Wound Management Flashcards
Why is wound classification important?
Ensures correct management of the wound and patient
What are the characteristics of a class 1 wound?
0-6 hours old
Clean laceration
Minimal contamination
What are the characteristics of a class 2 wound?
6-12 hours old
Significant contamination
What are the characteristics of a class 3 wound?
> 12hrs old
Gross contamination
What is a clean wound?
A wound created under sterile conditions (surgical)
What is a clean contaminated wound?
Wound with minimal contamination (easily removed)
Surgical penetration of a tract
Can close after appropriate treatment
What is a contaminated wound?
Wound with gross contamination with foreign debris
Can close after appropriate treatment
What is a dirty/infected wound?
Wound with infection >10^5 organisms per gram
Never close primarily
What is an incision wound?
Created by sharp objects, smooth edges with minimal surrounding trauma
What is an abrasion wound?
Created by blunt trauma/shearing force, damage to skin
What is an avulsion wound?
Tearing of tissue from attachment, avulsion of limbs, degloving
What is a laceration wound?
Irregular wound created by tearing, variable damage to tissues
What is a puncture wound?
Penetrating wound by sharp object, minimal superficial damage but substantial deeper damage
What are the 3 stages of wound healing?
Inflammatory phase
Proliferative phase
Maturation phase
When is the inflammatory phase of wound healing?
Within first 72 hours post-injury
What happens in the inflammatory phase of wound healing?
Haemorrhage within minutes of injury, then vasoconstriction
Vasodilation to release clotting elements into wound
WBCs leak from blood vessels into wound, initiating debridement
When does the early proliferative phase of wound healing begin?
3-5 days post-injury
What happens in the early proliferative stage of wound healing?
Granulation tissue fills wound
Fibroblasts lay network of collagen in wound bed for strength
Epithelial cells from wound margins migrate to cover wound
What happens in the maturation stage of wound healing?
Remodelling phase -
Collagen fibres reorganise, remodel and mature to give wound tensile strength, forming scar tissue
When does the maturation stage of wound healing occur?
2-4 weeks post-injury
What are the broad goals of wound healing?
Full epithelialisation without scar formation in as minimal time as possible
Without re-occurrence/risk of breakdown
Cost effective as possible
What are the 6 goals of wound management?
- Prevent further contamination
- Remove foreign debris
- Debride dead/dying tissue
- Promote viable vascular bed
- Provide drainage
- Select appropriate method for closure
How do you assess viability of tissue in wound healing?
Colour, warmth, pain sensation, bleeding
What is a primary wound closure?
When can sutures be removed?
Closure for wounds with minimal tissue contamination/loss/trauma
Explore, lavage and debride wounds before closing
Sutures removed at day 10
What is a delayed primary wound closure?
For wounds which have gone beyond the ‘golden period’ (0-6 hours)
Explore, lavage and surgically debride thoroughly
What is a secondary wound closure?
For heavily contaminated/dirty wounds
Managed as open until granulation established, then wound edges are debrided and closed
What is secondary intention healing of a wound?
Wounds with significant tissue loss/contamination/ infection
Managed as open wound
Allowed to granulate and epithelialise
What factors make a wound suitable for closure?
Significant tissue to allow reconstruction without dehiscence
No devitalised tissue
No signs of infection/contamination
Adjacent skin is healthy
Functional structures will be affected by delayed closure
Why might you choose a non-adherent/passive/absorbent dressing (e.g. Allevyn)?
Absorbs fluid - suitable for exudative wounds
Semi-permeable (breathable)
Delivers moist environment
When might you choose a non-adherent/passive/MILDLY absorbent dressing?
Lightly exuding lesions, sutured wounds, superficial cuts and abrasions, light burns
Allows epithelialisation and light absorption of exudate
How often should you change a wet to dry/dry to dry dressing?
Daily/twice daily depending on volume of exudate
How often should you change a dressing on a granulating wound?
Every 2-3 days
What are some of the limitations which can be encountered during wound care?
Cost (main)
Infection
Patient tolerance of nursing care
Owner patience
What are the most important things to consider when triaging a wounded patient?
Any life-threatening concerns (pneumothorax, diaphragmatic hernias, ruptured bladder, head injuries)
Hydration status
TPMR
Visual check of wounds/haemorrhage severity
Respiratory effort or concerns
What are the main steps in cleaning and prep of a wound?
- Cover and protect wound (sterile lube or saline-dampened swab)
- Clip hair away from around wound
- Flush wound with sterile technique
- Investigation of wound can now be carried out
What equipment is required for flushing a wound?
Warm Hartmanns/saline Giving set 3-way tap 18/19G needle 20-30ml syringe Incontinence pads (lots)
How does nursing of an equine wound differ to cat/dog nursing?
Often involves radiographs/ultrasound
More concern over tension on wound
Quills sometimes used to release pressure
Aim for minimal scar tissue
Care with selection of topical ointments
Are these drains active or passive?
Active
Are these drains active or passive?
Passive
How often should a wound dressing be checked?
At least every 4-6 hours
When checking a wound dressing, what should you be looking for?
Damp/wet, slipping
Patient interference and tolerance of dressing
Tightening (swelling above/below elbow)
Checking toes for moisture/temperature
When should wound management patients be discharged and allowed to go home?
ASAP - usually when dressing are being changed every 2-3 days and wound has made good progress
