Week 1 Wound Healing Flashcards
what are the three phases of healing
inflammation
proliferation
maturation and remodeling
what two responses do you get in inflammation
vascular and cellular response
what is the goal of the vascular response
control bleeding, fight infectious agents
describe the vascular response
transudate leaks out of the vessel walls, and you get local edema. This cases local blood vessels to constrict. platelets aggregate and active and a plug is formed, which walls off area and closes lymph channels. MORE edema. so chemical mediators are released
within 30 minutes of vasoconstriction, what occurs
vasodilation
what 3 things result from vasodilation
localized redness, warmth and edema
what are the cardinal signs of inflammation
edema, redness, warmth, pain, decreased function
what is the cellular inflammatory response
you get an increase in leakiness vessel walls, and pushes polymorphonuclearneutrophils (PMNs) to the sides of the vessel walls. the macrophages arrive and kill pathogens and direct the repair process. Finally, mast cells produce histamine and secrete enzymes to accelerate the riddance of damaged cells
what are the key cells in the cellular inflammatory response
platelets, PMNs, macrophages, mast cells
what are the first to arrive at the site of the injury, what do they do? and what do they secrete
PMNs arrive within the first 24 hours, kill bacteria and clean, then secrete matrix metalloproteases (MMPs)
what is proliferation
this is where you get angiogenesis (formation of new blood vessels), granulation tissue and wound contracture. finally, you get epithelialization
what is angiogenesis
formation of new blood vessels
what si granulation tissue
fibroblasts lay down extracellular matrix, which will eventually be replaced by scar tissue
what is wound contracture
myofibroblasts pull wound margin together
what is epithelialization
keratinocytes and epidermal appendages multiply and migrate across the wound bed
what happens in the maturation phase
granulation tissue must be strengthened and reorganized, rapid collagen synthesis
how long does maturation last
up to 2 years following the wound closure
when do you see the greatest change in the maturation phase
in the first 6-12 months
TF: tissue strength returns to 100%
false, only 80%
TF: you are unable to sweat in a wound
true, because you lose the glands.
TF: your skin becomes less sensitive to touch and temperature
true
what are 8 general factors that affect wound healing
- mechanism of onset
- time since onset (acute or chronic)
- location (blood supply, bones and prominences)
- wound dimensions
- temperature
- wound hydration
- necrotic tissue
- infection
does thin or thick skin heal faster
thin is faster
in what order, in speed of healing, do wounds heal
circular is the slowest
then square or rectangle
linear is the fastest
what temperature is the best
37-38
what are the three local factors
circulation
sensation
mechanical stress
what things fall under the circulation category of local factors
macro and micro circulation and SNS response to cold, fear, pain
how does sensation affect wound healing
decreased knowledge of pain and you can get additional trauma to the area
what is mechanical stress
friction, shear, weight bearing and pressure
what are the 5 systemic factors that affect wound healing
age nutrition cormorbidities medications behavioral risk taking
TF: your immune response is faster when you age
false it is slowed
TF: you have decreased collagen synthesis as you age
true
TF: you have epidermal and dermal atrophy
true you have thinner skin
TF: as you age, you have less sweat and oil glands
true
TF: you have decreased pain perception and decreased inflammatory response when you age
true
what other things do you have more of when you age
more co-morbidities
more susceptible to infection
more medications
what kind of nutrition do we need and why
carbs for energy, and protein for cellular repair and regeneration
TF: if you are protein deficient, your wounds will heal slower.
true
TF: you heal slower when you are immunocompromised like when you have HIV AIDS or DM
true
does oxygen perfusion affect wound healing,
yes, like when you have PVD, anemia and COPD and heart conditions
how does activity limitations affect wound healing
you lose strength and ROM, and have an increase in shear forces in the area, and then decrease in healing
how do medications affect healing
steroids, chemo and NSAIDS all mess with healing
what are some behavioral risks that people take
smoking and using alcohol
smoking will decrease oxygen perfusion and alcohol will cause malnutrition and will impair judgement.
how does O2 perfusion change 1 hour after smoking
decreased by 30%,less oxygen, less healing.
what are some inappropriate wound care techniques by the clinician
- prolonged or inappropriate use of antiseptics
- wrong dressing (dries it out, or too wet)
- failure to detect and treat
- inappropriate irrigation and debridement and compression
- poor wound exploration
- poor temperature management
what are some appropriate wound care things that still affect healing
- initial use of antiseptics to kill all
- maintenance care is not priority
- use of iodine to encourage/maintain non-viable tissue desiccation
