Wound Care 2 Flashcards
Acute Wounds
induced by surgery or trauma
progress in predictable time and manner
Chronic Wounds
Fail to progress through phases of healing
healing is prolonged
Is it possible to accelerate normal healing?
No.
But it is possible to improve delayed healing by addressing factors complicating wound repair.
What areas heal more slowly?
areas w/decreased vascularity
wounds over bony prominences
areas w/decreased # of epidermal appendages
areas where skin is thicker
Which heals faster- larger or smaller wounds?
smaller wounds heal faster
Circle, Square and linear wounds- which is slowest to heal?
circle is slowest
linear is fastest
What is a good temp for wounds to heal?
98.6-100.4 F
This is because vasculature dilates, tissues are less vulnerable to infection, and oxygen levels are increased.
At what temp will healing slow down?
68 F
At 53.6 F what happens to tissue strength?
strength decreases and it becomes breakable
Dry Wounds go through phases of inflammation more slowly why?
epithelial cell migration is slowed
if covered with 0.2-0.3mm thick crust on top it dries more slowly.
wound will be inflamed and painful
Covered wounds trap wound fluids which…
stimulates collagen synthesis
induces angiogenesis
enhances wound contraction
Too much moisture can delay wound healing how?
periwound becomes macerated
macerated skin is more fragile and friable
Problems that may occur due to necrotic tissue
epithelial cells can only migrate over viable tissue
necrotic tissue provides food for microbes/promotes infection.
foreign bodies contribute to infection and perpetuate inflammatory response
What implies infection?
colonization (presence of microbes) does not imply infection..when the amount reaches high enough level THEN healing will be impaired because they compete with body cells for O2 and energy & secrete cytotoxic cells
What number of microbes implies infection?
greater than 10 to the 5th per gram of tissue.
What does infection do to the healing process?
prolongs inflammation, contributes to wound dehiscence, increases scarring, slows wound healing.
Circulation factors for wound healing
it’s possible to have normal macrocirculation but inadequate microcirculation. Diseases that impair microcirculation (PVD, diabetes) impair wound healing
What can affect circulation?
conditions that promote sympathetic response (fight or flight)
cold, fear, pain
Sensation and wound healing
deficits may cause failure to relieve pressure
can indirectly retard wound healing by leading to continued trauma
Mechanical stress can cause
pressure ulcers
periwound edema can restrict blood flow and impede healing.
tension on wound edges may delay wound healing
Age related changes that can change wound healing
slowed immune response decreased collagen synthesis thinner skin dry skin decreased pain perception decreased inflammatory response decreased vascular response frequent comorbities
Inadequate nutrition causes problems how
active cells require energy to fx
carbs are preferred source
if carbs aren’t present, body turns to burning amino acids and can lead to protein depletion—> impairs inflammation, immune response, proliferation, and maturation
Recent food intake more important than food consumed over past weeks or months
Comorbidities that may affect wound healing
diseases affecting tissue perfusion or oxygenation impair wound healing such as:
PVD
COPD
anemia
Immuno compromise increases risk of infection, for example..
HIV/AIDS diabetes hypothyroidism aging steroid use malnutrition chemo/radiation
Medication that impairs wound healing is:
steroids impair all phases by suppressing inflammation and the immune system, decreasing angiogenesis, slowing cell proliferation, decreasing collagen synthesis
Chemotherapy
Smoking impairs wound healing by…
vasoconstriction
increased platelet aggregation and clot strength
reduced oxygen availability
Inappropriate wound management by clinician
failure to refer to specialist
failure to follow guidelines
allowing wound to dry out (crust formation)
exposing wound to environment
wet-to-dry dressing (allowing dessication-dryness)
inappropriate use of antiseptics
overuse of whirlpool
When is it ok to use whirlpool?
wounds w/ thick exudates, slough, or necrotic tissue
When is whirlpool contraindicated and why?
contraindicated on clean wounds
because it increases edema, traumatizes granulation tissue, retards epithelialization
How to measure wound size
longest length
widest width
deepest part
not possible to detect depth with eschar covered wound
Wound tracing
use transparent wrap and trace with a pen
Photographic measurement
not effective because it’s time consuming and costly
hard to get same angle and lighting each time
volumetric measurement of wound
measuring either the amount of molding or saline required to fill wound void
Molding
time consuming
can be painful
molding material may have detrimental effect on wound healing
Saline
must assure good removal of exudates or saline prior to filling
wound must be perpendicular to gravity
can’t be used on wounds that extend into body cavity or fascial planes
Tunneling
narrow passage created by separation or destruction to fascial planes (CT that bind tissue)
measured by inserting probe into passage
position described in clock terms
Undermining
erosion of tissue under wound edges, resulting in large wound w/small opening
measured by inserting probe almost parallel to wound surface under wound edge.
clock terms used to identify area
Granulation tissue: healthy vs unhealthy
healthy-beefy red appearance
poor blood supply or infected-pale or dusky and friable
Necrotic tissue types/amounts
slough-yellow or tan and stringy or mucinous
eschar-black. can be soft or hard.
adherent or nonadherent- greater the depth of destruction, the more adherent
Chronic wounds often have what type of wound edges?
rolled edges
Wounds due to diabetes or peripheral neuropathy often have…
hyperkeratosis
