Wound Closure Techniques and Treatments

Wound Closure Techniques

• Absorbent sutures dissolve over time, eliminating the need for removal.
• Nonabsorbent sutures require removal, typically by a nurse.
• Surgical staples are quick and easy to apply, minimizing infection risk.
• Avoid stapling wounds on hands, feet, neck, or face.
• Surgical glue is suitable for clean, low-tension wounds; ideal for skin tears.

Collaborative Wound Treatments

• Surgical options address complicated wounds with extensive debridement, skin grafts, secondary closure, and flap techniques.
• Hyperbaric Oxygen Therapy (HBOT) increases oxygen concentration in tissue, boosting blood vessel growth and white blood cell activity for healing.
• Platelet-derived growth factor accelerates collagen formation and enhances the inflammatory phase of wound healing.

Factors Influencing Rest and Sleep

• Biorhythms are influenced by environmental factors like gravity, electromagnetic forces, light, and darkness.
• Body temperature is lowest upon waking. The female menstrual cycle is cyclical like the lunar cycle.
• Circadian Rhythm regulates sleep-wake patterns based on a 24-hour cycle.
  • Dietary L-tryptophan and adenosine found in milk, cheese, and animal products promote sleep by converting to serotonin.
  • Carbohydrates, through their effects on brain serotonin levels, can induce relaxation and sleep.
  • Hunger can interfere with sleep, especially in infants and children.
• Nicotine and Caffeine are CNS stimulants that interfere with sleep.
  • Nicotine makes it harder for smokers to fall asleep and stay asleep.
  • Caffeine inhibits sleep by blocking adenosine, but sensitivity varies.
• Alcohol speeds sleep onset, but disrupts REM and SWS sleep, leading to awakenings.
  • Heavy alcohol consumption may cause vivid dreams, leading to awakening during REM sleep.
  • Alcohol is a diuretic, increasing the risk of nocturia, which can interrupt sleep.
• Medications can cause sleeplessness or excessive grogginess and sedation.
  • Hypnotics increase sleep duration but decrease quality.
  • Zolpidem Tartrate (Ambien) promotes REM sleep and has less impact on sleep quality than other hypnotics.
  • Amphetamines, tranquilizers, and antidepressants reduce REM sleep.
  • Barbiturates interfere with NREM sleep.
  • Opioids suppress REM sleep and cause frequent awakenings.
  • Beta blockers may cause sleep disorders and nightmares.
• Illness increases the need for rest and sleep but also can interfere with sleep.
  • Disease symptoms such as fever, pain, nausea, and respiratory difficulty can disrupt sleep
  • Allergies, hyperthyroidism, and Parkinson's Disease can alter sleep quality.

Sleep Assessments

• Insomnia is a disruption in sleep quantity or quality that impairs functioning.
• Sleep Deprivation is a prolonged decrease in the amount, consistency, or quality of sleep.
  • Symptoms include confusion, paranoia, and fatigue.
• Disturbed Sleep Pattern is a short-term problem due to external factors (e.g., unfamiliar environment).

Sleep Outcomes

• Rest, Sleep, and Personal Well-being for disturbed sleep patterns.
• Rest, Sleep, and Symptom Severity for sleep deprivation.
• Concentration, Endurance, Fatigue Level, Mood Equilibrium, Personal Health Status, Personal Well-being, Quality of Life, Rest, and Sleep for insomnia.

Sleep Goals and Outcomes

• Verbalizes feeling rested/feeling less fatigue.
• Falls asleep within 30 minutes; sleeps 6 hours without awakening.
• Maintains a sleep-wake pattern that provides enough energy for daily tasks.
• Demonstrates self-care behaviors that balance rest and activity.
• Identifies stress-relieving rituals that aid in falling asleep.
• Demonstrates decreased signs of sleep deprivation.
• Verbalizes feeling less fatigued and more in control of life activities.

Sleep Interventions

• Coping enhancement, energy management, environmental management: comfort, relaxation therapy, and sleep enhancement interventions help address sleep deprivation and disturbed sleep pattern.

Sleep Assessment Questions

• How would you rate the quality of your sleep (1-10)?
• Do you take a nap? For how long?
• How often do you wake up during the night (e.g., to use the restroom)?
• Do you feel adequately rested when you wake up?

Sleeping Environment

• Do you want a nightlight?
• What room temperature do you prefer?
• What noise level do you prefer (e.g., quiet, radio, television)?

Bedtime Routines and Rituals

• What do you typically do in the hour before bedtime?
• What do you do to help you fall asleep?

Sleep Aids

• Do you need a special pillow or positioning aid?
• Do you take any sleep medications (prescription, natural, or homeopathic), or other drugs that may affect sleep?

Sleep Changes or Problems

• Have your sleep patterns changed? How?
• How often do you experience difficulty falling asleep/staying asleep?
• Have you ever experienced a sleep disorder (e.g., narcolepsy, insomnia)?
• Do you remember your dreams? Do you have night terrors, sleepwalk?
• Do you experience an unpleasant creeping, crawling, or tingling sensation relieved by moving your legs?
• Do you snore? Does your snoring ever wake you or anyone in the room?
• Do you wear a cap at night? Do you require oxygen at night? Do you need other medical aid or therapy while sleeping?
• Do you grind your teeth at night? Do you wear a dental appliance for this?
• Do you experience any pain that interferes with sleep?
• Is there anything I haven’t asked that could help you sleep in the hospital?

Sleep Medications

• Nonbenzodiazepines target specific sleep receptors, reducing CNS depression.
  • Common side effects include drowsiness, dizziness, fatigue, headache, and unpleasant taste.
  • Long-term effects are not yet known but may increase the risk of fatal overdose.
• Benzodiazepines, a class of sedative-hypnotics, are first-line treatments for insomnia.
  • They can be long-acting or short-acting.
  • Long-acting medications can cause daytime drowsiness, especially in older adults.
  • They carry a risk of rebound insomnia, dependency, and tolerance.
  • Combining with alcohol and some medications can be dangerous.
  • Examples include diazepam, alprazolam, flurazepam, lorazepam, and triazolam.
• Selective melatonin agonists target melatonin receptors, regulating the sleep-wake cycle.
  • Ramelteon is used for insomnia caused by difficulty falling asleep.
  • It is not a controlled substance.
• Barbiturates are rarely prescribed for insomnia due to addiction, abuse, and overdose risks.
  • Examples include amobarbital, pentobarbital, and secobarbital.
• Tricyclic Antidepressants are sometimes used off-label to treat insomnia and depression.
  • Examples include amitriptyline, doxepin, imipramine, and nortriptyline.

Nonprescription Sleep Medications

• Contain antihistamines and can help induce drowsiness.
  • Can lose effectiveness over time.

Explore various wound closure techniques including absorbent and nonabsorbent sutures, surgical staples, and surgical glue. Additionally, learn about advanced collaborative treatments such as surgical options and Hyperbaric Oxygen Therapy (HBOT) that enhance healing. This quiz will test your knowledge on effective wound management strategies.