Wound Healing

Question 1

Define: Repair

Answer 1

Healing as a result of lost cells being replaced by connective tissue.
Most common type of healing and results in scar usually. Most injuries heal by connective tissue repair.

More complex than regeneration.

Question 2

Repair: Primary intention** and Initial Phase

Answer 2

Primary intention = when wound margins are neatly approximated like a surgical incision or paper cut.

INITIAL PHASE: edges of the incision are sutured in place and it fills with brood from the cut vessel to form clots. Growth factor is released by platelets to begin the healing.

• acute inflammation reaction
• wbc migration
• composed of fibrin clots, erythrocytes and neutrophils dead and dying plus other debris

Question 3

Repair: Primary Intention: GRANULATION PHASE

Answer 3

Second steep
Pink vascular wound
Fibrous / scar tissue formed
Red granules present / young capillaries
Wound is friable at risk of dehiscence and resistant to infection
Edge of wound skin is regenerating and will eventually grown across the found from both directions to meet and start to look like the other tissue

Question 4

Repair: Primary Intention: Maturation Phase and Scare Contraction

Answer 4

Overlaps with the granulation days
Begins 7 days after injury and continues for months to years.

Collagen fibers further organized. Remodeling process occurs. Fibroblasts disappear because the wound gets stronger. Myofibroblast causes contraction of healing area. Mature scar tissue forms; it’s a vascular and pale. Scare may be more painful at this point

Question 5

Repair Secondary Intention***

Answer 5

Wounds from: trauma, ulceration, irregular margins with extensive tissue loss.

More debris, cells and equate.

Similar to primary intention.
Major differences:
greater defect and the gaping wound edges.
Granulation takes place from the sides inward and from the top and bottom inward (all directions).
More granulation tissue with a bigger scar.

Question 6

Repair: Tertiary Infection

Answer 6

Healing with delayed suture of a wound where two granulation sit-ups are sutured together

Usually occurs when an infected wound is left open to heal from the inside out

Question 7

Wound Classification:
Superficial
Partial thickness
Full thickness

Answer 7

Superficial- involves on the epidermis
Partial thickness- extends to dermis
Full thickness- deepens lay of tissue destruction involve sub q and sometimes fascia and underling structures like muscle, tendon or bone

Question 8

Wound Classification: Color

Answer 8

Red yellow black

Can be two or all three applies for all wounds

Question 9

Wound Assessment: What to record.

Answer 9

Consistency
Color
Odor
Drainage
Abnormalities
I.d healing and non healing factors

Question 10

What is a chronic wound?

Answer 10

A wound that does not heal within the normal time (3 months approx). Asses and I.D delaying factors and refer pt to a specialized wound managment.

Question 11

What is the purpose of wound managment?

Answer 11

1. Cleaning a wound to remove Andy dirt and de rise from wound bed
2. Treating infection to prepare the wound for healing
3. Protecting a clean wound from trauma so it can heal normally

Question 12

Red wounds

Purpose of treatment & Dressing

Answer 12

Purpose of rx: gentle cleansing if indicated. Clean healing wound and keep slightly moist and protected from trauma until naturally healed. DRYNESS IS THE ENEMY do not air out a wound. They need a moist environment to heal.

Dressing: transparent fail or adhesive semipermeable dressing are occlusive dressing there are permeable to oxygen. Then cover with a sterile dressing. Unnecessary manipulation can destroy healing tissue

Question 13

Yellow Wounds

Dressing and Cleaning

Answer 13

Dressing: absorption dressing to absorb equate and cleanse wound surface. Amount of wound secretions determines dressing changes. Hydro colloid dressings are used, leave on for 7 days or when leakage occurs.

Cleaning: gentle

Question 14

Black wounds: Immediate treatment

Answer 14

Immediate treatment = detriments of the nonviable tissue

Detriment method used depends on amount of debris and condition of wound tissue

Question 15

Negative Pressure Wound Therapy

Dressing. Purpose and what to monitor

Answer 15

Vacuum assisted wound closure to speed wound healing

Dressing:gauze or foam dressing is cut to wound size. Large occlusive dressing is applied and a small hole is made offer to gauge or foam dressing to put tubbing.

Purpose; pull excess fluid from the wound reduction bacterial load and encouraging blood flow into the wound base

Monitor: serum protein levels and fluid and electrolytes. Coagulation studies PT and PTT

Question 16

Hyperbaric oxygen therapy

How it works and What it does

Answer 16

Delivery of O2 at increased pressures. Oxygen diffuses into serum and transported to the tissues.

Stimulate angiogenesis / new blood vessel production, kills anaerobic bacteria and increases WBC killing power and certain antibiotics. Accelerates granulation tissue formation and wound healing.

Question 17

What nutritional measures facilitate wound healing?

Answer 17

• High fluid intake to replace fluid lost from sweat and exudate formation plus increased metabolic rate intensifies water loss
• malabsorption problems = at risk for wound healing problems
• under nutrition = poor healing risk
• high protein carb and vit with moderate fat = promotes healing
• vit C - collagen and fibroblast
• vit B complex = coenzymes for many metabolic reactions
• vit a = process of epithelialization and increases collagen production and tensile strength of healing wound

Question 18

What do proteins, carbs and fats have to do with wound healing?

Answer 18

Proteins = needed for making immune factors, leukocytes, fibroblast and collagen / the building blocks of the immune system

Carbs = increased metabolic energy required in inflammation and healing. If deficient they steal and break down proteins

Fats = make fatty acids and triglycerides. Which are part of cellular membrane

Question 19

How to prevent infections:

Answer 19

Follow aseptic procedures
Don’t allow the pt to touch the area
Keep pt environment free from contamination (obj, ppl)
Sometimes antibiotics may be given prophylactically

Question 20

Wound infection control:

Answer 20

Culture and sensitivity test to determine most effective treatment.

Taken by needle aspiration, tissue culture or swab technique. Nurses only use swab technique which are wound exudate a, z techniques and Levites technique

Question 21

Psychological Implications: What does an pt need to understand about their wound?

Answer 21

It’s all apart of the healing process. So avoid making funny faces when changing a wound.

Question 22

Wound Patient Teaching

Answer 22

Adequate rest and good nutrition
Minimize physical and emotional stress
Observe wound for complications: contracture a, adhesions and secondary infection*
Understand s/s or infection
Notify health care provider
Review drug side effects, adverse effects and easy to prevent side effects.Tell that they need to finish the entire prescription

Question 23

Define: REgeneration

Answer 23

Replacement of lost cells and tissues with cels of the same type. Regeneration depends of cell type.

Question 24

Complications: Dehiscence

Answer 24

Separation and disruption of previously joined wound edges

Question 25

Complication: Evisceration

Answer 25

Occurs when wounds edges separate to the extend that intestines come out of wound