Chronic Wounds & Their Management PDF

 -Wound which is secondary complication usually related to combination of ischemia and Neuropathic Ulcer neuropathy. -It’s related to the loss of protective sensation in the feet and legs as a result of a pri...

 -Wound which is secondary complication usually related to combination of ischemia and Neuropathic Ulcer neuropathy. -It’s related to the loss of protective sensation in the feet and legs as a result of a primary neurological condition, metabolic disease process (e.g., diabetes and/or renal failure), trauma, surgery.  1) Usually anesthetic, round, over bony prominences but can be located anywhere Neuropathic Ulcer commonly occurs where arterial ulcers usually appear; or where peripheral neuropathy appears Clinical features (plantar aspect of foot). 2) Pain: typically, not painful; sensory loss usually present. 3) Pulses: may be present or diminished. 4) Absent ankle jerks with neuropathy. 5) Sepsis common; gangrene may develop.  1) Peripheral vascular disease 2) Neuropathy Neuropathic Ulcer 3) Poor glycemic control cont. 4) Cigarette smoking 5) Diabetic nephropathy -Risk factors : 6) Previous foot ulcerations /amputations By far, the two most common risk factors are neuropathy and peripheral vascular disease.  Is localized area of tissue necrosis that tend to develop when soft tissue is compressed between a bony prominence and external surface for prolonged time. Pressure Ulcer: It also called “bed sores” or “decubitus ulcer”. When external pressure is applied to soft tissue over bony prominence (unrelieved pressure) resulting in ischemic hypoxia , edema and damage to underlying tissue.  Extrinsic risk factors Shearing and friction: which causes skin to Pressure Ulcer cont. stretch and blood vessels to kink, which can impair blood circulation in the skin. -Risk factors : Moisture: Wetness from perspiration, urine or feces makes skin under pressure more likely to suffer injury. People who can't control their bladders or bowels (people who are incontinent) are at high risk of developing bedsores. Pressure: prolonged pressure on skin over bony prominence.  Intrinsic risk factors Prolonged immobilization : Bedsores are common Pressure Ulcer cont. in people who can't lift themselves off the bed sheets or roll from side to side. Decreased sensation : Bedsores are common in -Risk factors : people who have nerve problems that decrease their ability to feel pain or discomfort. Circulatory problems: People with atherosclerosis, circulatory problems from long-term diabetes or localized swelling (edema) may be more likely to develop bedsores. This is because the blood flow in their skin is weak, even before pressure is applied to the skin.  Intrinsic risk factors Pressure Ulcer cont. Poor nutrition: Bedsores are more likely to develop in people who don't get enough protein, vitamins and minerals. -Risk factors : Age: Elderly people, especially those over 85, are more likely to develop bedsores because skin usually becomes more fragile with age. Incontinence: people who have urinary and\or fecal incontinence are more likely to develop bedsores because it make their skin Moist most of the time.  STAGE I Pressure Ulcer , Non-blanchable Erythema cont. - The skin is intact, but shows a red or dark mark, often over bony areas. - The skin marking does not fade when pressure is removed, although this might be difficult to see in people with darker skin. Stages of pressure ulcer - This stage could indicate people at risk of pressure ulcers. - The area may be painful, firm or soft, warmer or cooler than adjacent tissue.  STAGE II , Partial thickness skin loss Pressure Ulcer - Loss up to dermis presenting as a shallow open cont. ulcer with a red pink wound bed, without slough. - Intact or open/ruptured serum-filled blister. Stages of pressure - Presents as a shiny or dry shallow ulcer without ulcer slough or bruising (Bruising indicates suspected deep tissue injury). - This Category/Stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation  STAGE III , Full thickness skin loss Pressure Ulcer - Subcutaneous fat may be visible, but bone, tendon or cont. muscle are not exposed. - Slough may be present but does not obscure the depth of the tissue loss. Stages of pressure - Undermining and tunneling may be present. ulcer - N.B.: The Occiput, malleolus, bridge of nose, and ears do not have subcutaneous tissue a therefore Category/Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.HH  Pressure Ulcer STAGE IV cont. Full thickness tissue loss with exposed bone, tendon, or muscle. - Slough or eschar may be present on some parts of the wound bed. Stages of pressure - Tunneling and undermining are often present. ulcer - May be extending into muscle and/or supporting structures making osteomyelitis possible. HHH  UNSTAGEABLE PRESSURE ULCER Pressure Ulcer cont. Depth unknown - Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the Stages of pressure wound bed. ulcer - Stable (dry, adherent, intact without erythema or fluctuance) eschar serves as ‘’ the body’s natural (biological) cover ‘’ and should not be removed. HHH  SUSPECTED DEEP TISSUE INJURYR Pressure Ulcer cont. - Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. Stages of pressure ulcer - The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler in comparison to adjacent tissue. HHH  Location of pressure ulcers  SLOUGH? ESHCAR?? TUNNELING??? UNDERMINING???? Wound Assessment  1)History. Contents of wound assessment 2)Inspection. 3)Wound planimetry. HHH  -Personal (age, gender, occupation, etc.…). -Present (cause of wound, onset and duration, complain, etc.…). Contents of wound -Past(Immunosuppressive, DM, circulatory disorder). assessment History -When a specific etiology has been diagnosed, appropriate treatment should be implemented. In addition, efforts should be made to identify factors that might impede the healing of a cutaneous ulcer such as nutritional deficits, drugs, edema, hypoxia, and smoking. HHH  -A location can be marked on a body chart or be explained with proper terms and Contents of wound assessment anatomical marks. -Wounds by neuropathy are generally Inspection situated on the soles of the feet; on the other hand, pressure sores are often found -Wound Location: on bony projections such as the sacrum, coccyx, greater trochanter, and ischemic regions.HHH Contents of wound assessment Inspection - Wound Assessment Triangle Contents of wound assessment Inspection - Wound bed assessment Contents of 1)-Tissue type wound Viable tissue assessment Inspection Wound bed assessment Contents of 1)-Tissue type wound Non-viable tissue assessment Inspection Wound bed assessment Contents of 2) Exudate wound assessment Inspection Wound bed assessment  2) Exudate Contents of Level(amount) wound l assessment Inspection Wound bed assessment  2) Exudate Contents of Color wound l assessment Inspection Wound bed assessment  2) Exudate Contents of Consistency and Odor wound assessment Inspection Wound bed assessment Contents of 3) Infection wound assessment Inspection Wound bed assessment Contents of wound assessment Inspection - Wound edge assessment Contents of wound assessment Inspection - Wound edge assessment Contents of wound assessment Inspection - Wound edge assessment Contents of wound assessment Inspection Wound edge assessment  -Damaged or unhealthy peri-wound skin is a Contents of significant problem in chronic wounds, it wound needs to be explored and its relevance to assessment wound progression considered within wound healing practice. -The peri-wound area has been defined as Inspection the - area of skin extending to 4cm beyond the wound edge. Peri-wound Skin assessment  Contents of wound assessment Inspection - Peri-wound Skin assessment ACTIVITY Contents of wound assessment A- wound surface area. Wound B- wound depth/volume. Planimetry Contents of wound assessment A- Circulatory Assessment. Additional B- Assessment of Sensation. Assessment