Scott Gardner TCC Nursing Q2W05 Wound Healing
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- Define Normal Wound Healing
- A complex dynamic process that resutls in the restoration of anatomic continuity and functions.
- What kinds of wounds heal best, and which worst. Why?
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Clean approximated incision type wounds deal well.
Burns require much more healing.
The approximated incidion does not require as much tissue generation, but the burn (or other open wound) requires much more wound healing. - Name the Four Phases of Wound Healing?
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-Vascular Response
-Inflammation
-Proliferative
-Maturation - Describge the Vascular Response Phase.
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-Vessels constrict to stop bleeding and reduce exposure to bacteria.
-Clotting begins with platelett
-Fibrous meshwork builds a clot
-Capillaries dialate allowing plasma to flow into wound. - What wound phase does plasma come to a wound, and why?
- During vascular response. The plasma arrives to dilute toxins from bacteria, bring oxygen, nutrients, and phagocytes.
- Define the Inflammation phase of wound healing.
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-It is the second phase.
-Begins the moment of injury and lasts 4-6 days. It is necessary. "No Inflamation, No Healing".
-Walling off prevents spread of bacteria systemically.
-Neutrophils line up and "Pavementing" to help remove cellular debris. - Describe the Proliferative Phase of Wound Healing.
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-3rd Phase. Lasts 2 weeks to 1-2 Years.
-Fibroblasts are most important in this phase as they cynthassize collogen and granulation tissue.
-Tissue Macorphages patrol the cound tissue for foreign material.
-Macrophages secrete AGF which stimultes formation of new blood vessels. - Define Collagen. What does it need to be built?
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Helps reconstruct connective tissue.
Vitamin C // Zink // Oxygen / Fe are needed for normal collaen deposition. - Define angiogenesis.
- The development of new blood vessels i the wound bed. Begins within hours of injury.
- Define Granulation Tissue;
- A matrix of callagen, capillaries, and cells begin to fill the cound space with new connective tissue, forming a scar.
- Describe how granulation tissue grows.
- From the wound edges and base of the wound. Filled with new capillary buds, red, bumpy, granular in appearance.
- Define Wound Contraction.
- In large open counds, contraction can develop. Severe forms can produce deformaties, such as skin pulling the chin down toward the chest.
- Define Epitheliaziation
- The migration of epithelial cells from surrounding skin. Large wounds or full thickness wounds may require skingrafts.
- What helps hasten spitheliaization?
- Keeping wound moist.
- What is the upper limit of epidermal migration during epitheliaziation?
- About 3cm which can lead to the need for skin grafts in larger wounds.
- Define the Maturation phase of wound healing.
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Fourth Phase.
-Year or longer
-Scar is remodeled
-Regains about 2/3 of original strength, but never more than 80%. - What is wound healing intention?
- The probal process of healing for any wound.
- What is Primary (First) Intention?
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A process that closes the edge of a wound with little or no inflammatory reaction and in such a manner that little or no scar is left to reveal the site of the injury.
New cells are formed to take the place of dead ones, and the capillary walls stretch across the wound to join themselves to each other in a smooth surface. New connective tissue may form an almost imperceptible but temporary scar. In repairing lacerations and surgical wounds, the goal is to produce a repaired area that will heal by first intention. - What is Secondary Intention Healing?
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Requires more tissue generation such as a cavernous wound (tissue ulcer)
Granulation tissue is formed to fill the gap between the edges of the wound with a thin layer of fibrinous exudate. Granulation tissue also excludes bacteria from the wound and brings new blood vessels to the injured part - Define Tertiary (Third Intention) wound healing.
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-Contaminated with rise of infection.
-Left Open to heal
-Later closed when free of debris. - What is Intrinsic Wound Healing Factors, and name some of them.
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Local factors in the owund itself that can alter healing.
-Infection
-Foreign bodies
-Inadequate blood supply
-???Smoking???
-Neuropathy - What is ExtrinsicWound Healing Factors, and name some of them.
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Characteristics of the whole client that affect wound healing.
-Protein Malnutrtion prevents collegen deposition and WBC production
-Carbohydrate Malnutrtion slows all wound healing as protein is used for energy.
-Lack of vitiamin C slows collegen production. - When does inflammation occur?
- In all clients who have sustained any form of tissue injury.
- Name Four Systemic reactions to inflammation.
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-Fever
-Leukocytosis (In increase in WBC)
-^ Plasma Proteins
-Malaise - What are three things that Vitamin C hels with in regard to Wound Healing?
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-Creating WBC
-Collogen Production
-Angiogenesis (Vessel formation) - Differentiate between Inflammation and Inflamed.
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Inflammation is normal process in wound healing, which must happen for the healing process to begin. This is good.
Inflammed has generally been used to indicate that inflammation is rampant, that serous enfection might be present. This is not good and requires further assessment and intervention. - Decode the acronym R I C E regarding complications of Edema.
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R-Rest
I-Ice
C-Compression
E- Elevation - Describe some tips in using Ice on a wound.
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-Be sure it reaches the wound through whatever dressings might be inplace.
-Never place ice directly to a wound. - When inflammation has too much of a response, what might be done.
- Take antiinflamatory agents to stabilize mast cell produciton, which will reduce edema.
- Name Five Clinical Manifestations of Inflammation.
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-Redness
-Swelling
-Heat
-Pain
-Loss of Function - What is the purpose of inflammatory exudate?
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-Dilutes the toxins released by bacteria.
-Brings nutrients to the wound
-Carries phagocytes for defense response. - Describe Serous Exudate
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Thin, clear, yellow.
Made of water, colloids and phagocytic cells.
Present upto 1 week. - Define Dehisence
- A bursting open, as of a wound
- Define Hemorrhagic or sanguineous exudate.
- Bright Red, Bloody. Small amount, after trauma. Large amount might mean hemorrage.
- Define Serosanguineous Exudate.
- Blood tinges pink or yellow. Might last 48-72 hours.
- Define Purulent Exudate.
- Thin, cloudy and foul smelling. May be thick if filled with dead cells.
- What are the steps of exudate presentation in a surgical wound?
- Starts with sanguineous drainage, moves to serosangineous and finally serous as hemostasis progresses.
- The wall around the infected site as a result of the body's attempt to protect surrounding tissues from further invasion
- Granuloma
- An acceptably healed wound is characterized by
- restoration of sustained function and anatomic continuity.
- Capillaries dilate for 10 to 30 minutes after injury and remain dilated for some time because of
- serotonin
- These become active to clean up the wound and initiate further healing processes.
- White Blood Cells
- The use of sutures or other wound closures to approximate the edges of an incision or clean laceration is called
- Primary intention
- Wounds made intentionally with a scalpel and closed with sutures, staples, or strips of tape are called
- Incisions.
- These vital defense mechanisms are both the first and the most numerous cell types to arrive at any area of disease or injury.
- Neutrophils
- These help control the inflammatory response by secreting antihistamine.
- Esonophils
- Name the migration of epithelial cells from the edges of the wound to hair follicles within the wound.
- Epithelialization
- This has been defined as a complex and dynamic process that results in the restoration of anatomic continuity and function.
- Wound healing
- The use of the body's own digestive enzymes to break down necrotic tissue.
- Autolytic debridement
- Before a wound can heal, necrotic tissues must be removed. This is called:
- Debridement.
- Dressings or casts over an affected area may form a constriction. This response is called:
- Compartment syndrome.
- How many psi is recommended to remove debris, bacteria, and necrotic tissue through irrigation?
- 4 - 15
- If wound healing is delayed because of lack of venous return, the extremity will require:
- Compression and elevation.
- In humans, where can an ideally healed wound occur?
- Epidermal tissue
- Newly synthesized collagen just under the intact suture line forms an internal scar known as a:
- healing ridge
- The presence of WBCs usually indicates:
- Bacterial invasion
- What is the final phase of wound healing?
- Maturation
- What is the most favorable outcome of healing?
- A complete return to normal structure and function
- When the mast cell is stimulated, what does it release?
- Histamine and serotonin
- Why should low-grade fevers not be treated with antipyretics?
- High temperature retards bacterial growth
- WBCs that arrive at the site of injury following the neutrophils and phagocytose bacteria.
- Monocytes
- Cells filled with histamine and neutrophil chemotactic factors:
- Mast cells
- A matrix of collagen, capillaries, and cells that fill the wound with new connective tissue:
- Granulation tissue
- Formation of new blood vessels
- Angiogenesis
- Migration of epithelial cells
- Epithelialization
- A type of scar tissue that extends well over the suture line
- Keloids
- An unstable form of oxygen with an unpaired electron
- Free radicals
- Promotion of movement of leukocytes into the area of injury
- Chemotaxis
- Mediators of wound healing that regulate the mobility, differentiation, and growth of leukocytes
- Cytokines
- Catalysts for wound healing released by platelets and macrophages that prime other cells to enter the growth phase
- Growth factors
- Reconstructs connective tissues and adds strength to the wound
- Collagen
- WBCs that arrive first at the injury site and phagocytose foreign agents
- Neutrophils
- A series of physiologic responses to injury that is nonspecific and occurs in the same way regardless of the type of injury
- Inflammation
- Drawing in of the edges of the wound
- Wound contraction
- Chemicals causing the same reaction as histamine, but with a longer lasting response
- Leukotrienes
- Stimulates cells lining the capillaries to constrict
- Histamine
- Immature neutrophils are called
- Bands
- Define Suppuration
- Formation of Pus
- How often should a new incision be assessed?
- q.8h
- If you cant directly see an incidion, what assessement techniques could you use?
- Check dressing for drainaga and odor.
- When is a drain placed?
- When actual or potential fluid accumulation threatens the healing process.
- What is the only solution recommended for Wound Care?
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NS
Avoid iodine, hydrogen peroxide and Dakins Solution.
They damage the healthy cells along with bacteria. - What is yellow or tan adherent material in the wound base called?
- Slough
- List four types of debridement:
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1)Surgical or Sharp
2)Mechanical (Wet to Dry)
3)Enzematic
4)Autolytic - Define Superficial
- Wound that involves only epidermal layer of skin.
- Define Penetrating Wound
- Involving break in epidermal skin layers as well as dermis and deeper tissue organs. Gunshot or Stab wound.
- Describe perforating wound
- Penetrating wound in which a foreign object enters and exits an internal organ. Gunshot or stab wound.
- Define Laceration
- Teraing of tissues with irregular wound edges.
- Define abrasion
- Superficial wound involving scraping or rubbing of skins surfact.
- Define contusion
- Closed wound caused by a blow to body by blunt object. Characterized by swelling, discoloration, and pain. Bleeding in underlying tissue from blunt force.
- Why do moist covered wounds heal faster?
- Ephithelial cells can only migrate across the surface of the wound if it is moist.