wound management Flashcards
abrasion
wound caused by friction ex, scrape, blister
hematoma
a large blood clot under the skin caused by trauma, swelling is present
contusion
damage to the tissue without laceration to the skin ex. bruise, bowed tendon
puncture wound
wound caused by a foreign object (ex. nail), generally little to no bleeding which may cause infection, small hole on the skin surface
incision
cleaner than laceration, generally caused by a sharp object, edges of wound will come back together easily
laceration
complicated injury with turns and torn edges of the skin
complicated wound
difficult to heal, torn edges, necrotic tissue, infection may be involved. will take a long time to heal
3 phases of healing
- inflammation 2. granulation 3. contraction and epitheliazation
inflammation
clot provides scaffolding for new matrix and migration of cells, phagocytic cells will debride wound
granulation
cannot proceed until blood clots, necrotic tissue, debris, and infection have been eliminated. angiogenesis for blood supply, granulation tissue made of loose ECM develops 3-6 days after injury and continues until epitheliazation occurs. begins closing wound and protects against additional bacteria
construction and epithelialization
very slow, but starts within hours of wounding. cells migrate centripetally. healing epithelium is fragile and poorly adherent to underlying tissues. the wound contracts and a scar is formed
purpose of granulation tissue
- provides surface for epitheliazation (attachment of skin cells)
- resistant to infection
- necessary for wound contraction
factors that delay healing
location, infection, movement, wound dimensions, involvement of deep structures, poor blood and/or oxygen supply, foreign bodies, nutritional factor, previous treatment, age of wound, economic factor
how does location delay wound healing
wounds on limbs heal slower and are more problematic than other parts of the body due to decreased vascular supply, bone prominences, no supporting deep musculature, highly mobile joints, higher degree of contamination. wounds closer to the heart heal faster.
initial wound cleaning
wash wound with saline or water, cover the wound with hydrogel (water soluble gel) before clipping (remember hair becomes a foreign body and impedes healing). clean wound with 0.5% chlorohexidine. flaps of skin should be lifted and flushed underneath. do not wipe wound after it has been flushed. always clean wounds from the inside to outside
wound assessment
use sterile gloves to prevent contamination, may need to use anesthesia for safety
wound debridement
convert an accidental wound into a surgical wound by cutting along the edges. a scalpel should be used instead of scissors
provisions of a moist environment
use water soluble gels instead of petroleum
types of wound closure
primary closure, delayed primary closure, second intension. TETANUS VACCINE OR ANTISERUM SHOULD BE GIVEN
primary closure
wounds should not be completely closed unless the deeper tissues are sterile. suture dehiscence is a result of infection, skin loss, tension in suture line or marked swelling
when to use antibiotics
infection will delay healing, use for known or suspected infections and as prophylaxis, important to choose effacious drug, convenient route and dose with minimal side effects, it is important to give the full course to prevent bacterial resistance
parenteral antibiotic
used only initially unless the wound becomes complicated
wound lavage or flushing
removes dead tissue, bacteria, foreign matter without compromising the physiological status of the new forming tissues. the two main factors are the type of fluid and pressure
