Wounds Flashcards
Any break in the continuity of body tissue
Wound
Examples:
grazes, burns, surgical incisions, stabs,
leg ulcers, decubitus ulcers (pressure
sores)
Wounds
Stages of Wound Healing
- Stage 1
- Stage 2
- Stage 3
- Stage 4
Traumatic inflammation ( 0-3 days)- redness, heat, swelling
Stage 1
Destructive phase ( 2-5 days)- polymorphs and macrophages clear the wound of debris and stimulate new growth
Stage 2
The proliferative phase( 3-24 days increased collagen formation
Stage 3
Maturation phase ( 24 days-1 year)
scar tissue decreases granulating tissue gets
stronger and changes from reddish to pale
Stage 4
Closure of Surgical Wounds
- Primary Closure
- Delayed Primary Closure
- Secondary Intention
first intention direct suture- if no tissue loss
Primary Closure
Usually, when a drain is left in the situation.
Delayed Primary Closure
Wound closes by a process of contraction and
epithelialisation e.g ulcers and pressure sores
Secondary Intention
Factors Influencing Wound Healing
Good blood supply: ( oxygen, nutrients)
Good nutrition:
Rest: skin cells multiply more rapidly
during sleep
Lack of stress: increased levels of adrenaline
and steriods delay healing
Lack of infection:
Age : children heal more rapidly than older
people
Site of wound: face and neck heal more
rapidly
Factors Delaying Wound Healing: General Factors
General factors
poor diet
anaemia
pulmonary disease
cardiac insufficiency
arteriosclerosis
diabetes mellitus
smoking
Jaundice
malignant disease
high blood urea
stress
lack of sleep
drug therapy e.g.
steroids and
cytotoxic
radiotherapy
Factors Delaying Wound Healing: Local to Patient/Wound
skin edges not lined
up
dead tissue in wound
foreign bodies in
wound
tension on wound
infection
irritant material for
suturing
too tight suturing
Complications of wounds
Haemorrhage ( surgical wounds)
Infection
non union
rupture ( dehiscence)
pressure and strain ( coughing vomiting)
over granulation of scar tissue
contractures
Caring for Wounds: Assess For
Assess for:
type of wound
location of wound
size of wound
shape of wound
level of exudate
condition of wound bed
condition of surrounding skin
Caring for Wounds: Recognizing Inflammation
redness over area and surrounding
tissue
swelling
heat
pain/ tenderness
loss of function
Types of Cleansing Fluids
- Antiseptics
- Saline Solutions
- Tap Water
Generally discouraged now- can be toxic to tissue healing.
Antiseptics
True or False: cleansing fluids should be at body
temperature
True
Methods of Cleansing
- Swabbing
- Bathing
- Irrigation
Methods of Cleansing: not particularly effective,
mainly redistributes organisms
Swabbing
Methods of Cleansing: useful for chronic wounds
such as leg ulcers. Take care with equipment to avoid cross contamination.
Bathing
Method of Cleaning: shower head, waterjug,
syringes - don’t be overzealous.
Irrigation
Based on the principle that the wound or
dressing interface should be moist
rather than dry.
Modern Dressing Technology: Choice of Dressing
Common characteristics of the wound dressings
Capable of maintaining
high humidity at wound
site
free of particles and
contaminants]
non toxic / non
allergenic
capable of protecting
the wound from further
trauma
Impermeable to
bacteria
thermally insulating
capable of allowing
gaseous exchange]
able to withstand
infrequent changes
cost effective
long lasting
Patient Factors Influencing the choice
of dressing:
Age
Lifestyle
Medical History
Care environment
Ability to maintain /change own dressing
Competence and willingness of
potential carers
Types of Dressings
Low adherent dressings-Tullegras,Tegapore
Semi permeable films- Opsite, Tegaderm
Hydrocolloids - Comfeel plus, Granuflex
Hydrogels- Intrasite, Sterigel
Alginates- Sorbisan, Kaltostat
Foam dressings- Cavicare, Lyofoam extra
Antimicrobial dressings- Actisorb plus,
Inadine
Minimising Cross Infection
Dressing and cleansing wounds is at
the very minimum a Clean Procedure
and is often an Aseptic Procedures
Thorough hand-washing and use of
gloves are the most effective methods
of preventing contamination of the
wound
If wounds are infected then care must
be taken to prevent cross
contamination
