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

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

1. healing process

   • first intention
     • edges close together
   • second intention
     • granulation
     • wound edges widley separated
   • third intention
     • complete restoration of the damaged tissue e.g. skin graft

2. aetiology

   • external violence - falls, accidents
   • mechanical stress - muscle rupture
   • thermal agents - burns
   • infection agents - bacterial, viral
   • chemical agents - acids, alkalis
   • radiation

3. proccess of healing

   • 1. haemostasis
     • platelets and fibrin form a pulg
   • 2. inflammatory phase (24-48hrs)
     • platelets release cytokines into wound, messengers call in inflammatory response
       • fibrin attracts neutrophils
         • macrophages come along - reduce bacteria and debride necrotic tissue, stimulate angiogenesis
           • transition to prolipherative phase occurs as more macrophages join in
   • 3. proliferative phase
     • fibroblasts lay down a new matrix
       • endothelial cells crawl over matrix laying down capillaries and epithelial cells
     • granulation tissue produced
       • resistant to infection
       • prime time for reconstruction
       • provides surface for migration of epithelial cells
     • wound contraction - 5-9days post injury
     • collagen laid down - remodelling phase
   • 4. remodelling phase (7-10 days post injury)
     • scar formation
       • remodels and strengthens
       • hair regrows
     • tissues heal by:
       • resolution
       • regeneration
       • organisation

4. wound healing

   • skin elasticity aids this
   • take photo's to monitor progression
   • aims
     • quick healing
     • functional (and cosmetic) repair
     • relief from pain and distress
     • rapid return to normal
     • cost

5. patient assessment

   • age
   • hydration/nutritional status
   • concurrent disease
   • stress
   • current treatment

6. wound assessment

   • site and involvement of other tissue types
   • type
     • puncture
       • penetration
         • may cause widespread contamination
     • avulsion
       • separation of skin from underlying tissue
     • shear
       • severe frictional damage
     • deglove
       • skin from limb
     • incision
       • surgical
     • laceration
       • irregular tear
     • abrasion
       • graze/frictional damage
     • gunshots
       • may be contaminated
     • foreign bodies
     • burns
     • decubital ulcers
   • bacterial contamination
   • viability
   • foreign material

7. classification

   • closed wound/contusion
     • blunt force trauma - no break in skin tissue
     • 1st degree = bruise - rupture of capillaries in s/c area
     • 2nd degree = haematoma - rupture of large vessels causing an accumulation of blood
     • 3rd degree = internal bleeding - more extensive tissue injury, possible infection, organs may be affected
   • clean wound
   • clean contaminated
   • contaminated
   • dirty

8. exam of wound

   • circumstances
   • how old?
   • type
   • location
   • degree of damage
   • is emergency treatment required?
     • analgesics?
     • are body systems stable?