Wound Final

How do proteins help with wound healing

• Collagen synthesis 

• Granulation tissue formation, angiogenesis and remodeling 

• Immune function (phagocytosis, antibody response) 

• Affecting the osmotic pressure, which allows fluid to move within the vasculature into the interstitium. In turn, this increases edema accumulation, which decreases the tissue's ability to receive oxygen and blood to the affected areas. 

Nitrogen Balance

used as an indicator for protein amount

Negative Nitrogen Balance

Excreted > intake

Positive Nitrogen Balance

Excreted < intake

How do carbohydrates help with wound healing

Help to provide the energy needed to power repairs and regeneration. Glucose is also needed for phagocytosis

How do fats help with wound healing

Help provide 

• Secondary source for energy 

• Required to carry fat-soluble vitamins 

• Assists with thermoregulation

Vitamin A

• Epithelial integrity 

• Collagen synthesis 

• Granulation tissue formation 

• Increase wound tensile strength, prevent dehiscence 

Vitamin C

• Helps the body absorb iron 

• Required for collagen synthesis 

• Helps control infection by activating WBC

Vitamin K

Essential for blood clotting (if low, then prolonged phase of inflammation)

B Complex

• Required for normal immune function 

• Facilitates fibroblast function and collagen synthesis

Vitamin E

• Fat-soluble antioxide 

• Helps to prevent free radical cellular damage 

• Helps with the inflammatory phase by enhancing immune function, decreasing platelet adhesion

Micro-minerals: Zinc

Antioxidant & vital to many cellular processes [incl. collagen & protein synthesis]

Micro-minerals: Iron

Essential component of hemoglobin & required for O2 transport; most common cause of anemia

Micro-minerals: Copper

Required for hemoglobin synthesis & iron absorption/transport

Micro-minerals: Magnesium

Inadequate stores lead to HTN & vasoconstriction; deficiency found in diabetes, chronic diarrhea, and alcoholism

Macro-minerals: Calcium

Vital for bone formation/remodeling & also blood clotting

Macro-minerals: Phosphorus

required for bone formation, fluid balance

Normal Glucose levels

70-110 mg/dl

What does to much glucose indicate

Too Much: weakens the immune system, increases risk of ulceration, impairs cell function, and creates a nutrient-rich environment for bacteria. 

What does to little glucose indicate

Too little: Will lead to prolonged inflammation

Total Lymphocyte Count (TLC)

(>1,800 cells/mm3) Indirect measure of nutritional status and immune function

Erythrocyte Sedimentation Rate

– Measure of inflammation 

• Better for low-grade bone/joint infections 

• Increased concentration of fibrinogen and alpha globulins 

C-reactive Protein

– More sensitive measure of inflammation/tissue damage

 • Increases rapidly in acute phase – serum amyloid and procalcitonin

Normal Values for Serum Albumin

(at least 3.5g/dL)

What does serum albumin measure

plasma protein produced by the liver

a high serum albumin count

Increased valve = dehydration 

a low serum albumin count

Decreased valve = Malnutrition

Prealbumin normal range

18-45 mg/dL

What does Prealbumin measure

Major transport protein, has a good half-life, so it can be a better indicator of the  effect of nursing interventions 

Serum Transferrin normal value

>170 mg/dL

What does Serum Transferrin indicate

Sensitive indicator for protein status 

Iron deficiency will increase this value, and protein deficiency will decrease this value 

BUN (Blood Urea Nitrogen) normal values

8-20 mg/dL

What does BUN indicate

Indicator for renal function: Urea is a byproduct of protein metabolism

Elevated BUN levels are associated with a decrease in wound healing and dehydration

Creatinine normal values

0.7-1.4 mg/dL

Creatinine levels indicate

Measurement of kidney function and protein status 

Malnutrition will decrease the number 

Broad-spectrum agent

often the first line of defense since they have a large impact affect

Bactericidal

is to kill or destroy the bacterium

Bacteriostatic

limits the growth but can become bactericidal if the dose increases

Mechanism of Antibiotic Drugs

1. Inhibition of cell wall synthesis/function

2. Inhibition of protein synthesis

3. Inhibition of DNA/RNA synthesis and function

Types of drugs that Inhibition of cell wall synthesis/function

• penicillin

• Cephalosporins

Type of drugs that Inhibition of protein synthesis

• Aminoglycosides

• Erythromycins

• Tetracyclines

Type of drugs that Inhibition of DNA/RNA synthesis and function

• Fluoroquinolones

• Sulfonamides

General Characteristics of Virus:

• Nucleocapsid: nucleic acid “core” “capsid” (protein Shells) 

• Envelope: lipid bilayer  glycoproteins 

• Only contains genetic code and takes over the host cell to multiply 

The virus replicates through absorption to cause an infection 

Reverse Transcriptase Inhibitors

it can not eliminate the virus, but they slow down the viral proliferation, which in turn delays the disease 

Interferon Therapy:

interferons are androgynous proteins  that are created in healthy T cells, to help boost the body for the amount of beta cells that the antibodies we will need 

What is the suffix for antiviral

-clovir

Anti-fungal topical adjects suffix

-azole

tinea

athletes foot

candida albicans

yeast infection

aspergillus

fungal infection caused by breathing in mold spores

Contamination

presence of microbes on wound surfaces

Colonization

Presence of epilating microbes on the wound surface

Critical Colonization

 Increasing wound bioburden reaches a critical point and begins to adversely affect the host 

• Plateau in wound healing or decline in wound status 

Infection

Replicating microbes invade viable body tissue 

• Decline in wound statistics, signs, and symptoms of infections is likely 

Biofilms

communities of microorganisms attached to the wound surface encased in a glycocalyx 

• Protects against harsh environments, antiseptics, and antimicrobials 

• May increase bacterial virulence and resistance 

• Generally found on devitalized tissues, implanted devices, and within the gastric mucosa 

Multimicrobial

 contains multiple bacterial species, various strains/ mutations within each species 

Surface barriers

 intact skin may be contaminated with a bacterial count of up to 1,000 microbes per gram of tissue without any adverse tissue reaction within an individual 

• Resident microflora protects the body from pathogenic, or disease-causing organisms

Host factors that increase risk for skin infection

• break in skin integrity

• diabetes

• malnutrition

• obesity

• steroid use

• immunocompromise

• increased age

Local factors that increase risk for skin infection

• ischemia

• necrotic tissue

• would debris

• chronic wounds

Rubor

Redness

Calor

Warmth

Tumor

Swelling

Dolor

Pain

Functio laesa

impaired function

 Pressure Injuries risk factors

• Advanced age/ decline in function/ immobility 

• Impaired sensation 

• Malnutrition (protein loss) 

• Incontinence; excess moisture 

• Shear force 

tunning fork value

average range 8-10 secs but <4 secs means they have severe neuropathic

what does TcPO2 measure

Measures the amount of perfusion occurring in the blood

What do low TcPO2 values mean

< = 30 means the tissue will go necrotic

< = 40 means the tissue will have impaired wound healing

Pressure Injury 5Ps: Pain

tender or painful if sensory nerves are intact

Pressure Injury 5Ps: Position

• Deep ulcers covered with black eschar

• deep ulcers may have exposed deeper structures

• tunneling, undermining

Pressure Injury 5Ps: Periwound

• surrounded by a ring of erythema

• Nonblanchable erythema

• localized warmth

• fibrosis and induration

• dermatitis

Pressure Injury 5Ps: Pulse

Normal

Pressure Injury Temperature

Areas of hyperemia are warm to palpation

Areas of ischemia or necrosis are cool to the touch

What are the risk outcome scales

• Braden

• Norton

What is Pressure outcome instruments (healing prognosis)

• Pressure sore status tool (PSST) for risk

• Pressure ulcer scale for healing (PUSH) for treatment

5P’s of Neuropathic Ulcer: Pain

absent or significant decreased (hallmark)

5P’s of Neuropathic Ulcer: Position

plantar aspect of the foot

area is increased, plantar pressure or shear forces, such as under the metatarsal heads or navicalur

5P’s of Neuropathic Ulcer: Wound Presentation

Callused Rim (round Punch out position)

Little to no drainage

5P’s of Neuropathic Ulcer: Periwound

Skin appears dry, cracked, callused

structure deformities such as “clawing of the toes.”

5P’s of Neuropathic Ulcer: Pulse

Normal

Temperature for neuropathic ulcers

normal or increased

Neuropathic Ulcers Risk factors

primary: hyperglycerim

• decreased immune response

• sensory loss (loss of protective sensation)

• Mechanical repeated mechanical stress

What is Sensory Neuropathy

Lack of protective sensation = lack of detection or irritation or trauma or risk of ulceration

What is Motor Neuropathy

Leads to paralysis of the intrinsic muscles of feet/hands

• deformities: hallux valgus and claw toes

What is Autonomic Neuropathy

Disturbance in the sweating mechanism, callus formation, and blood flow

What is Diabetic Neuropathic Osteoarthropathy (DNO)

Charcot Deformity

Wagner Scale: 0

no ulcer in high-risk foot

Wagner Scale:1

superficial ulcer involving the full skin thickness but no bone involvement or abscesses formation

Wagner Scale: 2

Deep ulcer penetrating down to the ligaments and muscles, but no bone involvement or abscesses formation

Wagner Scale:3

Deep ulcer with cellulitis or abscess formation, often with osteomyelitis

Wagner Scale:4

Localized gangrene

Wagner Scale: 5

Extensive gangrene involving the whole foot

5P’s of Arterial Insufficiency: Pain

severe and increases with elevation

5P’s of Arterial Insufficiency: Position

Distal toes

dorsal foot

areas of trauma

5P’s of Arterial Insufficiency: wound presentation

Pale granulation tissue if present

little to no drainage

black eschar; gangrene

5P’s of Arterial Insufficiency: Periwound

Thin, shiny, anhydrous skin

loss of hair growth

thickened, yellow nails

pale, dusky, or cynotic nails

5P’s of Arterial Insufficiency: Pulse

decreased or absent pedal pulse (hallmark)

Arterial Insufficiency temperature

decreased

what is Intermittent Claudication

activity specific discomfort due to local ischemia

once reaching around 50% stenosis, then claudication