Wound assessment

Question 1

Name the 4 parts of the TIME assessment for wound assessment and wound bed preparation

Answer 1

1 Tissue
2 Infection/ inflammation
3 Moisture imbalance
4 Edge of wound

Question 2

For Tissue, what are the pathophysiology, clinical actions and effect on wound bed?

Answer 2

1 Pathophysiology - defective extracellular matrix and wound debris
2 Clinical action - Debridement
3 Effect - Viable wound bed and functional extracellular matrix proteins

Question 3

For infection/ inflammation, what are the pathophysiology, clinical actions and effect on wound bed?

Answer 3

1 Pathophysiology - high bacterial count or prolonged inflammation, reduced growth factor activity
2 Clinical action - remove infected foci with antimicrobials, anti-inflammatories or protease inhibitors
3 Effect - Bacterial balance, reduced inflammation, increased growth factor