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