (drop in temp delays healing by 4 hours)
  • excessive heat over 30 degrees
  • age - slower metabolic and circulatory functions
  • degree of immobility
  • obesity
  • stress
  • smoking or alcohol
  • malnutrition
  • deficiencies of vitamins
  • diabetes
  • cardiovascular compromise
  • anaemia
  • White cell disorders
  • shock
  • respiratory compromise
  • systemic infections
  • malignancy or terminal illness
  • radiotherapy, chemotherapy
19
Q

What is the midwife’s role in facilitating healing?

A
  • phases of wound healing need to be supported by controlling the environment as much as possible
  • provision of advice in relation to:
    • -> nutrition - vitamin A, C and E, zinc
    • -> hydration
    • -> sleep
    • -> cleanliness
    • -> signs of infection
    • -> management of pain
    • -> pelvic floor exercises
20
Q

What are some of the vitamins and minerals that aid wound healing?

A
  • Vitamin A is required for epithelial and bone tissue development, cellular differentiation and immune system function
  • vitamin C is an essential co-factor for the synthesis of collagen and other organic components or the intracellular matrix of tissues such as bones, skin, capillary walls and other connective tissue
  • vitamin E is popular among consumers for skin care and to prevent scar formation
    • -> it functions as the major lipophillic antioxidant, preventing per oxidation of lipids resulting in more stable cell membranes
  • zinc is an essential trace mineral for DNA synthesis, cell division, and protein synthesis, all necessary processes for tissue regeneration and repair
21
Q

What should a midwife do at each visit?

A
  • ask about a woman’s wound
  • obtain maternal informed consent to visualise it
  • note colour and appearance
    • -> persistent erythema (reddening)
    • -> non blanching hyperaemia (capillaries do not empty and refill)
    • -> blisters
    • -> alignment of margins
    • -> amount of exudate
  • note odour
  • localised heat (warm to touch)
  • localised oedema (swelling)
  • induration (hardness)
  • purplish/bluish areas in women with dark skin
22
Q

Describe some of the changes that can occur in the skin during pregnancy

A
  • increase in melanocyte stimulating hormone, progesterone and oestrogen results in skin darkening
    - -> secondary areola
  • linea alba is a line that lies over the midline of the rectus muscles from the umbilicus to the symphysis pubis, hyperpigmentation causes it to darken resulting in the linea negra
  • pigmentation of the face (chloasma)
  • as maternal size increases in pregnancy stretching of the collagen layer of the skin occurs, particularly over the breasts, abdomen and thighs - in some women this results in striae gravidarum caused by thin tears occurring in the dermal collagen
    - -> these appear as red stripes, changing to glistening silvery white lines

MIDW1002 Scientific Underpinnings of Midwifery Care (30 decks)

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