Wound healing and management Flashcards
What is tissue viability and give an example?
- A growing speciality that primarily considers all aspects of skin and soft tissue wound management- made up of specialist nurses
- Examples: Acute surgical wounds, pressure ulcers and all forms of leg ulceration
What are the aims and objectives of tissue viability
- Provision of healthcare practitioners with support on professional, evidence based, clinically confident tissue viability care
- Provision of a service for all specialities and age range
- Monday to Friday service
- Online referral process
What are the services provided
- Pressure ulcer assessment and management and prevention
- Leg ulcer assessment and management
- Wound management and advice- dressing types
- Negative wound pressure therapy
What is primary intention for wound closure and healing
Primary intention: direct closure of two wound edges with stitches, staples or tissue glue
What is secondary intention for wound closure and healing
Secondary intention: wound healing by granulation, tissue will heal itself from the base upwards to fill gap and close wound
What is tertiary closure for wound closure and healing
Wound stays open to allow for drainage and infection management, occurs prior to wound closing and skin grafting
What are the four stages of wound healing and briefly explain each one
Haemostasis- vasoconstriction and platelet aggregation
Inflammation- fibrin clot, release of pro inflammatory cytokines which cause arrival of neutrophils, macrophages, lymphocytes and necrotic debridement
Proliferation- regeneration of collagen in sync with glycosaminoglycan to rebuild extracellular matrix
Maturation- wound vascularisation decreases, collagen fibres reorganise and scar tissue reduces
What are factors that affect wound healing
Oxygenation
Age and gender
Infection
Venous sufficiency (leg ulcers)
Diseases: aids
Medication: steroids, NSAIDs, chemotherapy
Stress
Nutrition
Alcoholism and smoking
Obesity
Nutrition
What is important in a patient history you must find out before beginning wound management
Medical diseases: diabetes, peripheral vascular disease, long lie
Cytotoxic, steroids, anticoagulants
Clostridium difficile, MRSA and VRE
Allergies, previous dressings, pain tolerance
How do you do wound assessment
Location on body
Size and depth
Undermining or tunnelling
Wound bed: colour, type of tissue, devitalised or dead tissue
Exudate: fluid, amount, colour
Odour
Pain
Surrounding skin condition
What are properties of an ideal dressing
Bacteria proof Allows gaseous exchange Manages exudate Non adherent Fibre and toxic free Hypoallergenic Maintains temperature and haemostasis Acceptable to patient Cost effectiveness
Describe the alginate dressing type
- Haemostatic properties: release of calcium ions
- Made from brown seaweed that is highly absorbable
- Promotion of debridement of slough
- Made for WET or CAVITY wounds
Describe the hydrocolloid dressing type and give an example
- Provides moist wound healing, debridement and formulation of debridement tissue
- Occlusive and water proof
- Low to medium exudate wounds: limited absorption capacity
- Caution: if using on infected wounds
- Slight odour upon removal
- Example: Comfeel
Describe the Inadine dressing type
10% povidone iodine
Caution: thyroid sensitive iodine patients with renal problems
Describe the silver dressing type
Aquacel AG 1.2%
Coated with nano crystalline silver that kills bacteria at rapid rate due to high concentration of silver
Actisorb silver with charcoal for odour
