Wound Healing Stages and Complications
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Questions and Answers

Which factor, if altered, would most significantly impede the proliferative phase of wound healing?

  • Maintaining a sterile environment to prevent infection.
  • Effective management of pain to reduce stress hormones.
  • Sufficient protein intake to support collagen synthesis. (correct)
  • Adequate supply of vitamin K to facilitate blood coagulation.

A patient with poorly controlled diabetes mellitus develops a chronic, non-healing ulcer on their foot. What is the primary underlying pathophysiological mechanism that hinders wound closure in this patient population?

  • Enhanced keratinocyte proliferation resulting in hypergranulation.
  • Increased angiogenesis promoting abnormal vessel formation.
  • Excessive collagen deposition leading to fibrotic scar tissue.
  • Impaired leukocyte migration and function due to hyperglycemia. (correct)

A researcher is investigating novel approaches to accelerate wound healing. Which of the following strategies would directly target and enhance the re-epithelialization stage?

  • Applying negative pressure wound therapy to reduce edema and promote perfusion.
  • Utilizing collagen matrices to provide structural support for fibroblast migration.
  • Prescribing antibiotics to minimize bacterial bioburden and prevent infection.
  • Administering growth factors that stimulate keratinocyte migration and proliferation. (correct)

A patient develops a large, dehisced surgical wound with significant tissue loss. The wound is heavily contaminated and requires extensive debridement. Which type of wound closure is MOST appropriate in this scenario?

<p>Delayed primary closure, involving initial wound management followed by closure once infection is controlled. (A)</p> Signup and view all the answers

A 70-year-old patient with a history of peripheral vascular disease presents with a non-healing ulcer on their lower leg. Doppler studies reveal significant arterial insufficiency. What is the MOST critical intervention to promote wound healing in this patient?

<p>Surgical revascularization to improve arterial blood flow. (D)</p> Signup and view all the answers

A patient presents with a wound characterized by clearly aligned edges resulting from a sharp cutting instrument. Which type of wound is MOST consistent with these characteristics?

<p>Incision (C)</p> Signup and view all the answers

A patient is admitted with a wound exhibiting loose flaps of skin and tissue, and the medical history indicates the wound was caused by a blunt, irregular instrument. What type of wound is MOST likely present?

<p>Laceration (B)</p> Signup and view all the answers

A patient develops a wound after prolonged pressure that impairs circulation, further complicated by friction. Which type of wound is MOST likely?

<p>Pressure ulcer (A)</p> Signup and view all the answers

During the maturation phase of wound healing, what is the primary process that contributes to the increased strength of the healed tissue?

<p>Remodeling of haphazardly deposited collagen into a more organized structure. (D)</p> Signup and view all the answers

During surgery, a major break in aseptic technique occurs, leading to significant spillage from the gastrointestinal tract into the surgical site. How should this surgical wound be classified?

<p>Contaminated (C)</p> Signup and view all the answers

A patient who sustained a traumatic wound experiences delayed repair including fecal contamination. How should this wound be classified?

<p>Dirty (B)</p> Signup and view all the answers

Why does a scar typically lack the ability to sweat, grow hair, or tan in sunlight?

<p>Scar tissue is avascular and composed primarily of collagen, lacking the necessary accessory structures. (A)</p> Signup and view all the answers

How does edema at a wound site impede the healing process?

<p>By interfering with the blood supply, thereby limiting the delivery of oxygen and nutrients to the tissue. (A)</p> Signup and view all the answers

A patient undergoes an appendectomy, and there are no signs of unusual contamination but there was a minor break in sterile technique. How should this surgical wound be classified?

<p>Clean-Contaminated (B)</p> Signup and view all the answers

Which of the following processes is NOT directly associated with the hemostasis phase of wound healing?

<p>Epithelialization (B)</p> Signup and view all the answers

What is the primary reason that necrosis delays wound healing?

<p>The presence of dead tissue requires the immune system to clear debris, diverting resources from repair. (D)</p> Signup and view all the answers

What physiological mechanism primarily contributes to tissue repair during wound healing?

<p>Regenerating functional cells and replacing connective tissue with scar tissue (B)</p> Signup and view all the answers

How does pressure affect wound healing?

<p>Pressure disrupts the blood supply to the wound area, interfering with blood flow to the tissue. (A)</p> Signup and view all the answers

Why does desiccation (drying) delay wound healing?

<p>Cells dehydrate and die in a dry environment, causing a crust to form over the wound site. (B)</p> Signup and view all the answers

What is the primary mechanism by which infection impairs wound healing?

<p>Infection requires large amounts of energy to be spent by the immune system, leaving little energy for repair and healing. (D)</p> Signup and view all the answers

What is the underlying cause of tissue damage in maceration?

<p>Overhydration alters skin pH, promotes bacterial overgrowth, and increases friction damage. (B)</p> Signup and view all the answers

During hemostasis, what is the correct sequence of events involving blood vessels after an injury?

<p>Vasoconstriction, brief dilation, increased capillary permeability, exudate formation. (A)</p> Signup and view all the answers

Which statement accurately describes the role and timing of macrophages during the inflammatory phase of wound healing?

<p>Macrophages arrive about 24 hours after the injury and release growth factors essential for new blood vessel and epithelial cell growth. (B)</p> Signup and view all the answers

How does granulation tissue contribute to the healing process during the proliferative phase?

<p>It provides a foundation for scar tissue development and facilitates the supply of oxygen and nutrients via new capillaries. (A)</p> Signup and view all the answers

A patient exhibits leukocytosis and a mildly elevated temperature following an injury. How are these findings related to the healing process?

<p>They are part of the generalized body response during the inflammatory phase, indicating increased immune activity. (D)</p> Signup and view all the answers

What is the primary role of fibroblasts in the proliferation phase of wound healing?

<p>To build new tissue by forming fibrin and synthesizing collagen, filling the wound space. (D)</p> Signup and view all the answers

Why is increased capillary permeability a crucial step during the initial inflammatory response to an injury?

<p>It allows the influx of plasma and blood components into the injured area, facilitating the movement of cells necessary for healing. (B)</p> Signup and view all the answers

Collagen synthesis and accumulation are critical during the proliferation phase. What factor most significantly determines the duration of collagen deposition?

<p>The size of the wound, with larger wounds requiring collagen deposition for weeks or even years. (C)</p> Signup and view all the answers

A wound is noted to be highly vascular, red, and bleeds easily. Which phase of wound healing is most likely represented by these characteristics?

<p>Proliferation phase, specifically the formation of granulation tissue. (B)</p> Signup and view all the answers

Why does necrotic tissue impede wound healing?

<p>Healthy tissue cannot regenerate with dead tissue present. (C)</p> Signup and view all the answers

An elderly patient is recovering from surgery. Which physiological change associated with aging would most likely hinder their wound healing process?

<p>Diminished circulation reducing nutrient and oxygen delivery to the wound site. (A)</p> Signup and view all the answers

How does significant subcutaneous fat tissue in obese individuals potentially impede wound healing?

<p>Reduced blood vessels makes the tissue more prone to infection. (C)</p> Signup and view all the answers

A patient with a chronic wound is found to have very low serum protein levels. How does this nutritional deficiency impact the healing process?

<p>Impaired cell and tissue rebuilding. (B)</p> Signup and view all the answers

Why is the timely removal of sutures important for promoting optimal wound healing?

<p>Sutures act as foreign bodies in the wound. (D)</p> Signup and view all the answers

How do corticosteroid medications interfere with the wound healing process?

<p>By decreasing the inflammatory process, which may delay healing. (C)</p> Signup and view all the answers

How does radiation therapy negatively affect wound healing?

<p>It decreases leukocytes and increases the risk of infection. (D)</p> Signup and view all the answers

How does immunosuppression impair wound healing?

<p>It delays wound healing. (D)</p> Signup and view all the answers

Which factor least contributes to the risk of wound dehiscence or evisceration?

<p>Controlled hypertension (B)</p> Signup and view all the answers

What indicates an impending or present wound dehiscence?

<p>Separated wound edges (B)</p> Signup and view all the answers

Which of the following is the least likely cause of hemorrhage from a wound site?

<p>Application of a pressure dressing (D)</p> Signup and view all the answers

What is the primary reason for inserting drains in or near a wound?

<p>To promote drainage and reduce abscess formation (C)</p> Signup and view all the answers

Which finding in a postoperative wound is most indicative of a localized infection?

<p>Deep red, hot, swollen wound with purulent drainage (D)</p> Signup and view all the answers

A patient develops a fistula after surgery. What is the most significant risk associated with this complication?

<p>Fluid and electrolyte imbalances (C)</p> Signup and view all the answers

A nurse is assessing a surgical wound one week post-op. What change would indicate that the wound is healing as expected?

<p>The skin is closer to normal in appearance with wound edges healing together. (C)</p> Signup and view all the answers

What is the primary difference between wound dehiscence and evisceration?

<p>Dehiscence is the partial or total disruption of wound layers, while evisceration is the protrusion of viscera. (D)</p> Signup and view all the answers

Flashcards

Wound

A break or disruption in the normal integrity of skin and tissues.

Types of wounds

Different classifications of wounds, such as acute and chronic.

Physiology of wound healing

The biological process the body undergoes to repair damaged tissues.

Factors affecting wound healing

Elements that can hinder or promote the healing process, like nutrition and infection.

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Wound management

The care and treatment of wounds to promote healing and prevent complications.

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Incision

A wound caused by cutting with sharp instruments; edges are aligned.

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Contusion

A wound from blunt force, with intact skin and possible bruising.

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Abrasion

A wound caused by friction that scrapes away the top layer of skin.

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Laceration

A tearing of skin and tissue with irregular edges; may have loose flaps.

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Puncture

A wound created by a sharp or blunt object piercing the skin.

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Penetrating wound

A wound where a foreign object enters the body and lodges in tissue.

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Pressure ulcers

Wounds from compromised circulation due to pressure.

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Phases of wound healing

The process involved in repairing injured tissues; includes hemostasis.

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Exudate

A liquid formed by plasma and blood components leaking into an injured area.

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Inflammatory Phase

The phase following hemostasis lasting 4 to 6 days, involving white blood cell activity.

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Leukocytes

White blood cells that respond first to an injury to ingest bacteria and debris.

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Macrophages

Cells that enter the wound after 24 hours to ingest debris and release growth factors.

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Fibroblasts

Cells that produce new tissue and aid in healing by filling in the wound site.

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Granulation Tissue

New tissue that forms in the wound, rich in blood vessels and necessary for repair.

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Scar Tissue

Tissue that develops after granulation tissue forms, providing strength to healed wounds.

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Collagen Synthesis

The process where collagen is produced, peaking around 5 to 7 days after injury.

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Maturation Phase

The final stage of wound healing, lasting from 3 weeks to years.

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Collagen Remodeling

The process where disorganized collagen is rearranged for strength and tissue similarity.

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Avascular Scar Tissue

Scar tissue that lacks blood vessels, sweat glands, and hair follicles, making it flat and thin.

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Local Factors in Healing

Elements like pressure, desiccation, and trauma that affect the healing process.

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Pressure Impact

Pressure can disrupt blood flow to a wound, delaying healing.

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Desiccation Effects

Drying out of cells leading to cell death and crust formation, delaying healing.

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Maceration Damage

Overhydration of cells causing skin erosion, changes in pH, and increased infection risk.

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Infection Consequences

Infection uses energy, hindering the body's repair mechanisms and causing cell death.

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Infection

Bacteria invading a wound at any time, causing complications.

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Hemorrhage

Excessive bleeding from a wound due to various factors like dislodged clot.

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Dehiscence

Partial or total disruption of wound layers, leading to reopening.

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Evisceration

Protrusion of internal organs through the surgical incision.

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Fistula formation

An abnormal connection between an internal organ and skin or another organ.

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Wound assessment

Evaluating the wound for edges, color, and signs of infection or healing.

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Drainage types

Classifications of wound drainage: serous, sanguineous, and purulent.

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Necrotic tissue

Dead tissue that hinders wound healing, appearing as slough or eschar.

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Age impact on healing

Older adults heal slower due to diminished physiological processes.

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Circulation's role

Adequate blood flow is essential for delivering nutrients and removing toxins in wound healing.

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Obesity effect

Excess fat tissue can slow healing due to fewer blood vessels and increased infection risk.

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Nutritional support

Adequate proteins, vitamins, and fluids are necessary for optimal wound healing.

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Wound condition impact

The nature of the wound (size, infection) affects healing speed and effectiveness.

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Medications and healing

Certain drugs, like corticosteroids, can delay healing and increase infection risk.

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Immunosuppression

Suppressed immune function from illness or medication can delay wound healing.

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Study Notes

Wound Management

  • Wound is defined as a break or disruption in the normal integrity of skin and tissues.

Learning Objectives

  • Define wound
  • Describe different types of wounds
  • Describe the physiology of wound healing
  • Identify factors affecting wound healing
  • Outline wound complications
  • Describe wound management
  • Health educate patients on wound healing promotion

Types of Wounds

  • Incision: Cutting or sharp instrument; wound edges are close and aligned
  • Contusion: Blunt instrument; overlying skin is intact, underlying tissue injured; bruising possible
  • Abrasion: Friction; rubbing or scraping epidermal layers; top layer of skin is abraded
  • Laceration: Tearing of skin and tissue using a blunt or irregular instrument; tissue is not aligned
  • Puncture: Blunt or sharp instrument piercing the skin; intentional (e.g., venipuncture) or accidental
  • Penetrating: Foreign object enters skin or mucous membrane, lodges in underlying tissue; fragments may scatter
  • Burns: (thermal, chemical, irradiation); destroys skin layers
  • Pressure ulcers: Compromised circulation due to pressure and/or friction

Wound Healing Phases

  • Phase 1: Hemostasis: Occurs immediately after injury; blood vessels constrict, clotting begins (platelet activation and clustering), exudate leakage causing swelling and pain. Blood vessels dilate; increased perfusion results in redness and heat. Clot forms to protect the injury. Platelets release substances that stimulate other cells for participating in other healing phases.
  • Phase 2: Inflammatory Phase: Lasts 4-6 days; white blood cells move to the wound (leukocytes ingest bacteria and debris, macrophages for 24 hours). Macrophages release growth factors to attract fibroblasts for wound healing. Characterized by pain, swelling, heat, and redness. Body response may include a mildly increased temperature and malaise.
  • Phase 3: Proliferation Phase: Fibroblastic/regenerative/connective tissue phase (several weeks). New tissue (granulation tissue) forms the foundation for scar tissue, capillaries grow across the wound. Fibroblasts produce fibrin that stretches across the clot. A thin layer of epithelial cells forms across the wound, renewing blood flow. Granulation tissue is highly vascular, red, and bleeds easily, collagen synthesis peaks within 5-7 days.
  • Phase 4: Maturation Phase: Final stage, begins 3 weeks post-injury and potentially continues months to years. Collagen that was deposited haphazardly is remodeled, making the wound stronger and more like adjacent tissue. New collagen compresses blood vessels; scar formation (avascular collagen tissue that does not sweat, grow hair, or tan). Scar is a flat, thin line.

Factors Affecting Wound Healing

  • Local Factors:
    • Pressure: Disrupts blood supply to wound, interfering with tissue blood flow, delaying healing.
    • Desiccation (drying up): Cell dehydration and death create a crust delaying healing.
    • Maceration (overhydration): Moisture causes skin damage, bacterial overgrowth, infection, and skin erosion from friction.
  • System Factors:
    • Age: Children/healthy adults heal faster; older adults experience delayed/impaired healing due to reduced fibroblastic activity and circulatory issues
    • Circulation & Oxygenation: Proper blood flow is crucial for delivering oxygen/nutrients and removing toxins.
    • Nutritional status: Adequate protein, carbohydrates, vitamins, and minerals are needed for cell regeneration; poor nutritional status slows wound healing.

Wound Complications

  • Infection: Bacteria introduce infection at trauma/surgery/later.
  • Hemorrhage: Clot displacement from suture stress, operative site infection, or a blood vessel erosion.
  • Dehiscence: Partial/total disruption of wound layers
  • Evisceration: Protrusion of viscera through the incision
  • Fistula Formation: Abnormal passages from internal organs to skin or between internal organs; results from delayed healing.

Nursing Management of Wounds

  • Appearance Assessment: Wound edge approximation, color, drainage, and signs of dehiscence are assessed. Healthy wounds have clean, well-approximated edges and a crust. Infection is indicated by redness, swelling, heat, foul odor, and discharge.
  • Drainage: Inflammatory response causes exudate formation (yellow/white drainage if infected). Drains may be placed to promote wound healing. Drainage amount, color, odor, and consistency are assessed.

Pain

  • Constant pain may be from the wound itself. Increasing or purulent drainage with pain suggest delayed healing/infection. Pain related to incisions is most severe for a few days and gradually lessens.

Patient Education for Wound Care

  • Keep wound dry and clean. Report any infection signs.
  • Elevate affected area to reduce swelling.
  • Apply cool packs or, if necessary, analgesics for pain/discomfort.
  • Eat plenty of protein-rich meals for optimal healing.

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Wound Management PDF

Description

Explore factors affecting the proliferative phase of wound healing and the impact of conditions like diabetes on ulcer development. Investigate strategies to enhance re-epithelialization and appropriate wound closure techniques for complex cases. Identify critical interventions for patients with vascular disease and non-healing ulcers.

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