wound healing

Question 1

1 STAGE name

Answer 1

vascular response/hemostasis

Question 2

hemostasis activities

Answer 2

• blood vessels constrict
• clotting factors to anticoagulate
• platelets release growth factors to attract cells needed to begin repairing

Question 3

onset of stage #1

Answer 3

immediate

Question 4

2 STAGE name

Answer 4

inflammatory

Question 5

2 stage activities

Answer 5

vasodilation
leukocytes arrive
macrophages eat
cleaning up of wound bed

Question 6

onset of inflammatory

Answer 6

immediate

Question 7

duration of inflammatory

Answer 7

4-6 days

Question 8

3 STAGE name

Answer 8

proliferative

Question 9

3 stage activities

Answer 9

epithelialization, proliferation
granulation**
angiogenesis (new capillaries)
collagen synthesized to provide strength to wound bed

Question 10

proliferative onset

Answer 10

1-4 days

Question 11

proliferative duration

Answer 11

14-21 days

Question 12

4 STAGE name

Answer 12

maturation

Question 13

maturation activities

Answer 13

collagen remodeled to become stronger and provide tensile strength to wound
outer appearance in noncomplicated wounds is a well healed scar

Question 14

maturation onset

Answer 14

14-21 days

Question 15

maturation duration

Answer 15

up to 2 years to stabilize in appearance

Question 16

primary intention

Answer 16

sutures/wound closures used to approximate edges (surgical incision); but doesnt have to have sutures (ie paper cuts); well-approximated

Question 17

secondary intention

Answer 17

wound left open (ie pressure ulcer)

Question 18

tertiary intention

Answer 18

delayed primary closure

• • a contaminated wound, or in cases of edema++/inflammation, is left open and closed 3-5+ days later with staples/sutures
• • high infection risk, needs to be well-controlled and sterile environment

Question 19

granulation tissue

Answer 19

red
result of increasing amount of new blood vessels
considered healthy

Question 20

slough tissue

Answer 20

yellow

nonviable tissue and in some cases indicates infection

Question 21

eschar

Answer 21

black/brown
represents full thickness tissue destruction
necrotic tissue

Question 22

assessment acronym for wounds

Answer 22

REEDA

Question 23

REEDA

Answer 23

Redness
Edema
Ecchymosis
Discharge
Approximation

Question 24

when to administer analgesic before wound care? PO?

Answer 24

30 minutes before

Question 25

administer IM before wound care?

Answer 25

10-15 minutes

Question 26

administer IV analgesic before wound care?

Answer 26

5 minutes before

Question 27

sanguineous

Answer 27

aka hemorrhage | bright red, bloody, fresh bleeding

Question 28

sanguineous seen when

Answer 28

small amount normal after surgery or tauma, +++ may mean hemorrhage

Question 29

serosanguineous

Answer 29

blood-tinged yellow or pink (pale-red) | more watery than sanguineous

Question 30

serosanguineous seen when

Answer 30

48-72 hrs after injury or trauma | ++ may mean dehiscence

Question 31

serous

Answer 31

thin yellow clear, watery plasma

Question 32

serous when

Answer 32

up to 1 week after injury or trauma | ++ may mean draining seroma (pocket like build-up of serous fluid post-op)

Question 33

purulent

Answer 33

thin, cloudy, foul-smelling, thick if filled w dead cells, yellow/green/brown in colour indicated infection

Question 34

catarrhal

Answer 34

thin, clear mucus (sputum but is grouped w exudate) | seen with URTI (expectorant)

Question 35

SEPSIS 3 MAJOR WARNING SIGNS

Answer 35

tachycardia hypotension decreased urine output

Question 36

evisceration

Answer 36

protrusion of internal organs through wound

Question 37

incisional hernia

Answer 37

a weakness of incision line, may need repair later

Question 38

fistula formation

Answer 38

wound grows into another surface during the healing process (a bridge/passage)