Wound management Flashcards
why do wounds need to be classified?
allow correct management of wound and patient
state the 3 initial wound classifications
when did it occur
how contaminated is the wound and how did it occur
what is the type of wound
why is it important to find out when wounds occurred?
allows estimation of amount of bacterial multiplication that will be taking place in the wound
how do you classify the time since a wound has happened?
class 1- 0-6 hours old, clean laceration, minimal contamination class 2- 6-12 hours old, significant contamination class 3- over 12 hours or assumed if dont know when it happened, gross contamination
list the different ways to describe how contaminated a wound is
clean
clean contaminated
contaminated
dirty or infected
define a clean wound
surgical wounds created under sterile conditions
what is a clean contaminated wound and when are they closed?
minimal contamination which is easily removed
surgical tract penetrated with minimal spillage
are able to close after treatment
what is a contaminated wound and when are they closed?
gross contamination with foreign objects
close after appropriate treatment
what is meant by a dirty or infected wound and when are they closed?
infection already present in the wound
not closed primarily
list the classifications of types of wounds
incision abrasion avulsion laceration puncture
define incision
smooth edges cut by sharp object, minimal trauma around
define abrasion
blunt trauma, damage to skin and epidermis
define avulsion
tearing tissue from attachment, degloving
define laceration
irregular wound by tearing, variable damage
define puncture wound
penetration by sharp object causing deep damage
list the overall goals of wound healing
full epithelialisation with minimal scarring in as short time as possible, without risking recurrence or breakdown, and as cost effective as possible
what are the aims in wound healing?
prevent further contamination remove foreign debris and contamination debride dead and dying tissue promote viable vascular bed provide drainage close with appropriate method
state the 3 phases of wound healing and when they take place
inflammatory phase- first 72 hours
proliferative phase- 3-5 days
maturation phase- 2-4 weeks
what happens in the inflammatory phase of wound healing?
haemorrhage within minutes of injury
vasoconstriction to allow clots to form then vasodilation to reduce clotting elements into wound to trigger healing
white blood cells leak from vessels into wound to initiate debridement
what is the main aim of the inflammatory phase of wound healing?
debridement
what treatment can be provided in inflammatory phase of wound healing?
wet to dry or dry to dry swabs
hydrogels
topical agents
wound vac
what is meant by the proliferative phase of wound healing?
reconstruction phase
what happens during the proliferative phase of wound healing?
granulation tissue fills the wound
fibroblasts lay network of collagen in wound bed to give strength to tissues
epithelial cells from wound margins migrate to cover wound
what is the aims of the proliferative phase of wound healing?
maintain moist wound environment
prevent damage to cells
what happens in the late proliferative phase?
wound contracts
epithelialisation
exudate reduces and moist environment is maintained
what is meant by the maturation phase of wound healing?
remodelling phase
when does maturation phase begin?
when wound has filled in and resurfaced
what happens during the remodelling phase?
collagen fibres reorganise, remodel and mature to give wound tensile strength forming scar tissue
what factors are used to assess tissue viability?
colour
warmth
pain sensation
bleeding
what factors make it okay for wounds to close?
sufficient tissue to allow reconstruction without dehiscence
no devitalised tissue
no foreign material
functional structures affected by delayed closure or contraction
no infection or contamination
healthy adjacent skin
what are the 4 types of closure?
primary closure
delayed primary closure
secondary closure
second intention healing
when is primary closure used?
minimal tissue contamination, loss or trauma
still within golden period/6-8 hours
what do you do before allowing primary closure or delayed primary closure?
explore wounds
lavage to clean
debride
define debridement
removal of dead or damaged tissues, foreign bodies, MOs to promote wound healing
describe the process of primary closure
fibrin seal forms in 4-6 hours to protect wound against MOs and prevent fluid leakage from wound
epithelialisation of wound surface happens after 48 hours
tensile strength of wound increases by days 7-10
why are sutures normally removed on day 10?
generally enough tensile strength of wound
when is delayed primary closure done?
wounds passed golden period
needing further debridement
when is secondary closure done?
heavily contaminated and dirty wounds
what is the process of secondary closure?
managed as open wounds until granulation bed established
wound debrided and closed
what wounds need second intention healing?
significant tissue loss, contamination or infection
what is the process of second intention healing?
managed as open wound and allowed to granulate and epithelialize
state some areas that are hard to dress?
ears
bottom
back
some extremities
how can you help make easier hard areas to dress?
held by tie over dressings, bandages, vac pac
how is the type of dressing chosen?
correct for most appropriate stage of wound healing to promote healing
what are the properties of non-adherent/passive/absorbent dressings?
absorb fluid breathable deliver moist environment semi permeable membrane made of hydrophilic polyurethane foam dressings
what are non-adherent/passive/absorbent dressings used for?
exudative wounds
what are the properties of non-adherent/mildly absorbent/passive dressings?
perforated PET film
cellulose backing
allows epithelialisation
absorbs exudate
when are non-adherent/mildly absorbent/passive dressings used?
exudating lesions
sutures wounds
superficial cuts and abrasions
light burns
what affects when dressings get changed?
type of wound
volume of exudate
type of dressing
stage of wound healing
when are wet to dry and dry to dry dressings typically changed?
1-2x daily
when are granulating wound dressings usually changed?
every 2-3 days
what is important when triaging patients with superficial wounds?
look at whole patient for other more serious injuries
what are the stages of triaging patients with wounds?
get brief history then gain full later when patient stable
clinical exam- TPR, fractures, respiration, hydration, haemorrhage
further investigations as needed
manage wounds- restrained with GA or sedation, analgesia
describe the process of cleaning wounds
cover and protect wound with sterile lube or damp sterile swab
clip hair around wound to keep clean and check for further injury
thoroughly flush wound to remove debris
investigate wound, potentially doing bacteriology swab for culture
list equipment needed for flushing wounds
large bag of warm 0.9% saline or hartmanns giving set 3 way tap 18/19g needles 20-30ml syringe incontinence pads
what is an important consideration when flushing patients wounds?
limit fluid on patient to prevent hypothermia
when are dressings placed on patients with wounds?
after cleaned and bacteriology swab taken
what are nursing considerations for patients with wounds?
analgesia
antibiotics where needed
prevent patient interference
all elements of patient care
how are dressings and wounds managed?
type of dressing correct for wound and stage of healing
should be same staff but if not possible photos to allow consistent monitoring of progress and changes
what are some considerations specific to equine wounds?
usually lower limbs
most dirty due to environment
commonly have tension over wound due to location and inability to fully restrict movement
need to aim for minimal scar tissue
why is it important to minimise scar tissue when healing wounds?
scar tissue is weaker than original tissue
state the 2 types of surgical drains and examples of each
passive- latex tubing
active- blake-wound explorations, jackson pratt (abdomen)
what determines what type of surgical drain is used?
location
requirement of drain
patient consideration
how can you ensure good communication between client and staff when managing patients with wounds?
photos to show development
address any concerns
make owner aware of responsibility if caring for at home
why is it vital to have good communication with client when managing patients with wounds?
may be in hospital for long time
may be hard to visit around dressing changes and recovery
what are other considerations when managing patients with wounds?
weight- hard to maintain when multiple dressing changes a day, need enough calories, monitor weight daily
stimulation- hospitalised for long time, may have exercise restrictions, allow supervised play, grooming, walks, TLC
how should bandages be managed?
prevent interference
keep dry
check regularly for wetness, slipping, interference, tightening, temperature of toes
when should you discharge patients with wounds?
as soon as possible but when dressing changes are every 2-3 days and wound has made good progress
what needs to be done before discharging patients with wounds?
give client clear instructions on care and managing dressings, contact information if concerned, cover for walks
