Wound Management

Wound

Any sharp injury that damages the dermis of the skin

Classification of Wounds

1. Clean wound

2. Contanminated wound

3. Infected wound

Clean Wound

These types of wounds are not infected, do not exhibit any signs of inflammation, and are typically closed

Cotaminated Wound

these are open traumatic or surgical wounds involving a major break in sterile technique that shows evidence of inflammation

Infected wound

Old, traumatic wounds containnig dead tissue and wounds with evidence of clinical infection.

Types of wounds

Open and closed wounds

Open wounds are classified with what

…the objeect that caused the wounds

Types of Open wound

• Incisions or incised wounds

• Lacerations

• Abrasions (Grazes)

• Puncture wounds/Penetration wounds

• Gunshot wounds

Incisions or incised wounds

These are wounds caused by a clean sharp object such as a knife

Lacerations

an irregular wound caused by a blunt impact to soft tissue that lies over hard tissue

Abrasion (grazes)

A superficial wound in which the topmost layer of the skin (epidermis) is scraped off

Puncture wounds/ Penetration wounds

this wound is caused by a pointed object entering the body

Gunshot wound

this is the wound caused by a bullet or projectile driving into or through the body

Types of closed wounds

• Contrusions (Bruises)

• Haematomas (Blood Tumors)

• Crushing injuries

Contrusions

This wound is caused by a blunt force that damages the tissue under the skin

Haematomas (Blood Tumors)

This wound is caused by a damage to a blood vessel that causes blood to collect under the skin

Crushing injuries

This wound is caused by a great amount of force applied over a long period of time

Wound Healing

This is a dynamic process that leads to the restoration of a tissue’s integrity and function

Phases of wound healing

• Inflammatory Phase

• Proliferative Phase

• Maturation Phase

Inflammatory Phase

This occurs when damage on the endothelial cells causes a release of cytokines that increase the expression of integrands in circulating lymphocytes
This phase controls bleeding and prevents infection

Function of Histamine, serotonin and kinins

Causes vasoconstriction, decreases blood loss and act as chemotactic factors for neurophils

Neurophils

These are cells that travel to the site of an infection to quickly destroy invading bacteria or pathogens.
They also remove cellular debris

Poliferative Phase

In this phase, fibroblasts migrate into the wound and secrete collagen type III
Angiogenesis occurs by 48 hours.
This lasts for about 3 weeks.

Maturation phase

In this phase, collagen III is converted to collagen I. This stage lasts for 9-12 months

Acute wound

this is a wound that goes thorugh an orderly and timely reparative process that results in the restoration of an anatomic function

Chronic wound

this is a wound that has faile to go through the orderly process of wound healing. The healing process is prolonged and incomplete with a lack of complete restoration of integrity

Factors that affect wound healing (DIDNT HEAL)

• Diabetes

• Infections

• Drugs

• Nutritional problems

• Tissue necrosis

• Hypoxia

• excessive tension on wound edges

• Another wound

• Low temperature

Hypoxia

inadequate tissue oxygenation due to local vasoconstriction

What nutrient deficiencies affect wound healing

Vitamin A, C and Zinc

How does Diabetes affect wound healing

it slows down wound healing because high blood sugar levels damage blood vessels, reducing blood flow to the wound. This means less oxygen and nutrients reach the wound, making it harder for the body to repair itself.

Tissue Necrosis

This is tissue death, and it causes when there is too little of blood to the tissue

Common Chronic Wounds

• Diabetic Ulcers

• Decubitus Ulcers/ Pressue sore/ bed sore

Ischemia

a condition that results to a reduction in the flow of blood to a part of the body due to blood vessel blockage

The common cause of foot and leg amputation

Diabetic ulcers

Decubitus Ulcers/ Pressue ulcer/ Bed sore

This is a type of wound that results in a prolonged pressue on the skin leading to ischemia

what indicates deep tissue injury

Bruises

Stages of Pressure Ulcer

1. Non-blanchable erythema

2. Partial thickness

3. Full thickness skin loss

4. Full thickness tissue loss

Full Thickness Skin Loss

• Subcutaneous fat may be visible

• Tendon and or muscles are not exposed

• Slough may be present

Full thickness tissue loss

• slough may be present

• Bone, tendon or muscle maybe exposed

• This stage may go so deeep that it may cause osteomyelitis or osteitis

• Bone or muscle may be directly palpable

In what areas can stage 3 of pressure ulcer be shallow

Areas of the body without a lot of adipose tissue like the bridge of the nose.

the tendons and bone are not visible in what stages of pressure ulcer

Stage 1 and stage 2

Inverse pressure Relationship

Low pressure over a very long time is more damaging than high pressure over a short time.

Prevention of Pressure Ulcers

• understanding the etiologial factors

• Shear

• Nutritional Status

• Impaired mental status

• Diabetes

Wound Management

• reduce or eliminate the causative factor

• Identify and eliminate infections

• Absorb excessive exudate

• Protect healing wound

Functions of Blood

• Carries oxygen and carbon dioxide to and from and cells

• Carries nutrients

• carries hormones

• Removes wastes

Arteries

Carries blood away from the heart

Veins

Carries blood to the heart

Capillaries

this is where gas, nutrients and waste exchange takes place

Types of Bleeding

Internal bleeding and External bleeding

Signs of Internal Bleeding

• Pain and ternderness

• Vomiting blood

• Broken ribs

• Brusies on the neck and chest

• Bllod in urine

Types of External Bleeding

• Arterial Bleeding

• Venous Bleeding

• Capillary Bleeding

Ways to control external bleeding

• Use of a tourniquet

• ELevation

• Application of pressure

• Pressure points

When not to use the elvation method

• when there are possible fractures

• Spinal injury

Endothelial Cells

forms a single cell layer on blood vessels that facilitatae the exchange of materials between the bloodstream and the surrounding tissues

Cytokines

These molecules control the activity and growth of the immune system