Chapter 41: Wound healing

Dehiscence

separation of wound (abdomial)
- exposes organs

Evisceration

Complete separation of wound with protrusion of abdomial organs.
- the organs can come out when pressure is applied, coughing, vomiting, or sweliing

Serous Drainage

clear, watery fluid
- No blood cells or platelets

Sanguineous Drainage

Bloody drainage (sanguis)

Serosanguineous Drainage

thin, watery drainage with blood
- A mix of serous+sanguineous drainage

Purulent Drainage

thick green, yellow, or brown drainge with odor

Open Drain System: Penrose drain

a rubber tube that drains on to a dressing by gravity. Microbes can enter wound.

Open Drain System: Sump drain

more than one tube is inserted to allow air, suction, or drugs to instill.

Closed Drain System: Hemovac drain

shaped like a cylinder, compressed from top to bottom The device presses at the top and bottom and closed to create suction.

Closed Drain System: Jackson-Pratt

shaped like a bulb. A port at top will hold contents to create suction.
- Most popular drainage system

Applying tape: Mongomery Straps

Prevents skin irration from frequent dressing changes.
- Similarly to a cut up corset in the middle of abdominal wound

Should drainage leave the wound?

Yes, trap drainage causes swelling underneath tissue

What happens if the patient is feeling pain while applying dressing?

Pain medications should have been administered 30 mins before.

What is the only job as a CNA when dealing with wound care?

• Aid the nurse when removing old dresses by wetting it with saline solution if dry.

• Supply new dressing by holding it on the edge with gloves

• Clean and dry only closed wounds as CNAs

Binders and compression garment: What does Elastic fibers do?

Prevents the woud from dehiscence while providing pain relief and decrease swelling.

How should the tape by applied over the dressing?

Outside within bounds of the dressing.

Wound healing: Stage 1

The wound has stopped bleeding and a scab has formed

Wound healing: Stage 2

Cells have multiplied to repair the wound
- Chronic wound = wound has not healed within 3 months

Wound healing: Stage 3

The scar gains strength, scar becomes thin and pale
- Hydration and nutrution (protient) is key during wound healing

Types of Wound Healting: First intention

wound is closed by sutures, stitiches, staples, glue, etc

Types of Wound Healting: Second intention

The wound is contaminated or infected.
- Nurse must clean and remove dead tissue

Types of Wound Healting: Third intention

Wound remains open and has poor circulation
- Wounds heal in moist environment.

Internal hemorrhage

bleeding inside

External hemorrhage

bleeding outside

Types of Ulcers: Venous Ulcer

Result of Poor venous blood flow

Types of Ulcers: Arterial Ulcer

Result of Poor arterial blood flow

Types of Ulcers: Diabetic Foot Ulcer

Result of nerve damage and poor cirulcation = gangrene/necrosis
- CNAs must check for ulcer signs daily