Wound Helaing & Management Flashcards
What are the phases of wound healing?
Haemostasis
Inflammation
Repair
Maturation
What is involved in the haemostasis stage?
Initial bleeding flushes the wound
Vasoconstriction reduced blood flow
What forms in the haemostasis stage?
-platelet plug forms which is triggered by damage to the blood vessel wall
-formation of fibrin plug and Escher (scab)
What is involved in the inflammation stage?
Vasodilation (increased blood flow) and inflammatory response
Wound exudates (pus) - fluid, dead neutrophils and tissue debris
T-lymphocytes are released
What enters the wound in the inflammation stage?
Neutrophils
Monocytes
Macrophages
-phagocytose bacteria and debris
What is involved in the repair stage?
Escher sloughs
Epithelialisation occurs, new epidermal cells are formed at wound edges
(May take weeks to months to fully stratify)
How long does it take for epithelialisation to occur in different wounds?
Immediately in partial thickness wounds
Several days later in full thickness wounds
What develops in the repair stage?
Granulation tissue and connective tissue develops from the fibrin plug
New capillaries develop
Collagen forms
What happens during wound contraction during the repair stage?
Are of the wound reduces
Surrounding skin stretches
What is involved in the maturation stage?
Wound edges meet and epithelialisation is completed
Redness reduces
Remodelling and reorganisation of connective tissue
What % does wound strength reach at the maturation stage?
70-80% of normal tissue
What are factors that promote wound healing?
-Moist wound environment
-Nutrition
-Tissue oxygenation
-Limited movement of wound edges
-Clean wound
-Good immune system
What are factors that delay wound healing?
-Excessively dry or exudating wound
-Poor circulation
-Lack of essential nutrients
-Lack of oxygen delivery and waste removal from tissues
-Patient interference
-Infection
What can cause wounds?
Bites
Branches
Glass
Matting
Urine scalding
Burns
Metal or barbed wires
What is a puncture wound?
Open wound
Deep narrow wound caused by a sharp pointed instrument
What can cause a puncture wound?
Nails
Stakes
Thorns
Claws
Canine teeth
What is an incised wound?
Open wound
Clean, sliced wound
They bleed freely and are often deep
What causes an incised wound?
A sharp implement
What is an abrasion wound?
Open wound
Dragging or friction injury causing removal of skin surface (graze)
What is a lacerated wound?
Tear wound in the tissues with rough edges
What causes laceration wounds?
Barbered wire
Dog teeth
Cat claws
Sharp objects
What is a degloving wound?
Open wound
The top layers of skin and tissue is torn away from the underlying muscle, connective tissue or bone
What causes a degloving wound?
RTA
Fighting
Falls
What is a contusion wound?
Closed wound
Blunt blow or impact that has caused the capillaries below the skin to rupture
Associated with fractures
What is a haematoma wound?
Closed wound
Damage to the veins and arteries under the skin surface causing pooling of blood
What causes haematoma wounds?
Allergies
Ear infections
These can lead to excessive shaking or scratching
What are crush injury wounds?
Closed wound
Excessive force or pressure is put on a body part causing injury under the skin to organs/skeletal framework
What is involved in a wound assessment?
Asses the whole patient initially
Stabilise the patient if required
The time since the injury
Contamination status
Any concurrent diseases or medication
What are the wound contamination statuses?
Clean
Clean-contaminated
Contaminated
Dirty
What is included in wound preparation?
-swabbing for culture and sensitivity
-keep covered with sterile dressing
-ensure analgesia is adequate
-GA is usually required
How is the wound cleaned?
Insert water soluble jelly into the wound
Clip the area around the wound
Debridement
How should lavage be carried out?
-wear gloves and use towel to prevent cross contamination
-requires pressure
-produced by a syringe through needle
-should be carried out initially and at every dressing change
What are techniques of wound closure?
Sutures
Staples
Reconstruction
Surgical drains
When should wounds not be reconstructed?
Not appropriate for contaminated wounds
How should open wound management be assessed?
Tissue
Infection and inflammation
Moisture
Epithelialisation
Why should open wounds receive lavage?
To rehydrate necrotic tissue and remove debris and bacteria
Why are open wounds debrided?
To create a viable tissue edge
Why are dressings applied to open wounds?
To create an optimum environment for effective healing
What factors are included in choosing an appropriate dressing?
Effective wound assessment
Location of the wound
Consideration of costs
Knowledge of stages of healing
When is a hydrogel dressing used?
For burns or infected wounds
When is a cloth dressing used?
Minor injuries such as grazes or cuts
What are the 2 types of absorbent dressings?
Alleyvin - foam dressing, absorbs exudates from wound surface
Melolin - low adhering absorbent dressing used in exudating wounds
What is laser therapy?
The use of a low level laser waves to enhance wound healing and reduce or prevent infection
What are the benefits of laser therapy?
Increased blood flow
Increased oxygenation
Decreased inflammation
Decreased pain
What is a vacuum assisted closure?
The use of negative pressure to encourage epithelialisation and contraction of the wound through the use of a vacuum pump sealed within a plastic dressing
What are the 3 most common wound problems?
Devitalised tissue
Exudating wounds
Infection
How does devitalised tissue create wound problems?
Provides an optimum condition for growth of bacteria
Reduced the viability of the wound bed
Requires debridement
How does exudating wounds affect healing?
Normal part of inflammatory process
Excess, prolonged, infected or fresh bleeding is abnormal
What is maceration damage to wounds?
Prolonged contact with moisture causing it to become soggy
What is excoriation damage to wounds?
Contact with toxins from wound causing damage to top layers of skin
How does infection develop in wounds?
Contamination
Colonisation
Critical colonisation
Infection
What are signs of infection in wounds?
Erythema
Pain
Oedema
Localised heat
What does infection cause to delay healing?
It damages and allows for deterioration of the wound to occur
How is infection prevented in wounds?
Must check wound is properly debrided and cleaned
Antimicrobial dressings
