Wounds

Question 1

Skin

Answer 1

• Largest organ
• Acidic to maintain our normal skin flora
• ⅓ Blood Volume
• Function: Protection, Thermoregulation, Sensation/Communication, Elimination

Question 2

What are the skin layers?

Answer 2

• Epidermis
• Dermis
• Subcutaneous

Question 3

Epidermis

Answer 3

A thin, Avascular layer regenerates itself every 4-6 weeks

Question 4

Dermis

Answer 4

• Provides tensile strength, moisture retention, blood and oxygen to the skin
• Protect underlying muscles, bones and organs
• Promote an ongoing blood supply to the dermis for regeneration
• It provides a cushion between skin layers, muscle and bones

Question 5

Subcutaneous

Answer 5

• A layer of fat and connective tissue that houses larger blood vessels and nerves
• Regulation of temperature of the skin itself and the body

Question 6

Younger Skin

Answer 6

• Flatten between epidermis and dermis by 50%
• Decrease in the number of sweat gland and dermal protein and blood vessels
• Decreased elastin fibers so easily stretched

Question 7

Older Skin

Answer 7

• Skin becomes less effective barrier
• Decreased pain perception
• Diminished immune

Question 8

Acute Wounds

Answer 8

• Less than 6 weeks duration that progress through the phases of healing without delay
• Without complications
• Follow the normal healing process in an orderly timely way
• Limited interventions required
• Return to function

Question 9

Chronic Wounds

Answer 9

• Wounds which deviate from the expected sequence of repair in terms of time, appearance and response to appropriate treatment
• A wound that has not demonstrated significant signs of healing in 6 weeks can be classified as chronic
• Prolonged inflammation complication may occur
• Return to normal function much slower, delayed
• May not heal completely or may re-occur

Question 10

4 main stages of wound healing:

Answer 10

• Heamostasis
• Inflammation
• Proliferation or reconstruction
• Maturation or remodelling of scar tissue

Question 11

Wound Healing: Heamostasis (1)

Answer 11

Immediate: Redness, pain, swelling. Vasoconstriction occurs, blood clot form

Question 12

Wound Healing: Inflammation (2)

Answer 12

• 0-10 days: Vasodilation/Capillary permeability increases, bringing Neutrophils and macrophages to the wound
• Phagocytosis of microbes and debris
• Macrophages stimulate the formation of granulation tissue and production of fibroblasts

Question 13

Wound Healing: Proliferation or reconstruction (3)

Answer 13

• 2-24 days: fibroblasts produce collagen
• New cells and capillary buds form in wound bed
• Fragile granulation tissue forms
• Contraction begins
• Epithelial cells migrate across granulated wound bed wound is sealed and tensile strength increases

Question 14

Wound Healing: Maturation or remodelling of scar tissue (4)

Answer 14

• 24 days up to 1 year
• Collagen fibres reorganise/realign and tighten, scar tissue reduces
• Tensile strength increases
• Vessels restored to normal

Question 15

Healing by Primary Intervention

Answer 15

• Edges close together or wound edges brought together by sutures loss of structural tissue
• Healing occurs faster
• Less chance of infection
• Minimal tissue destruction
• Granulation tissue not visible
• Minimal scar

Question 16

Healing by Secondary Intervention

Answer 16

• Wound not closed or unable to be closed (pressure injury, burns, Infection, excessive trauma, wound breakdown)
• Significant loss of structural tissue
• Healing occurs slower
• Greater chance of infection
• Cavity fills with granulation tissue- later forms connective tissue- scar

Question 17

What promotes healing?

Answer 17

Nutrition 
Hydration 
Oxygen 
Wound protection 
Warmth 
Moisture 
Circulation 
Cleanliness

Question 18

Complications for healing

Answer 18

• Poor nutrition
• Co- morbidities
• Medication (any medications that could compromise skin thickness etc)
• Age (older you are, harder to heal)
• Smoking (takes longer to heal as 1 cigarette = vasoconstriction for 6 hours)
• Patients; some patients may be noncompliant with wound care, or may be depressed as a result of scarring
• Location (e.g. over a joint)

Question 19

Wound Closures

Answer 19

• Wound glue
• Staples- see them on major abdominal surgery, joint repair and heads
• Sutures

Question 20

Cleaning a Suture Line

Answer 20

• Spread bacteria away from the centre of the wound. Spread to the side.
• Clean from the centre out
• Get a new cleaning tool after each swipe; don’t reuse

Question 21

Wound Assessment

Answer 21

What type of wound is this?

• How do I expect this wound to heal?
• What risks factors for healing are evident?

Wound healing?

• Is the wound healing?
• Is the wound improving or getting worse?
• Is there any complication occurring?
• How can I promote effective healing with this patient? And how can I involve the patient in their care?

Wound care

• How could wound contamination occur
• How will I prevent wound contamination from occurring/
• What can I touch?
• What can I not touch? What standard precautions are needed? Do I need to wear sterile gloves? How confident am I to provide this care? What assistance do I need?

Question 22

Steps in wound washing/dressing

Answer 22

• With clean hands clean trolley
• Gather dressing pack, place on bottom shelf
• Hand hygiene
• Open pack, place drape on top shelf, position waste bag
• Assemble equipment on top shelf
• Apply non sterile gloves
• Position drape under wound
• Remove dressing, expose wound and dispose of dressing into waste bag
• Hand hygiene
• Apply sterile gloves
• Clean wound
• Dress wound
• Dispose of equipment
• Clean trolley
• Hand hygiene