Lecture 8

Wound care is important to

prevent infection, prevent less scarring, reduces the risk of infection

Promoting healthy skin…

self assessment, bathing, nutrition, oral hydration, sunscreen, skin moisturizing, perfusion, mobility

Skin care considerations for older adults

complete bath every other day, tepid water temperature, pat dry, no tight/rubbing clothes, maintain adequate nutrition, avoid caffeine & alcohol

Dry skin is also dependent on external factors such as

dry climate, colder temperatures, repeated washing

Types of impaired skin integrity

disorders (inflammatory, papulosquamous, vesiculobullous, vascular) infections, lesions, insect bites, burns, pressure ulcers, surgery, trauma

acute wound

occurs suddenly, (trauma), heal in orderly sequence of events

chronic wound

caused by chronic conditions, don’t heal in orderly manner

partial thickness wound

involves partial loss of skin layers, not deeper tissues, superficial and painful due to exposed nerve endings, (scraped knee), heals quickly

full thickness wound

involves total loss of epidermis and dermis, plus extends into sc & occ muscle, heals by complex process of scar formation

primary intention

healing that occurs when a clean laceration or a surgical incision is closed primarily with sutures, semi-strips, or skin adhesive

secondary intention

happens when a wound has great deal of lost tissue, or is extensive and the edges can’t be brought together.

Drs will leave the wound to heal naturally in these cases (ex: pressure ucler)

tertiary intention

healing by delayed primary closure, occurs when there is a need to delay the wound-closing process

often if a dr fears that they may trap infectious germs in a wound by closing it

the wound may need to drain or antibiotics may need to kick in before the wound is closed

Inflammatory phase

1-5 days, controls bleeding, established clen wound bed, clot dissolution, releases growth factors, release vasoactive substances

proliverative phase

6-21 days, “rebuilding phase”, granulation tissue fills the wound with vessels and connective tissue, epithelialization,

contraction wound edges pull together to reduce the size of the wound opening

remodeling

3 weeks - 2 years final thickness of full thickness repair, replacing connective tissue - strength is acquired within 3 months, tissue may never be as strong as original skin (80% is optimal)

keloid scar - tissue extending beyond boundaries of original wound bed, common in specific skin types

factors affecting wound healing

tissue perfusion (ischemia, environmental), nutritional status, T2D, obesity, medications, age

dehiscence

a condition where a cut made during a surgical procedure separates or ruptures after it has been stitched back together

evisceration

rare, occasionally happens in abdominal surgeries when wound dehisce happens and abnormal organs spill out of opening

dehiscence treatment

leave open, keep moist

evisceration treatment

place moist dressing over area, don’t push back into abdominal cavity

Wound assessment

location - where

dimension and depth - length, width, depth, tunneling, undermining

stage - what layers involved

status of wound bed - presence of eschar, slough

exudate - fluid how much, appearance

status of wound edges - open, proliferative, closed

status of surrounding skin, pain, treat agressively

signs and symptoms of infection

purulent drainage, pain, redness, swelling, elevated temperature, increased WBC, smelly, incresed quatitiy

ovtaining a wound culture

gloves

roll the culture into 1 area only

after cleaning

Stage 2 pressure ulcer

partial thickness skin loss(epidermis, dermis)

presents clinically as: abrasion, blister, shallow crater

Stage 3 pressure ulcer

clinically presents as: deep crater, undermining

risk factors for pressure ulcers

altered LOC, immobility, maceration, malnourshed, impaired sensory perception, shear, friction

Braden scale

sore risk

norton scale

ulcer risk _{< 14 + risk}