Ch 11 inflammation and wound healing

Infection

Involves the invasion of tissue of cells by microorganism. -Infection is not always present with inflammation

Pressure ulcer

Is a localized area of tissue necrosis caused by unrelieved pressure that occludes blood flow to the tissue.

What does the nature and quality of exudate depend on?

It depends on the type and severity of the injury and the tissue involved

Chronic inflammation

Last for weeks, months, even years

Acute inflammation

Lasting 2-3 weeks and usually leaves no residual damage

Cellular response to inflammation

Neutrophils and monocytes move to the inner surface of the capillaries (margination) and then through the capillary wall (diapedesis) to the site of injury

Inflammatory response

Sequential reaction to cell injury. -It neutralizes and dilutes the inflammatory agent, removes necrotic materials and establish an environment suitable for healing and repair. -Undergoes vascular response and cellular response.

Secondary intention healing

wound in which the tissue surfaces are not approximated and there is extensive tissue loss; formation of excessive granulation tissue and scarring

Systemic manifestation to inflammation

Fever Leukocytosis (increase WBC shift to left) Malaise N/V Increase BP

Tertiary intention healing

- aka delayed primary intention - type of wound healing where wounds that are left open 3-5 days to allow edema or infection to resolve or exudates to drain and are then closed with sutures, staples or adhesive skin

Negative pressure wound therapy

(vacuum-assisted wound closure), a type of therapy that uses suction to remove drainage and speed wound healing.

Management of inflammation

-Preventing of infection, trauma, surgery, and contact with potentially harmful agent -Adequate nutrition -Drug therapy with aspirin, NSAIDs -Antibiotics for those immunocompromised -R.I.C.E

Stage 3 pressure ulcer

Full-thickness pressure ulcer extending into the subcutaneous tissue and resembling a crater. -no muscle, bone, or tendon. -undermining and tunneling may be present -slough may be present

Therapies for would healing

Negative pressure wound therapy Hyperbaric O2 therapy Platelet-derived growth factor (drug) Special nutritional measures

Special nutrition measure

A diet high in protein, carbohydrate, and vitamins with moderate fat intake is needed to promote would healing

Vitamin C and B function in wound healing

C For capillary synthesis and collagen production by fibroblast. B for coenzymes of metabolic reaction, if deficient then a disruption of protein, fat, and carbohydrate occurs

Purpose of wound management

Cleaning a wound to remove dirt and debris Treating infection to prepare for healing Protecting clean wound from trauma

Prostagladins

Considered proinflammatory and are potent vasodilators contributing to increase blood flow and edema formation. Also performs a role in sensitizing pain receptors to stimuli that would normally be painless.

Exudate

Consist of fluid and leukocytes that move from circulation to the site of injury.

Granulation phase of primary intention

Fibroblasts migrate to site and secrete collagen. Wound is pink and vascular. Surface epithelium begins to regenerate (scar tissue or fibrous).

How does secondary intention usually heals?

From the edge inward and move upward, causes more scarring

unstageable pressure ulcer

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 wound bed.

Stage 4 pressure ulcer

Full-thickness tissue loss with exposed bone, muscle, or tendon

Subacute inflammation

Has same features as acute inflammation but persists longer

Healing process

Includes two major components such as regeneration and repair.

Vitamin A function in wound healing

Needed for epithelization and increase collagen synthesis and tensile strength of wound

Carbohydrate function in wound healing

Needed to increase metabolic energy that inflammation and healing require. If deficient then it will breakdown protein for energy.

Thromboxane

Potent vasoconstrictor and platelet aggregation agent, causes pallor and promote clot formation

Shearing forces for pressure ulcer

Pressure that is exerted on the skin when it adheres to the bed, the skin layers slides in one direction of the body movement.

Chemical mediators of inflammation

Prostaglandins (PG), Thromboxane, Leukotrienes

The local response to inflammation (Manifestion)

Redness, heat, pain, swelling, and loss of function

Major functions of chemical mediators of inflammation

Responsible for the complement system of phagocytosis, increase vascular permeability, and chemotaxis, and cellular lysis

Maturation phase of primary intention

Scar contraction occurs and overlaps with the granulation phase. Collagen fibers are organized and remodeling occur. Fibroblast disappears the movement of myofibroblast causes contraction and bring skin edges close.

Leukotrienes

Slow acting anaphylaxis (SRS-A), they constrict smooth muscles of bronchi and narrow the airway. Resulting in increase capillary permeability and edema

Example of primary intention

Surgical incision or paper cut

Primary intention healing

Takes place when wound margins are neatly approximated. Undergo 2 phases (initial, granulation, and maturation)

Protein function in wound healing

They correct negative nitrogen balance resulting from increase metabolic rate, synthesis of immune factors, leukocyte, fibroblast, and collagen

What healing intention does pressure ulcers call under?

They heal by secondary intention

Fat function in wound healing

To synthesize fatty acids and triglycerides

Examples of secondary intention

Ulcers

Vascular response to inflammation

Vasodilation causing hyperemia (increase blood flow) and increased capillary permeability. This causes redness, heat, and swelling at the site of injury

Hyperbaric O2 therapy

accelerates granulation tissue formation and wound healing

Risk factors for pressure ulcers

advanced age, anemia, contractures, diabetes, elevated body temperature, immobility, impaired circulation, incontinence, low diastolic blood pressure, mental deterioration, neurologic disorders, obesity, pain, prolonged surgery, vascular diseases,

sanguineous drainage

bloody drainage

Stage 1 pressure ulcer

intact skin with nonblanchable redness

serous drainage

clear, watery plasma

Repair

common type of healing and has to do with scar formation. Repair can be done via primary, secondary, and tertiary intention.

Goals for pressure ulcers

have no deterioration reduce and eliminate factors do not develop infection have healing no reoccurences

Initial phase of primary intention

incision edges are aligned, blood clots form & release platelets that release growth factor to start healinfg(3-5 days)

Stage 2 pressure ulcer

partial thickness skin loss involving epidermis, dermis, or both -no slough or bruising

platelet derived growth factor

stimulates blood vessel healing by promoting cell proliferation and migration eg. Becaplermin (regranex) gel

Regeneration

the replacement of lost cells and tissues with cells of the same type

purulent drainage

thick green, yellow, or brown drainage

serosanguineous drainage

thin, watery drainage that is blood-tinged