wound management: wound = a disruption in continuity of the surface of the body or organ

healing process
1. first intention
  1. edges close together
2. second intention
  1. granulation
  2. wound edges widley separated
3. third intention
  1. complete restoration of the damaged tissue e.g. skin graft
aetiology
1. external violence - falls, accidents
2. mechanical stress - muscle rupture
3. thermal agents - burns
4. infection agents - bacterial, viral
5. chemical agents - acids, alkalis
6. radiation
proccess of healing
1. 1. haemostasis
  1. platelets and fibrin form a pulg
2. 2. inflammatory phase (24-48hrs)
  1. platelets release cytokines into wound, messengers call in inflammatory response
    1. fibrin attracts neutrophils
      1. macrophages come along - reduce bacteria and debride necrotic tissue, stimulate angiogenesis
        transition to prolipherative phase occurs as more macrophages join in
3. 3. proliferative phase
  1. fibroblasts lay down a new matrix
    1. endothelial cells crawl over matrix laying down capillaries and epithelial cells
  2. granulation tissue produced
    1. resistant to infection
    2. prime time for reconstruction
    3. provides surface for migration of epithelial cells
  3. wound contraction - 5-9days post injury
  4. collagen laid down - remodelling phase
4. 4. remodelling phase (7-10 days post injury)
  1. scar formation
    1. remodels and strengthens
    2. hair regrows
  2. tissues heal by:
    1. resolution
    2. regeneration
    3. organisation
wound healing
1. skin elasticity aids this
2. take photo's to monitor progression
3. aims
  1. quick healing
  2. functional (and cosmetic) repair
  3. relief from pain and distress
  4. rapid return to normal
  5. cost
patient assessment
1. age
2. hydration/nutritional status
3. concurrent disease
4. stress
5. current treatment
wound assessment
1. site and involvement of other tissue types
2. type
  1. puncture
    1. penetration
      1. may cause widespread contamination
  2. avulsion
    1. separation of skin from underlying tissue
  3. shear
    1. severe frictional damage
  4. deglove
    1. skin from limb
  5. incision
    1. surgical
  6. laceration
    1. irregular tear
  7. abrasion
    1. graze/frictional damage
  8. gunshots
    1. may be contaminated
  9. foreign bodies
  10. burns
  11. decubital ulcers
3. bacterial contamination
4. viability
5. foreign material
classification
1. closed wound/contusion
  1. blunt force trauma - no break in skin tissue
  2. 1st degree = bruise - rupture of capillaries in s/c area
  3. 2nd degree = haematoma - rupture of large vessels causing an accumulation of blood
  4. 3rd degree = internal bleeding - more extensive tissue injury, possible infection, organs may be affected
2. clean wound
3. clean contaminated
4. contaminated
5. dirty
exam of wound
1. circumstances
2. how old?
3. type
4. location
5. degree of damage
6. is emergency treatment required?
  1. analgesics?
  2. are body systems stable?

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wound management: wound = a disruption in continuity of the surface of the body or organ

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	Created by joanna_stopher almost 11 years ago