Wounds PDF

WOUNDS WOUND HEALING AND CARE OF WOUNDS The verb form of the word "wound" means to injure or to damage. In short a wound is a cut or break in the continuity of the skin, tissues, mucous membranes and other body structures resulting from physical means. It may be superfici...

WOUNDS WOUND HEALING AND CARE OF WOUNDS The verb form of the word "wound" means to injure or to damage. In short a wound is a cut or break in the continuity of the skin, tissues, mucous membranes and other body structures resulting from physical means. It may be superficial, affecting only the surface, severe, involving blood vessels, muscles, nerves, fascia, Tendons, ligaments and bones. Surgical wound are wounds gotten after surgery. CONT. 1. INTENTIONAL WOUND: They occur during operation or surgery and other therapeutic procedures. Examples are in surgical incision which result to surgical incised wounds, stab wounds (Assault), circumcision, gunshot wounds 2. UNINTENTIONAL WOUNDS (ACCIDENTAL WOUNDS): They are commonly acquired through accidents (RTA) or traumatic injury from knife cuts which mostly occur during cooking CLASSIFICATION OF WOUNDS Classifying wounds are done under two main headings which include: Mechanism of injury Degree of contamination  CLASSIFICATION OF WOUNDS ACCORDING TO MECHANISM OF INJURY It identifies the wound according to the continuity of surface covering that is whether wound will be opened or closed after being injured. OPEN WOUNDS: These are wounds involving a break in skin or mucous membrane. They are normally caused by trauma of a sharp object or blow. Examples surgical wound (surgical incisional wounds), Venipuncture or punctured vein (punctured wound), lacerations (where application of force that tears or splits the skin leaving the edges of the wound rough or ragged. Abrasions (injuries confined to the epidermis or the mucous membrane and it's usually caused by a blow or fall  CLASSIFICATION OF WOUNDS ACCORDING TO MECHANISM OF INJURY CLOSED WOUND: These wounds results when the tissues of the part affected are traumatized without the skin breaking. It occur through sprain which results from twisting of a joint (by forceable wrenching of joint) with partial rupture or other injuries caused to the tendons or ligaments at the joints mostly it is accompanied with bones which dislocated.  CLASSIFICATION OF WOUND ACCORDING TO THE DEGREE OF CONTAMINATION This is the presence or absence of infections which results from the activity of invading micro-organisms. CLEAN WOUNDS/ASEPTIC WOUNDS: They are wounds which have no pathogenic organisms present. Example of a clean wound is a closed surgical wound. The wound heals without infection. Mostly they have no inflammation. CLEAN CONTAMINATED WOUNDS: These wounds are under aseptic conditions but it involves a body cavity that normally harbours micro-organisms. The possibility of the wound getting infected is between three to eleven percent. CLASSIFICATION OF WOUND ACCORDING TO THE DEGREE OF CONTAMINATION CONTAMINATED WOUNDS: They are wounds which have potential for infections thus wounds infection is relatively great. Examples are open wounds, traumatic (accidental) wounds in which there have being a break in maintenance of asepsis or aseptic technique because there is acute, non-purulent inflammation. Possibility of wound infection is between 10-17 percent. CLASSIFICATION OF WOUND ACCORDING TO THE DEGREE OF CONTAMINATION INFECTED WOUNDS/DIRTY WOUND/SEPTIC WOUND: In these kind of wounds, bacterial organisms are present in the wound which presents signs of infection, inflammation, purulent drainage and skin separation (gapped wound. that's caused from post-operation infection and also from the field of patient before surgery) COLONIZED WOUNDS: They are wounds which contain multiple micro-organisms, example pressure sores Inflammation When there is an injured cell or tissue of the body by any agent (which can be physical, chemical or infections) naturally, there will be a response to the adjacent healthy tissue at the site of injury and this is called inflammation. For example, inflammation that occur in bee sting, inflammation that occur from sore throat, in burns such as first degree burns. some surgical incision where there is presence of infection  Signs and symptoms of inflammation Heat Pain at the site Swelling Redness Loss of function Types of wounds INCISED WOUNDS (INCISION): It is an open wound which has its edges smooth and even. It may be classified as aseptic or infected depending upon circumstances that caused it. It is acquired as a result of an incision done on a patient during surgery or in an operation and this called incisional wounds It can be intentional such as one made by a surgeon with a scapel knife or blade and also it can be accidental or unintentional such as a cut from a sharp blade or knife Types of Wounds CONTUSED WOUND (CONTUSION) This is a closed wound which occurs from a blow from a blunt instrument. The skin appears bruised (ecchymotic) because of a release of blood from a damaged blood vessel. Contusions are most often unintentional. It is accompanied with pain and oedema under the skin.  CONT. ABRASIONS (ABRAIDED WOUND): considered as an open wound occurring as a result of friction such as scrapped knee from a fall on a rough surface. These wounds or injuries are confined to epidermis or the mucous membrane. Abrasion at times can be intentional. Example when the superficial layer is removed from plastic surgery Treatment is irrigation with copious amounts of saline to irrigate wound to remove any foreign particles or wash with mild antiseptic or antibiotic ointment and apply dressing CONT. PUNCTURED WOUND (STAB WOUNDS): This is an opened wound made by a sharp pointed instrument that penetrate the skin and underlying tissues. It can he accidental by stepping on nast or contionally by surgeon puncturing to insert dram like dramage tube to tap fluids from a particular cavity in the body. Venipuncture, intramuscular injection and sometimes a nail prick at hospital are all considered as examples of such wound. It also involves surgical exploration of wound to assess its internal damage to know the treatment to give CONT. LACERATIONS (LACERATED WOUNDS): These are open wounds which occur as a result of tearing apart tissues, producing irregular wound edges. Lacerations are accidental and often results from animal bites, machinery cuts and tissue cut by a broken glass. In managing such wounds, the wound is cleaned with an antiseptic solution and the rough edges are trimmed, the wound is left opened to heal by second intention. CONT. PENETRATING WOUND: They occur when a sharp instrument penetrates deeply into the tissues through the skin, mucous membrane to a deeper tissue. They are usually accidental and often result from accident involving car. They are also considered as open wound. One example is gunshot wound which is obtained with bullets and from metal fragments CONT PERFORATING WOUND: This is an open wound which is caused by exposing body cavity and an instrument entering into the cavity. Example a gunshot This can also be used as an example for penetrating wounds as well as perforating wounds WOUND HEALING PHASES It is referred to as regeneration (renewal) to tissues. It can be broken down into three The stages of wound healing proceed in an organized way and follow four processes: hemostasis Inflammation Proliferation maturation. Hemostasis Phase Hemostasis is the process of the wound being closed by clotting. Hemostasis starts when blood leaks out of the body. The first step of hemostasis is when blood vessels constrict to restrict the blood flow. Next, platelets stick together in order to seal the break in the wall of the blood vessel. Finally, coagulation occurs and reinforces the platelet plug with threads of fibrin which are like a molecular binding agent. Hemostasis Phase The hemostasis stage of wound healing happens very quickly. The platelets adhere to the sub-endothelium surface within seconds of the rupture of a blood vessel's epithelial wall. After that, the first fibrin strands begin to adhere in about sixty seconds. As the fibrin mesh begins, the blood is transformed from liquid to gel through pro- coagulants and the release of prothrombin. The formation of a thrombus or clot keeps the platelets and blood cells trapped in the wound area. The thrombus is generally important in the stages of wound healing but becomes a problem if it detaches from the vessel wall and goes through the circulatory system, possibly causing a stroke, pulmonary embolism or heart attack.  Inflammatory Phase Inflammation is the second stage of wound healing and begins right after the injury and last 3 to 4 days when the injured blood vessels leak transudate (made of water, salt, and protein) causing localized swelling. Inflammation both controls bleeding and prevents infection. The fluid engorgement allows healing and repair cells to move to the site of the wound. During the inflammatory phase, damaged cells, pathogens, and bacteria are removed from the wound area. Inflammatory Phase These white blood cells, growth factors, nutrients and enzymes create the swelling, heat, pain and redness commonly seen during this stage of wound healing. Inflammation is a natural part of the wound healing process and only problematic if prolonged or excessive. Proliferative Phase The proliferative phase of wound healing is when the wound is rebuilt with new tissue made up of collagen and extracellular matrix. In the proliferative phase, the wound contracts as new tissues are built. In addition, a new network of blood vessels must be constructed so that the granulation tissue can be healthy and receive sufficient oxygen and nutrients. Myofibroblasts cause the wound to contract by gripping the wound edges and pulling them together using a mechanism similar to that of smooth muscle cells. In healthy stages of wound healing, granulation tissue is pink or red and uneven in texture. Proliferative Phase Moreover, healthy granulation tissue does not bleed easily. Dark granulation tissue can be a sign of infection, ischemia, or poor perfusion. In the final phase of the proliferative stage of wound healing, epithelial cells resurface the injury. It is important to remember that epithelialization happens faster when wounds are kept moist and hydrated. Generally, when occlusive or semiocclusive dressings are applied within 48 hours after injury, they will maintain correct tissue humidity to optimize epithelialization.  Maturation Phase Also called the remodeling stage of wound healing, the maturation phase is when collagen is remodeled from type III to type I and the wound fully closes. The cells that had been used to repair the wound but which are no longer needed are removed by apoptosis, or programmed cell death. When collagen is laid down during the proliferative phase, it is disorganized and the wound is thick. During the maturation phase, collagen is aligned along tension lines and water is reabsorbed so the collagen fibers can lie closer together and cross-link. Cross-linking of collagen reduces scar thickness and also makes the skin area of the wound stronger. Generally, remodeling begins about 21 days after an injury and can continue for a year or more. Maturation Phase Even with cross-linking, healed wound areas continue to be weaker than uninjured skin, generally only having 80% of the tensile strength of unwounded skin. The stages of wound healing are a complex and fragile process. Failure to progress in the stages of wound healing can lead to chronic wounds. Factors that lead up to chronic wounds are venous disease, infection, diabetes and metabolic deficiencies of the elderly. Careful wound care can speed up the stages of wound healing by keeping wounds moist, clean and protected from reinjury and infection.  Importance of wound care It prevents the entry of pathogenic organisms protects the wound from further injuries The dressing material absorbs the exudates. it reduces haemorrhage by applying pressure where there is bleeding from the wound. It also prevent odour from the wound especially with septic wounds and cerous wounds example cancerous wound of the arm. Dressing Restricts motions that disrupt the coming together of wound edge It hides the ugliness of the wound because they are normally covered with adhesive plater after dressing and packing with a sterile gauze Purposes of wound dressing To remove a soiled dressing (one with exudates and/or drainage). To clean the wound removing micro-organisms and drainage To access the healing process To assist the healing process It aids in haemostasis Helps in supporting or splinting the wound site Symptoms of wound infection Local symptoms are (inflammation) Redness Heat Swelling Pain Loss of function General symptoms of wound Elevation of body temperature Increase in pulse rate and respiration Malaise Anorexia Nausea Headache Chills Factors that reduces wound healing Age: Aging reduces wound healing Malnutrition: there is less nutrition to meet body requirement Obesity: Blood flow becomes inadequate Inadequate blood supply and decrease in oxygen supply to the affected site Smoking Drug like aspirin, cortico-steriods and prolonged use of anti- biotics Diabetes mellitus (condition) Radiation Wound stress  Factors that improve wound healing Absence of other diseases and infections Good health Young age Intake of balanced diet Proper use of anti-biotics Strict aseptic technique in wound dressing Small injury Complications of wound healing Haemorrhage Infection Pain Abscess formation Dehiscence (is partial or total rupturing or separation of wound by skin repair) Evisceration (is a protrusion of internal visceral content if the abdomen) Fistulas Keloids Contractures