Wound healing + management Flashcards
1
Q
Name the 5 layers of the skin
(In order)
A
Stratum..
1. Corneum
2. Lucideum
3. Granulosum
4. Spinosum
5. Basale
2
Q
How many types of cells does the Epidermis have
+
What are they?
A
- 3
- Squamous, Basal, Melanocytes
3
Q
What do Melanocytes create?
A
Melanin
4
Q
Where is the Dermis located?
A
Beneath the Epidermis
5
Q
How many layers are in the Dermis?
+
What are they?
A
- 2
- Papillary (upper) + Therectiular (lower)
6
Q
What 2 things does the Dermis provide?
A
- Flexibility
- Strength
7
Q
List 5 structures that lie within the Dermis
A
- Connective tissue
- Hair follicles
- Blood vessels
- Lymphative vessels
- Sweat glands
8
Q
What are the 5 structures of the Dermis held together by?
A
Collagen
9
Q
What 2 types of receptors are located within the Dermis?
A
- Pain receptors
- Touch receptors
10
Q
What is the lowest layer of the dermis called?
A
The Hypodermis
11
Q
What 2 things does the Hypodermis do for the body?
A
- Protects the body from Injury
- Acts as a shock absorber
12
Q
What 3 things does the Hypodermis consist of?
A
- Fat
- Connective tissue
- Collagen
13
Q
Identify the 3 layers of this diagram.
Starting from top to bottom
A
- Top = Epidermis
- Middle = Dermis
- Bottom = Hypodermis
14
Q
Name the 7 functions of the skin
A
- Protection
- Sensation
- Mobility
- Endocrine activity
- Exocrine activity
- Immunity
- Temperature regulation
15
Q
How does the skin provide Protection?
A
Protects against:
1. Microorganisms
2. Dehydration
3. Ultraviolet light
4. Mechanical damage
First physical barrier against external environment
16
Q
How does the skin provide Sensation?
A
Provides sensation of:
* Pain
* Temperature
* Touch
* Deep pressure
17
Q
How does the skin provide Mobility?
A
Allows smooth movement of the body, particularly over Joints
18
Q
How does the skin provide Endocrine activity?
A
- Skin intiates biochemical processes involved with VItamin D production
- Essential for Calcium absorption + normal bone metabolism
19
Q
How does the skin provide Exocrine activity?
A
Occurs by the release of:
1. Water
1. Urea
1. Ammonia
Secretes:
1. Sebum
2. Sweat
3. Pheromones
Exerts:
1. Important immunologic functions by secreting bioactive substances, such as Cytokines
20
Q
How does the skin provide Immunity?
A
Prevents development against pathogens
21
Q
How does the skin provide Temperature regulation?
A
- Conserves or prevents release of heat
- Helps maintain body’s water + homeostatic balance
22
Q
Define the 2 classifications of wounds
A
- Open
- Closed
23
Q
What 3 ways are wounds classified by?
A
- Type of wound
- Duration of wound
- Degree of contamination
24
Q
What type of wound is this?
A
Incision
25
What type of wound is this?
Laceration
26
What type of wound is this?
Abrasion
27
What type of wound is this?
Puncture
28
What type of wound is this?
Penetration
29
What type of wound is this?
Contusion
30
What type of wound is this?
Haematoma
31
Identify the 5 types of **Open** of wounds
1. Incision
2. Abrasion
3. Avulsion
4. Laceration
5. Puncture
32
Identify the 2 types of **Closed** of wounds
1. Contusion
2. Crushing
33
Describe what is meant by a **Incision** wound
* An open wound
* Created by sharp tool (Scalpel, w/minimal tissue trauma)
34
Describe what is meant by a **Abrasion** wound
* An open wound
* Damage with the loss of Epidermis + Portion of Dermis
35
Describe what is meant by a **Avulsion** wound
* Open wound
* Tearing of tissues, away from attachments, underlying tissue + surroundsing strutures
* Can be caused by a Cat bitee
36
Describe what is meant by a **Laceration** wound
* Open wound
* Irregular in shape
* Causes damge to the superficial + underlying tissues
* Caused by objects like Barbed wire
37
Describe what is meant by a **Puncture** wound
* Open wound
* Penetrating wound
* Can introduce contaminants deep into tissue
* Resulting in high-risk infection
* Typically created by a sharp object
* Caused by metal oject, cat or dog bite
38
Describe what is meant by a **Contusion** wound
* Closed wound
* Otherwise known as a bruise
* Caused by blunt force trauma
* Doesn't break skin
* Causes damage to skin + underlying tissue
39
Describe what is meant by a **Contusion** wound
* Closed wound
* Force applied to the tissue for a long period of time
40
What is meant by the 'Duration of Contamination'
The time between the wound being inflicted + treatment
41
What is important to ascertain from a client when communicating about a wound?
When it was inflicted + how long it has been like that for
42
Can a new wound have a high degree of contamination?
Yes
43
How many degrees of contamination are there, when it comes to wounds?
3
44
What are the **3 degrees of contamination**, when it comes to wounds?
+
What are there durations?
1. Class 1 = Clean wound w/minimal contamination, from 0 - 6hrs
2. Class 2 = Significant contamination, from 6 - 12hrs
3. Class 3 = Gross contamination, for 12+hrs
45
What are the 4 classifications of Surgical wounds?
1. Clean
2. Clean-Contaminated
3. Contaminated
4. Dirty
46
Give the 2 characteristics of a **Clean** wound
1. No break in surgical asepsis
2. Not entered a body cavity (Resp, GI, Urogential etc)
47
Give the 2 characteristics of a **Clean-Contaminated** wound
1. Minor break in surgical asepsis
2. Elective opening of body cavities - w/minimal leak
48
Give the 2 characteristics of a **Contaminated** wound
1. Major break in asepsis
2. Spillage from body cavities, in presence of infection
49
Give the 2 characteristics of a **Dirty** wound
1. Purulent inflammation of body cavities
2. Presence of gross foreign material +. necrotic tissue
50
What is wound healing?
The normal physiological function that restores the continuity of tissues after injury
51
What is a complex process that is characterised by Macroscopic, Microscopic + Biochemical event?
Wound healing
52
# They describe the microscopic changes that occur at that time.,.
What are the 4 phases of wound healing?
1. Haemostasis
2. Inflammation
3. Proliferative (Repair)
4. Maturation (Remodeling)
53
When does **Haemostasis** occur, in wound healing?
* 1st stage
* Occurs immediately after the injury
54
When does **Inflammation** occur, in wound healing?
* 2nd stage
* Occurs within 6hrs of the injury
* Lasts 3-5 days
55
How long does the **Inflammation** stage last in wound healing?
3 - 5 days
56
When does **Proliferation** occur, in wound healing?
* 3rd stage
* Known as the Repair stage
* Occurs 3 - 7 days post-injury
57
How long does the **Proliferative**/**Repair** stage last for in wound healing?
3 - 7 days
58
When does **Maturation** occur, in wound healing?
* 4th stage (Last)
* Known as the Remodelling stage
* Occurs 5 - 7 days post injury
* Can last as long as 2 years
59
How long can the **Maturation**/**Remodelling** phase last for in wound healing?
Up to 2 years
60
When does the Maturation/Remodelling phase occur in wound healing?
5 - 7 days post-injury
61
True or False.
Each of the phases of healing occurs at completely seperate times + as a seperate process.
False
They can occur all at similar times + can overlap
62
If the phases of healing overlap, what can this influence?
The development + duration of the next phase of healing
63
Why is the phases of healing important to identify + treat accordingly?
Because if the the healing phases overlap, they can influence the development + duration of the next phase of healing, becoming critical to reaching the final result
64
What do the numbers at the bottom of this graph indicate?
+
What does this graph demonstate?
1. The 'Days after Injury'
2. Demonstrating the cross-over of the wound healing phases
65
What is Phagocytosis?
Process of cells using it's plasma membrane to engluf large particles, surrounding + destroying foreign substances
66
What are Macrophages?
* Type of WBC
* Helps eliminate foreign substances
* Initates immune response from other immune system cells
67
What are Neutrophils?
* Type of WBC
* Function - to phagocytose, to kill bacteria
68
What is a platelet?
* Disc-shaped cell
* No nucleus
* Found in blood
* Plays an important role in clotting
69
What is a Fibroblast?
* A cell that contributes to the formation of connective tissue
* By secreting collagen proteins
70
What is Vasoconstriction?
* Constriction of BVs
* Making them narrower
* Aided by muscle of vessel wall
71
What is Vasodilation?
* Dilation of BVs
* Making them wider
* Aided by muscle of vessel wall
72
What is Exudate?
* Fluid that leaks out of BVs
* Into surrounding tissues
* Contains:
1. Cells
1. Proteins
1. Solid materials
73
What 3 components make up Exudate?
1. Cells
2. Protein
3. Solid materials
74
What is this process called?
Haemostasis
75
How long does vasoconstriction last for in haemostasis?
5 - 10 minutes
76
What is an Eschar?
Scab
77
What does the inital bleeding do to the wound in Haemostasis?
Flushes the wound
78
What is the 1st thing that occurs in Haemostasis?
* Blood + Lymph flows from damaged vessel
* Initial blood flushes wound
79
List the 8 basic step process of Haemostasis
1. Blood + Lymph flows from damaged BV
2. Bleeding flushes wound
3. Vasconstriction
4. Vasodilation
5. Intravascular cells + fluid pass into extravascular space
6. Platelet plus forms
7. Fibrin plug + Eschar formation
8. Injured cells release thromboplastin
80
What is the function of Vasoconstriction in Haemostasis?
Preserves blood
81
What triggers platelet plug formation?
Damaged BV wall
82
When the injured cells release thromboplastin, what does this activate?
The Extrinsic Coagulation Process
(ECP)
83
What characteristic makes platelets good for Platelet plug formation?
They're sticky!
84
Name the 4 characteristics of Inflammation
1. Redness
2. Swelling
3. Heat
4. Pain
85
What is the Inflammation stage otherwise known as in healing?
The Debridement Phase
86
What does **Transudates** mean?
* Fluids that pass through a membrane or squeeze through tissue or into the Exracellular space of the tissues.
* Thin and watery and contain few cells or PROTEINS
87
How long does the Inflammation or Debridement stage last for in healing?
3 - 5 days
Post-injury
88
What are the 5 basic steps of the **Inflammation** stage in healing?
1. BVs dilate, inc blood flow + bring transudates into the wound - causing heat, redness + swelling
2. WBCs in exudate initiate debridement
3. Neutrophils help break down bactreia, debris + stimulates monocytes
4. Monocytes convert to macrophages = continuing to phagocytoize debris
5. Macrophages release growth factors that aid in tissue repair
89
What is the **Proliferation** stage otherwise known as?
The Repair phase
90
When does the **Proliferation** or Repair phase **occur** in healing?
From 4 - 12 days
91
What is the Proliferation stage characterized by?
**Replacement of lost tissue** with normal, functioning cells of the same type
92
What **3 types of tissue or organs** are **capable** of undergoing **mitosis**, to heal damaged cells in **Proliferation** stage of healing?
1. Epithelia
2. Bone
3. Liver
93
What are the 6 basic steps of the **Proliferation** stage of healing?
1. Angiogenesis begins (formation of new BVs), capillaries grow into the wound
2. Growth factors allow migration of fibroblasts, leading to creation of collagen + myofibroblasts
3. Granulation tissue begins to form 4-7 days followed by epithelialization + wound contraction
4. Epithelialisation takes weeks > months to fully stratify
5. Wound contraction occurs 5-7 days after, wound area reduces + surrounding skin stretches
94
What is Angiogenesis?
The formation of new BVs
95
What does epithelialization do during the Proliferation stage in healing?
Provides structure or scaffolding to the wound
96
What stage of healing is this?
Inflammation/Debridement phase
97
What stage of healing is this?
Proliferation phase
98
What stage of healing is this?
Maturation phase
99
What is name given to the final stage of healing?
**Maturation** phase
100
What is the Maturation stage otherwise known as?
The **Remodelling** stage!
101
At what stage does scar tissue form?
The Maturation stage
102
What are the 5 basic steps of the **Maturation** stage of healing?
1. Begins when collagen fibres begin to orient along lines of stress
2. Wound edges meet (Epitheliasation completed)
3. Redness reduces
4. Skin strength grows (10% @ 14 dyas, 25% @ 4 weeks + 80% @ several months)
103
How long can the Maturation stage of healing last for?
Years!
104
During the Maturation phase of healing, how many **days** does it take for **10% strength** to form?
14 days
105
During the Maturation phase of healing, how many **weeks** does it take for **25% strength** to form?
4 weeks
106
During the Maturation phase of healing, how many **months** does it take for **10% strength** to form?
Several months
107
What is the approx **day** after injury for picture one?
Day 7
108
What is the approx **day** after injury for picture one?
Day 11
109
What is the approx **week** after injury for picture one?
Week 6
110
What is occuring during this stage of healing?
Day 7
* Necrotic tissue + aschar remains after a large section of skin + sloughes
* Microscopically, the WBCs are selectivel debriding the diseased tissue
111
What 2 interventions should be performed at this stage?
1. Surgical debridement
2. Lavage
112
Why should you wait a few days during this stage before intervening?
(especially if it is caused by trauma)
* Allow it to declare itself!
* This allows the VS to determine what skin is viable or not
## Footnote
Flush, pain relief etc..
113
What is occuring during this stage of healing?
Day 11
* Granulation tissue is moving from periphery of wound
* Central area is undergoing debridement of WBCs still
114
What is occuring during this stage of healing?
Week 6
* Granulation tissue is filling the wound
* Rim of pink epithelial cells are migrating inward, across the granulation tissue + building new skin
* Contraction is occuring, pulling pre-eexisting skin inward, thus diminishing the size of the wound
115
List the 7 factors that **promote** wound healing
1. Moist wound environment
2. Good nutrition
3. Tissue oxygenation
4. Limited oxygenatoin
5. Limited movement of wound edges
6. Clean wound
7. Good immune system
116
What will a dry wound environment predipose the wound to?
Scarring
117
What 3 nutrients help aid wound healing?
1. Minerals
2. Vitamins
3. Carbohydrates
118
Why are wounds that are over joints usually harder to heal?
Because movement cannot be limited, to give the wound a chance to heal or reform new skin
119
With grande wounds, when it comes to movement, what might the VS prescribe - tx wise?
Cage rest!
120
List 9 potential factors that delay wound healing
1. Excessively dry wound
2. Exudating wound
3. Poor circulation (Shock, concurrent conditions, age or recumbency)
4. Lack of essential nutrients (anorexia, poor perfusion, malnourished)
5. Lack of oxygen delivery (poor perfusion, resp problems, lack of mobility)
6. Excessive wound edge tension
7. Patient interference
8. Damage during dressing changes
9. Infection
121
What does poor perfusion predispose a healing wound to delay?
Because there are a lack of deoxgenated RBCs
122
When might excessive wound edge tension occur, that may delay wound healing?
1. Applying dressings
2. VS closing wound surgically
123
What might a lot of exduate tell you about a wound?
That its infected
124
What are the 2 classifications of wounds?
1. Open
2. Closed
125
Is this wound open or closed?
Open
126
What type of wound is this?
Laceration - as has irregular edges!
## Footnote
Looks quite fresh ..
But ..
Most likely, contaminated!
127
Is this wound open or closed?
Closed
128
What type of wound is this?
Contusion
129
Why might this closed, contusion wound worry you?
* Because you don't know whether this it superfical or deep!
* If deep, it can be bleeding into the abdominal cavity..!
130
Is this wound open or closed?
Open
131
What type of wound is this?
Puncture
132
What can you do to explore this puncture wound + when?
* When the px is under GA
* Explore wound site with a sterile surgical instrument
* To identify the depth of the wound + if any foregin bodies present or other abnormalities
133
Is this wound open or closed?
Open
134
What type of wound is this?
Degloved +/or Laceration
135
Is this wound open or closed?
Open
136
What type of wound is this?
Abrasion
## Footnote
Nasty abrasion...
Probably been dragged...
137
Is this wound open or closed?
Open
138
What type of wound is this?
Laceration +/or Wound breakdown
139
What type of surgery could potentially cause this wound?
Dew-claw removal
140
Is this an open or closed wound?
Open
141
What type of wound is this?
Penetration (full)
142
What does the dark red colour in this wound possibly indicate?
Contamination
143
What are the 4 aims of wound management?
1. To produce a functional + cosmetic repair
2. Relief of pain + distress to px
3. To be economic + time efficient
4. To make prompt decision making in the event of signs of delayed healing
144
What does it mean when we say we aim for a functional repair, in wound managment?
The area that the wound is located, remains functional
145
What is the primary aim of wound management?
To close the wound, restoring px to normal function
146
What are the 4 things that wound management plan should aim for?
1. Wound closure should aim to return px to normal function
2. VS + RVN disucss as team to plan method for wound/s closure (Primary or Secondary)
3. Should be revised regularly on reassessment of wound condition
4. Provide indication of tx + costs to owner
147
How often should a wound re-assessment occur?
Q3 days
148
What are the 9 things you should establish during a wound assessment?
| Think questions..
1. Assess the patient as a whole + are they stable?
2. Time since injury?
3. What caused the wound?
4. What is the degree of contamination? *
5. What is the degree of trauma?
6. Is there any necrosis?
7. Is there any concurrent disease present?
8. Are they on medication?
9. Is tx or cost a viable option for the owner? Or will euthanasia have to be considered?
## Footnote
* = Degrees of contamination:
- Clean
- Clean-contaminated
- Contaminated
- Dirty
149
What are the 4 wound closure options?
1. Primary
2. Delayed primary
3. Secondary
4. Second Intention
150
What **class** of wound(s) should be closed using **primary** wound closure?
Clean
151
What **class** of wound(s) should be closed using **delayed primary** wound closure?
* Clean-contaminated
* Contaminated
* **Wounds with questionable tissue viability**
152
What **class** of wound(s) should be closed using **Secondary** wound closure?
* Contaminated
* Dirty
153
What **class** of wound(s) should be closed using **Second intention** wound closure?
* Extensive contamination
* Devitalisation
154
# 2 instances...
What **class** of wound(s) should **NOT** be closed using **Second intention** wound closure?
* Surgical closure
* Wounds over joints (will restrict blood flow)
155
How are **primary** wound closures managed?
* Immediate closure if there is enough skin with surgical sutures
* Closure in the first couple of hours
* No tension applied
156
How are **delayed primary** wound closures managed?
* Lavage + debridement until healthy (under sedation)
* Use appropriate dressing
* Closure after 2-3 days
157
How are **Secondary** wound closures managed?
* Lavage + debridement until healthy (under sedation)
* Use appropriate dressing
* Closure after 5-7 days
* Once granulation bed has begun to form
158
How are **Second intention** wound closures managed?
* Open wound management
* Constant lavage + debridement until healthy
* Use appropriate dressing
* Allowed to heal
159
Why should contaminated wounds never be closed using primary intention?
Because that would be surgically closing the bacteria in the wound!
160
Why is it important to not manage an open wound for an excessive period of time?
Because open wound management is to create an environmnt that will allow wound closure + return to normal function
161
What is the most important thing to ensure you do during wound preparation?
Wear STERILE gloves + apron!!
162
List the 7 basic steps for wound preparation
1. Apply sterile gloves + apron
2. Ensure adequate analgesia takes effect at time of procedure (often GA)
3. Keep covered with sterile, non-linting dressing prior to prep
4. Swab wound bed for culture + sensitivty test
5. Insert sterile water soluble jelly into wound
6. Clip around wound - total injury should be visable! (clip past unviable tissue + provide 2cm margin MINIMUM)
7. Debride
163
When clipping a wound for preparation, what are the 3 most vital things to remember?
1. Clip around wound - until whole injury site is visable
2. Clip past unviable tissue
3. **Provide a 2cm margin MINIMUM**
164
What type of swabs should you use for swabbing a wound for a culture + sensitivity test?
Lint-free guaze swabs
165
What do sterile water soluble jelly often come in?
Sachets
166
How much saline is too much?
No such thing!
(Unless hypothermic)
167
Where should you store a culture + sensitivity test after use?
In the fridge
168
Why do you use sterile water soluble **jelly**?
To:
1. Protect wound
2. Clumps all clipped hair together + away from the wound
169
