Wound Management Flashcards
What is the skin made up of? What is its role?
made up of three layers
- epidermis = elastic layer constantly regenerated
- dermis = contains sweat glands, hair follicles, sebaceous glands
- subcutaneous tissue = connective tissue and fat
main role is
- protection provides a barrier against mechanical, thermal, physical injury and hazardous substances
- prevents loss of moisture
- protects against UV radiation
- sensory organ (touch, temperature etc).
- helps regulate temperature
What is a wound?
is an injury to living tissue caused by a cut, blow or other impact, typically one in which the skin is cut or broken
- can be acute or chronic
What are the types of wounds and their causes?
acute
- surgical wounds = skin trap/flaps
- traumatic wounds = skin tears, burns/scalds, abrasion
chronic (>6 weeks)
- leg ulcers = poor circulation in arteries and veins (arterial and venous ulcers)
- pressure ulcers = shear or friction, prolonged periods of time without pressure relief
- diabetic foot ulcers
What are the causes of ulcers?
poor nutrition
- poor oxygen permeation/perfusion
smoking
- poor oxygen perfusion
decreased sensory perception
= e.g. diabetes
age
- skin is losing collagen and becomes looser
infection
stress
obesity
medication
alcoholism
- decreases vitamin B concentration
How are wounds classed?
are classified according to their appearance and type
- colours are indicative of the stage of wound healing
pink, red, green, yellow, green or black
What are the different colours of wounds?
pink
- colour indicates the depth of granulation tissue (new connective tissue and microscopic blood vessels that form on the surfaces of a wound)
red
- healthy looking tissue is clean and granulating
- beefy red indicates possible infection
yellow
- are comprised of injured tissue which dies and forms a soft yellow mass (slough) which can fully or partially cover the wound
green
- clinically infected (can also present as dark yellow slough)
- need infected material to be removed before healing can occur
black
- necrotic, occurs when slough is produced faster than can be removed, the excess will dehydrate on the wound surface, forming a firm brown and black eschar (dead tissue)
- debridement required
What are the stages of wound healing?
haemostasis
- formation a platelet plug and stable fibrin clot to prevent excessive blood loss
inflammatory (reaction)
- blood vessels dilate to allow essentials cells to reach area, exudate is produced
= heat, swelling, pain
proliferative (repair)
- new network of blood vessels, allow production of granulation tissue
maturation (regeneration)
- remodelling and contraction of wound edges until wound is closed epithelisation
What are the methods of healing? How long do they take to heal?
primary
- sutures, adhesives, clips
secondary
- the wound left open to allow granulation to occur and heal eventually
tertiary
- wound is left open for granulation to occur and then stitched together
normal healing occurs around 2-3 weeks depending on wound and person
wounds are considered ‘chronic’ after 6 weeks
How can wounds affect quality of life?
painful mobility sleepless nights odour - causes embarrassment isolation/burden leaking -embarrassment employment social issues
What are factors that can affect wound healing?
patient and environment
patient
- good nutritional status
- adequate skin perfusion
- age
- well controlled underlying condition (e.g. diabetes)
- avoid medication detrimental to healing process
- smoking
environment
- moist environment
- wound temp maintained at 37
- adequate oxygenation of the tissue
- pH as determined by oxygen concentration
- low bacterial count on wound surface
- wound surface clean – no particulate contamination
- avoid antiseptics (are alcohol based and dry out the skin/removes moisture)
= use saline to irrigate wound surface
What are the classification of wound management materials?
primary wound dressings - are at the site pharmaceutical preparations bandages surgical tapes surgical absorbents dressing packs
What are different types of dressings?
foam
- absorbs and retains fluid, creates a moist wound environment
hydrocolloid
- adhesive dressings that form a gel over the wound and sticks to the skin, donates moisture to the wound and provides a barrier
hydrogel
- hydrates a dry wound, keeps the wound bed moist, gel or sheet form
alginate
- absorbs exudate, turns into a gel, remains intact, shallow wounds
aquafiber
- absorbs exudate, turns into a gel, remains intact, used in cavity wounds
Why/How do dead tissues impair wound healing?
they do this by:
- facilitating growth of bacteria
- inhibiting the migration of immune cells important in wound repair and for the control of infection
black, dry devitalised tissue requires debridement
