Wound Management and Healing
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Questions and Answers

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

  • To reduce swelling by absorbing excess fluid
  • To facilitate wound healing by promoting drainage (correct)
  • To monitor wound healing by collecting drainage
  • To prevent infection by removing excess fluid

    • Increased pain and purulent drainage always indicate a delayed healing process.

    False (B)

    What are the three main types of wound drainage described in the text?

    Serous, sanguineous, and purulent

    When a wound exhibits separation of its edges, it is referred to as ______.

    <p>dehiscence</p> Signup and view all the answers

    Match the wound care instructions with their corresponding benefit:

    <p>Keep the wound dry and clean = Minimizes the risk of infection Report any signs of infection = Early detection and treatment of complications Elevate affected part to level of the heart = Reduces swelling Eat plenty of food rich in protein and vitamin C = Supports overall tissue healing and immune function</p> Signup and view all the answers

    During which phase of wound healing does collagen synthesis peak?

    <p>Phase III - Proliferative (D)</p> Signup and view all the answers

    Scar tissue is more elastic than uninjured tissue.

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

    What are two important patient care considerations during the healing process?

    <p>Adequate nutrition and oxygenation</p> Signup and view all the answers

    What effect do corticosteroids have on wound healing?

    <p>They delay the inflammatory process. (A)</p> Signup and view all the answers

    The final stage of healing begins about _____ weeks after the injury.

    <p>3</p> Signup and view all the answers

    Chronic illnesses such as diabetes can impair wound healing.

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

    Which factor does NOT hinder wound healing?

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

    Match the phases of wound healing with their time frames and characteristics:

    <p>Phase I = Incision to second postoperative day: Inflammatory response Phase II = Third to fourteenth postoperative day: Granulation tissue forms Phase III = Third to sixth postoperative week: Raised scar formed Phase IV = Months to 1 year: Flat, thin scar</p> Signup and view all the answers

    What is dehiscence?

    <p>Dehiscence is the partial or total disruption of wound layers.</p> Signup and view all the answers

    Overhydration of cells can lead to maceration.

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

    The presence of a __________ increases the risk for infection and fluid imbalances.

    <p>fistula</p> Signup and view all the answers

    Which of the following patients is at higher risk for wound complications?

    <p>An obese patient. (D)</p> Signup and view all the answers

    What happens to collagen during the maturation phase?

    <p>Collagen is remodeled and strengthens the healed wound.</p> Signup and view all the answers

    Match the wound complications with their descriptions:

    <p>Dehiscence = Partial or total disruption of wound layers Evisceration = Protrusion of viscera through the incision Fistula = Abnormal passage between internal organs and skin Infection = Bacterial invasion of the wound</p> Signup and view all the answers

    Patients undergoing __________ radiation therapy are at risk for delayed healing.

    <p>postoperative</p> Signup and view all the answers

    The appearance of a healing surgical wound should be swollen and deep red.

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

    What type of wound is characterized by tearing of skin and tissue with blunt or irregular instruments?

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

    What is one of the primary reasons that edema interferes with wound healing?

    <p>It decreases oxygen and nutrient supply. (C)</p> Signup and view all the answers

    A clean-contaminated wound results from entry into a non-contaminated site.

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

    Infection aids the immune system's ability to repair and heal wounds.

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

    What is the process called that tissues undergo to heal after injury?

    <p>Wound healing</p> Signup and view all the answers

    What are the two types of dead tissue that can delay wound healing?

    <p>Slough and eschar</p> Signup and view all the answers

    A ______ wound is characterized by the destruction of skin layers due to thermal, chemical, or irradiation factors.

    <p>burn</p> Signup and view all the answers

    Adequate _____ is essential for wound healing and helps deliver nutrients and oxygen.

    <p>blood circulation</p> Signup and view all the answers

    Match the type of wound with its description:

    <p>Incision = Cutting or sharp instrument Contusion = Blunt instrument causing bruise Puncture = Blunt or sharp instrument puncturing skin Pressure ulcer = Compromised circulation due to pressure</p> Signup and view all the answers

    Which type of wound is defined as having devitalized tissue and possible fecal contamination?

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

    Match the nutrient to its role in wound healing:

    <p>Vitamin A = Essential for re-epithelialization Vitamin C = Important for collagen synthesis Zinc = Role in cell proliferation Proteins = Necessary to rebuild cells and tissues</p> Signup and view all the answers

    Abrasion is caused by a sharp instrument slicing through the skin.

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

    Which population is likely to heal more slowly due to physiological changes?

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

    Obesity generally enhances the speed of wound healing.

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

    What is the primary distinction of a clean wound?

    <p>Non-traumatic site and uninfected</p> Signup and view all the answers

    What types of wounds typically heal slowly?

    <p>Large, contaminated, infected wounds or wounds with foreign bodies</p> Signup and view all the answers

    What occurs immediately after the initial injury during the hemostasis phase?

    <p>Blood vessels constrict and blood clotting begins (B)</p> Signup and view all the answers

    During the inflammatory phase, white blood cells primarily move to the wound site to ingest bacteria and cellular debris.

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

    What substance do platelets release to stimulate other cells to migrate to the injury?

    <p>growth factors</p> Signup and view all the answers

    The phase known for the formation of granulation tissue is the ______ phase.

    <p>proliferation</p> Signup and view all the answers

    Which of the following is characterized by heat, redness, swelling, and pain at the injury site?

    <p>Inflammatory Phase (A)</p> Signup and view all the answers

    Match the following phases of wound healing with their characteristics:

    <p>Hemostasis = Clotting and initial vessel constriction Inflammatory Phase = White blood cell migration and debris ingestion Proliferation Phase = New tissue formation and granulation tissue Maturation Phase = Scar tissue development and remodeling</p> Signup and view all the answers

    Macrophages enter the wound area immediately after an injury.

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

    What is the primary role of fibroblasts during the proliferation phase?

    <p>To build new tissue</p> Signup and view all the answers

    Flashcards

    Incision

    A wound caused by a cutting or sharp instrument with aligned edges.

    Contusion

    A blunt instrument injury causing intact skin and possible bruising.

    Abrasion

    A scraping injury affecting the top layer of skin due to friction.

    Laceration

    A tearing of skin with irregular edges, often with loose flaps.

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    Puncture

    A wound caused by a blunt or sharp instrument that penetrates the skin.

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    Penetrating wound

    A wound where an object enters the skin and lodges in tissue beneath.

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    Pressure ulcers

    Wounds caused by compromised circulation due to prolonged pressure.

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    Clean contaminated wound

    Wounds entering tracts like gastrointestinal with minor contamination.

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    Hemostasis

    The first phase of wound healing where blood clotting occurs immediately after injury.

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    Exudate

    A liquid formed from plasma and blood components that leaks into the injury area after hemostasis.

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    Inflammatory Phase

    The phase that follows hemostasis, lasting 4 to 6 days, characterized by white blood cells moving to the wound.

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    Leukocytes

    White blood cells that are the first responders to ingest bacteria and debris at the wound site.

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    Macrophages

    Cells that enter the wound area 24 hours after injury, ingest debris and release growth factors for healing.

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    Proliferation Phase

    The phase where new tissue is built to fill the wound, primarily through fibroblasts.

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    Fibroblasts

    Cells that produce fibrin and help form new tissue during the proliferation phase.

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    Granulation Tissue

    The new tissue formed that serves as the foundation for scar tissue, highly vascular and red.

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    Collagen Synthesis

    The process of producing collagen, which peaks at 5 to 7 days post-injury.

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    Maturation Phase

    Final stage of healing, starts around 3 weeks post-injury, lasting for months or years.

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    Healing Timeline

    Phases of wound healing from incision to recovery, typically lasts 1 year.

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    Scar Formation

    Avascular tissue that forms post-injury; becomes flat and thin through healing.

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    Factors Affecting Healing

    Conditions that influence how well a wound heals, both local and systemic.

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    Desiccation Impact

    Drying of the wound, leading to cell death and delayed healing.

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    Maceration Impact

    Overhydration causing damage to healing tissues and delaying recovery.

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    Trauma Effect

    Repeated injury to a wound area that delays or prevents healing.

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    Edema

    Swelling at a wound site that limits blood supply.

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    Infection

    Microorganisms that use energy from the immune system, hindering healing.

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    Necrosis

    Dead tissue in a wound that delays healing.

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    Age and Healing

    Older adults heal slower due to changes in physiology.

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    Circulation and Oxygenation

    Adequate blood flow is crucial for delivering nutrients and removing toxins.

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    Nutritional Status

    Proper nutrition is essential for wound healing; proteins and vitamins aid recovery.

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    Wound Condition

    The state of the wound, such as size and contamination, affects healing speed.

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    Role of Zinc

    Zinc is important for cell proliferation during wound healing.

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    Wound Drainage

    The exudate released from a wound, categorized by amount, color, odor, and consistency.

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    Types of Exudate

    Wound drainage can be serous, sanguineous, or purulent, depending on the condition of the wound.

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    Signs of Infection

    Indicators like increased warmth, redness, tenderness, and foul odor that suggest an infection is present in a wound.

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    Dehiscence

    A condition where wound edges are separated, often signaling complications in healing.

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    Patient Education on Wound Care

    Key instructions include keeping the wound clean, reporting infections, and ensuring proper nutrient intake for healing.

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    Corticosteroids

    Medications that reduce inflammation but delay wound healing.

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    Radiation therapy

    Treatment that can depress bone marrow, leading to infection risks.

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    Immunosuppression

    Reduced immune function due to disease, medication, or age, impairing healing.

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    Evisceration

    Protrusion of organs through a surgical incision.

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    Fistula formation

    An abnormal passage between an organ and the skin or another organ.

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    Wound assessment

    Evaluating wound edges, color, and signs of complications.

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    Infection signs

    Indicators like swelling, redness, and deep color in a wound.

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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 to each other and aligned.
    • Contusion: Blunt instrument; overlying skin remains intact; injury to underlying soft tissue; possible bruising, and/or hematoma.
    • Abrasion: Friction; rubbing or scraping epidermal layers of skin; top layer of skin is abraded.
    • Laceration: Tearing of skin and tissue with blunt or irregular instrument. Tissue is not aligned; often with loose flaps of skin and tissue.
    • Puncture: Blunt or sharp instrument puncturing the skin; intentional (e.g., venipuncture), or accidental.
    • Penetrating: Foreign object entering the skin or mucous membrane and lodging in underlying tissue. Fragments may scatter.
    • Burns: (thermal, chemical, irradiation) destroy the layers of skin.
    • Pressure ulcers: Compromised circulation secondary to pressure or pressure combined with friction.

    Classifications of Wounds

    • Clean: Non-traumatic site, uninfected, no inflammation, no break in aseptic technique.

    • Clean-contaminated: Entry into respiratory, alimentary, genitourinary, or oropharyngeal tracts without unusual contamination. Minor break in aseptic technique; mechanical drainage.

    • Contaminated: Open, newly experienced traumatic wounds. Gross spillage from gastrointestinal tract. Major break in aseptic technique; entry into genitourinary or biliary tract when urine or bile is infected.

    • Dirty: Traumatic wound with delayed repair, devitalized tissue, foreign bodies, or fecal contamination. Acute inflammation and purulent drainage.

    Physiology of Wound Healing

    • Wound healing is a tissue response to injury.
    • Mechanisms repair injured tissue by regenerating functioning cells and replacing connective tissue with scar tissue.
    • Wound healing has phases.

    Phases of Wound Healing

    Phase 1: Hemostasis

    • Occurs immediately after injury.
    • Involved blood vessels constrict.
    • Blood clotting begins through platelet activation and clustering.
    • Blood vessels dilate after constriction.
    • Increased capillary permeability allows plasma and blood components to leak out; forming exudate (liquid).
    • Accumulation of exudates causes swelling, pain, increased perfusion results in heat and redness.
    • Blood clot forms (hard scab) to protect the injury.
    • Platelets release substances that stimulate other cells to participate in healing.

    Phase 2: Inflammatory Phase

    • Follows hemostasis.
    • Lasts about 4-6 days.
    • White blood cells move to the wound.
    • Leukocytes arrive to ingest bacteria and cellular debris.
    • Macrophages enter the wound area, about 24 hours after injury, and remain for an extended period.
    • Macrophages ingest debris and release growth factors for epithelial cells and new blood vessels.
    • Growth factors attract fibroblasts, which help fill in the wound.
    • Acute inflammation characterized by pain, heat, redness, and swelling.
    • Patient experience generalized body response; including mildly elevated temperature, leukocytosis (increased white blood cells), and generalized malaise.

    Phase 3: Proliferative Phase

    • Known as the fibroblastic or regenerative phase.
    • Tissue formation to fill the wound gap.
    • Primarily occurs through fibroblasts.
    • Capillaries grow across the wound, providing oxygen and nutrients for continued healing.
    • Fibroblasts form fibrin that stretches through the clot.
    • Thin layer of epithelial cells forms across the wound.
    • Blood flow resumes (reinstituted) across the wound.
    • Granulation tissue formation (basis for scar tissue).
    • Highly vascular, red, easily bleeds.
    • Collagen synthesis and accumulation peak in 5-7 days.
    • Collagen deposit continues for weeks or years depending on the wound size.
    • Majority of white blood cells leave the wound area towards the end of the second week.
    • Wound lighter in color (wound area).

    Phase 4: Maturation Phase

    • The final stage of healing.
    • Begins about 3 weeks after injury.
    • Continues for months or years.
    • Collagen that was haphazardly deposited is remodeled for a stronger wound; like adjacent tissue.
    • New collagen continuously deposited, which compresses blood vessels (in the healing wound).
    • Scar (avascular collagen tissue) becomes flat and thin and does not sweat, grow hair, or tan.
    • Scar tissue is strong but less elastic than uninjured tissue.

    Factors Affecting Wound Healing

    • Local Factors:

      • Pressure disrupts blood supply; interferes with blood flow to the tissue; delays healing.
      • Desiccation (drying up): cells dehydrate and die in a dry environment; causes crusting; delays healing.
      • Maceration (overhydration of cells): occurs due to moisture, pH of skin changes, overgrowth of bacteria and infection, and skin erosion from friction on moist skin.

    • Systemic factors:

      • Age: Children and healthy adults heal faster; older adults have slowed fibroblastic activity and circulation, and more chronic illnesses; impede the healing process.
      • Circulation and Oxygenation: Adequate blood flow is needed to deliver nutrients and oxygen; and to remove toxins, bacteria, and debris. Certain conditions (obesity) can affect the outcome of healing due to fat tissue hindering healing and elevating infection risk.
      • Nutritional status: adequate proteins, carbohydrates, fats, vitamins (A & C), minerals, and calories essential for rebuilding cells. Zinc plays a role in proliferation. Poor nutrition and fluid balance can negatively affect wound healing.

    • Other factors: - Trauma: Repeated trauma to a wound area results in delayed healing.

        - Edema: Edema at a wound site interferes with blood supply (to the area), resulting in an inadequate supply of oxygen and nutrients.

  - Infection:-Infection requires large amounts of energy from immune system to fight microorganisms; leaving little, or no reserve energy to focus on repair.  Toxins from bacteria interfere with wound healing and cell death.

  - Necrotic tissue: Presence of necrotic or dead tissue in wound inhibits healing (slough, moist yellow stringy tissue and/or eschar).

    Wound Complications

    • Infection: Bacteria invades wound at time of trauma, surgery, or anytime after.
    • Hemorrhage: Bleeding from a slipped suture, a dislodged clot, stress on the suture line, infection, or a blood vessel erosion by a foreign body (e.g., a drain).
    • Dehiscence: Partial or total disruption of wound layers.
    • Evisceration: Protrusion of viscera (organs) through the incision.
    • Fistula formation: Abnormal passage from internal organ to skin, or internal organ to another; often from delayed healing; manifested by drainage; increases risk of infection, fluid, and electrolyte imbalances.

    Nursing Management of Wound

    • Assessment: Assess wound edges, color, condition (dehiscence or evisceration), drains, tubes, sutures, presence of infection.
    • Drainage: Assess amount, color, odor, consistency, using wound, dressing, drainage bottles, or under patient.
    • Pain: Pain can increase. Pain accompanied by increased drainage suggest delayed healing or infection.

    Educating the Patients on Wound Care

    • Keep wound dry and clean (and change dressings when necessary).
    • Report any signs of infection (redness, swelling, tenderness, warmth around the wound, pus/discharge, and foul odor).
    • Elevate affected part to heart level to reduce swelling.
    • Dry cool packs or analgesics/pain medicine for pain.
    • Plenty of food rich in protein and vitamin C should be consumed.

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    Description

    This quiz covers the basic concepts of wound management, including the definition of a wound and its various types. Learn about the physiology behind wound healing, factors that influence it, and how to educate patients on promoting healing. This is essential for healthcare professionals focused on patient care.

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