N333: Wound Healing

Hemostasis (Wound Healing)

Blood clot formation and vasoconstriction to stop bleeding

• Immediate Response

Inflammation (Wound Healing)

Neutrophils and macrophages clear debris, pathogens, and promote healing

• 0-4 days

Proliferation (Wound Healing)

Fibroblasts deposit collagen, forming granulation tissue and new blood vessels

• 4-21 days

Maturation (Wound Healing)

Collagen remodeling strengthens the tissue, scar tissue stabilizes

• 3 weeks to months

Primary Intention

Clean, minimal tissue loss (e.g., surgical incision)

• Heals with minimal scarring

Secondary Intention

Significant tissue loss or contamination (e.g., ulcers, burns)

• Requires more granulation tissue, leading to more scarring

Tertiary Intention

Contaminated or infected wound cleaned before closure (e.g., skin grafts)

• Delayed closure, resulting in scar formation

Factors Affecting Wound Healing

• Age

• Obesity

• Nutrition

• Oxygenation and Circulation

• Diabetes

• Corticosteroids

• Immunosuppressive Agents

Keloid

Raised, thick scars due to excess collagen

Contractures

Tightening of wound tissue, causing deformity

Dehiscence

Premature separation of wound edges

Evisceration

Wound opening with protrusion of internal organs

Stricture

Abnormal narrowing of a body passage due to scar tissue

Fistula

Abnormal connection between organs or the skin

Adhesions

Internal scar tissue between tissues or organs

Topical Antibiotics (e.g., Neomycin, Bacitracin)

• Prevent infection in minor wounds

• ADR: Allergic reactions, irritation

Growth Factors (e.g., Platelet-derived Growth Factor)

• Stimulate cell proliferation in chronic wounds

• ADR: Risk of infection and tissue irritation

Corticosteroids

• Reduce inflammation but inhibit healing and collagen formation

• ADR: Delayed healing, increased infection risk

Nursing Considerations for Wounds

• Wound Assessment: Monitor for infection, dehiscence, and delayed healing

• Infection Prevention: Use aseptic techniques and monitor for infection signs

• Nutritional Support: Ensure adequate protein, vitamins, and minerals (vitamin C, zinc, calcium)

• Pain Management: Provide analgesics for comfort during healing

• Patient Education: Educate on proper wound care, nutrition, and recognizing complications