Wounds, wound healing and wound management (DONE) Flashcards
Normal skin
A complex multi-layered organ of continuous epithelium that: Regulates water and temperature Responds to UV Limits ingress of chemicals Prevents invasion by microorganisms
What is a wound?
Discontinuity of epithelium barrier
Typically refers to the skin, can include contiguous tissues e.g. lips, anus
Can be caused by trauma, injury or infection
Usually deep enough to rupture microcirculation in skin
With or without loss of underlying tissues or organs
Why is it important for a pharmacist to know about wounds?
Increasing encouragement for patients to consult pharmacist prior to booking a GP appointment, which can be up to 2 weeks
Must be able to spot potentially severe cases, in relation to:
Discuss professionally with GP or A+E
For less serious cases, must be able to recommend, from a wide variety of products, the most appropriate treatment, and provide advice on bandages/stockings
Why is a wound bad?
Loss of blood and exudate Pain Shock Ingress of microbes Can lead to contamination or infection- systemic infection (septicaemia)
Skin microbiota
The microorganisms (flora) which reside on the skin
Up to 1000 species on human skin from 19 phyla
Most are found in the superficial layers of the epidermis and the upper parts of hair follicles
Types of skin flora
Skin flora is usually non-pathogenic and either commensal or mutualistic
Bacteria, fungi and viruses can cause skin diseases and enter the blood system, creating life-threatening diseases, particularly in immunosuppressed people
Wounds therefore provide convenient entry point for opportunistic microorganisms
Wound classification
Clean wound- made under sterile condition, no organisms present, likely to heal without complications
Contaminated wound- result of accidental injury, pathogenic organisms and foreign bodies in wound
Infected wound- pathogenic organisms present and multiplying, showing clinical signs of infection, yellow, oozing pus, having pain, redness
Colonized wound- chronic, number of organisms present, very difficult to heal e.g. pressure sore
Abrasion
Often referred to as a graze
Occurs after skin rubs against hard surface, often contains foreign particles
Usually superficial
Friction scrapes away the epithelium, exposing epidermal or dermal layers
Bleeding low to moderate
Incision
Precise, regular wound caused by intended blunt trauma using a sharp edged object e.g. scalpel
Surgical incision is a cut made through the skin to facilitate an operation or procedure, in general made as small and unobtrusive as possible to facilitate safe and timely operating conditions
Laceration
Imprecise tear-like wounds caused by blunt trauma and a sharp edge e.g. broken glass
Usually irregular edge
Most lacerations affect only the upper layers of the skin and subcutaneous tissues
permanent damage may occur if there is injury to internal structures such as muscles, tendons, blood vessels or nerves
Significant/profuse bleeding
Avulsion
Skin is forcibly detached or torn from tis normal point of insertion by either trauma or surgery
Commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures
Involves partial or full detached from the body
Puncture
Penetration of skin by sharp pointed object to create small hole e.g. nail, pin, needle
A puncture wound does not usually cause excessive bleeding
Often the wound seems to close almost instantly- hard to locate
Can still be a risk of infection
Surgical punctures- intentional, vary from superficial to deep, presumed sanitised
Penetration/perforation
An object pierces the skin and enters subcutaneous tissue of the body, creating an open wound
Object may remain in the tissues, come back out the way it entered, or pass through the tissues and exit via another area
Perforation- where an object enters the body and passes all the way through
Penetration with envenomation
Envenomation is the process by which venom is injected into an animal by the bite of a predator- a penetration wound
Necrosis or death may occur as a result of bites or stings
Most venoms are administered by biting the skin of the victim
Symptoms of anaphylaxis
Loss of consciousness
Hives
Swelling of tongue, inability to swallow
Rapid swelling of throat tissues
Haematoma
Haematomas (blood tumour) caused by damage to a blood vessel that in turn causes blood to collect under the skin
Haematomas that originate from internal blood vessel pathology are petechiae, purpura and ecchymosis
Contusion
Blunt trauma causing damage to subsurface tissue without the skin being broken, more commonly referred to as a bruise
Eye contusion- black eye
Some claim to get relief from products containing arnica
Blister
A pocket of plasma or pus between epidermis and dermis
Typically caused by forceful rubbing, burning, freezing, chemical exposure or infection
Hemidesmosomes
In skin as well as in other complex epithelia, multi-protein complexes called hemidesmosomes are involved in promoting the adhesion of epithelial cells to the underlying basement membrane
These are weak structures compared to desmosomes
Break down to allow ingress of fluid and create blister
Burns
A burn is a thermal injury to the skin caused by heat, cold, electricity, friction, chemical or physical agents
Usually defined in terms of burn depth
Pressure ulcer/pressure sore
Pressure ulcers are injuries that break down the skin and underlying tissue
They are caused when an area of skin is placed under pressure
They are sometimes known as bedsores or pressure sores
pressure ulcers range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle
Decubitis
Degenerative change to microcirculation caused by the influence of compression and shear forces
How do pressure ulcers develop?
Pressure ulcers can developwhen: large amount of pressure of applied to an area of skin over a short time; less pressure is applied over a longer period of time
The extra pressure disrupts the flow of blood through the skin
Without a blood supply, the affected skin becomes starved of oxygen and nutrients, and begins to break down, leading to ulcer formation
Pressure points
About 500,000 people in the UK will develop at least one pressure ulcer in any given year. this is usually people with an underlying health condition.
People over 70 years old are particularly vulnerable to pressure ulcers, as they are more likely to have mobility problems and ageing skin
Treatment for pressure ulcers
Includes alleviation of decubitus, the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases.
For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be serious and lead to life threatening complications, such as infection, blood poisoning or gangrene
Venous ulcers
Occur due to improper functioning of venous valves, usually of the legs, blood flow against gravity
They are the major occurrence of chronic wounds, occurring in 70% to 90% of leg ulcer cases
Develop mostly along the medial distal leg, and can be very painful
Diabetic foot ulcer
Major complication of diabetes mellitus, and the major component of the diabetic foot
Key feature of wound healing is stepwise repair of lost extracellular matrix that forms the largest component of the dermal skin layer
Prolonged inflammatory phase which causes a delay in the formation of mature granulation tissue and a parallel reduction in wound tensile strength
