Wound Healing (ATI)

intrinsic factors that affect wound healing

1. age: epidermis thins, making it more prone to injury 2. increased risk of chronic illness as people age contributes to slower wound healing 3. immunosupressed patients and patients with reduced skin sensation are also prone to injury and poor wound healing

remodeling phase

completes the wound healing process and often takes several years. Beginning and overlapping with the proliferation phase, remodeling works to form and lyse collagen within a scar to help increase strength and skin integrity. It is during this phase that the initial 15%-strength scar eventually regains 80% of the skin's original strength. During the remodeling phase, scar tissue changes in appearance. In light-skinned individuals, the scar's color changes from pink or red to a white color as vascular changes occur. The diminished need for additional worker cells to repair the site reduces the need for additional vascular support. Scar tissue also becomes more flexible as it ages.

Alginate dressings

composed of calcium, calcium or sodium salts, or seaweed within a gel dressing. Alginates provide a moist environment for healing and good absorption of exudate, establish hemostasis, and do not adhere to the wound. They are helpful in treating wounds with large amounts of exudate including ulcers, donor sites, tunneling wounds, and some bleeding wounds

dry dressings

composed of some form of gauze pad that is secured to the wound by rolled gauze and tape or as a self-adherent bandage with a gauze center. Dry dressings are simple, inexpensive, and widely available and are an appropriate dressing choice for numerous types of wounds. They generally work well for wounds with small amounts of exudate, but they can stick to the wound bed of heavily exudative wounds or expose the wound to the outside environment.

Wound cleansing

involves a liquid solution (often normal saline solution) to help rid the wound area of necrotic tissue, exudate, blood, or debris. Cleansing methods include passive irrigation, mechanical irrigation, and pressurized irrigation. Make sure to assess patient's pain level before, during and after wound cleansing and place pad under wound to collect drainage

passive irrigation

involves a solution and gravity. The solution is introduced in a top-to-bottom fashion to allow it to flow by gravity along the full length of the wound to the absorbent pad beneath the patient. This allows micro-organisms, tissues, and any unwanted materials to run down and away from the wound gradually for better overall wound cleansing. Top-to-bottom irrigation can sometimes eliminate the need for mechanical cleansing with a gauze pad.

Stage 4 Pressure Ulcer

involves full-thickness tissue loss with exposed bone, muscle, the possibility of tunneling, and sometimes eschar (black scab-like material) or slough (tan, yellow, or green scab-like material).

Stage 3 Pressure Ulcer

involves full-thickness tissue loss without exposed muscle or bone.

Stage 2 Pressure Ulcer

involves partial-thickness skin loss with a visible ulcer

extrinsic factors that affect wound healing

medications- such as aspirin that inhibit platelet clotting and corticosteroids that suppress the immune system and cancer treatments inadequate nutrition stress

Stage 1 Pressure Ulcer

non-blanchable redness caused by pressure or shear typically over a bony prominence.

epithelialization phase

provides temporary protection at the site of injury to keep outside organisms from entering and causing infection. Keratinocytes make up the basic cell structure of the layers of the dermis and the epidermis (along with other internal structures). In response to injury and acute inflammation, inflammatory cytokines are released to activate a proliferation cycle. Epithelialization typically begins at the wound's edges and gradually moves upward to form a fully covered surface.

chronic wounds

wounds with prolonged healing time and heal through secondary intention a process during which the wound edges do not come together; instead the wound heals by the formation of granulation tissue, wound contraction, and epithelialization. Chronic wounds go through the same healing stages as acute wounds do, but the phases are delayed

Foam dressings

additional foam padding to protect wound fields. These foam dressings are absorptive and provide a moist healing environment while protecting wounds that resulted from pressure, friction, or shear. These dressings are used widely for early-stage pressure ulcers.

Hydrogel dressings

autolytic debridement, or promoting the body's own natural functions of removing necrotic tissue. Hydrogel dressings work by maintaining a moist wound environment. This dressing type is used for wounds with necrosis, infection, moderate amounts of exudate, and a need for a moist healing environment. Do not use hydrogel dressings to treat dry gangrene or dry ischemic wounds.

inflammatory phase

begins once the skin (and sometimes underlying tissues) is injured and continues for about 24 hours. The major characteristics of the inflammatory phase are skin color changes, heat, swelling, pain, and loss of function.

What is the most commonly used scale for presssure ulcer risk?

Braden: This scale incorporates six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Scores range from 6 to 23, with a cutoff score of 18 for most adults. The lower the score, the greater the risk for pressure ulcer formation.

pressurized cleansing

Some wounds require pressurized solutions for adequate cleansing coverage. Most wound solutions delivered at a minimum of 8 psi via a syringe or a catheter can achieve this.

Wet-to-dry dressings

eet-to-dry dressings have been used extensively for wounds requiring debridement. While many providers now use more sophisticated dressings or negative-pressure wound therapy (NPWT), also known by a common brand name Vacuum Assisted Closure (V.A.C), wet-to-dry dressings are still in use in many facilities. To create this type of dressing, place a saline-soaked gauze or cotton sponge within a wound with exudate or drainage. As the dressing dries, it pulls exudate out of the wound. The disadvantages of wet-to-dry dressings are that they are nonselective with debridement; therefore, they take healthy as well as necrotic tissue with them. Wet-to-dry dressings may appear inexpensive initially because of the materials used, but the labor and frequency of dressing changes makes them fairly costly

Hyrdofiber dressings

hydrofiber dressings do not affect hemostasis. Hydrofiber dressings are composed of the polymer carboxymethylcellulose, a substance that can absorb exudate vertically. These dressings are manufactured in sheets to place in wounds that have considerable exudate. The sheet materials swell on contact with exudate, thus absorbing the unwanted material

Chemical impregnated dressings

impregnated with chemicals or agents intended to speed up the healing process. Examples are povidone-iodine (Betadine), silver, petroleum, collagen, and antibiotics.

three phases of wound healing

inflammatory, epithelialization, proliferative

proliferative phase

restores skin integrity by filling in the wound with new tissue. New blood vessels form within the wound by extending from the wound's edges; this is called angiogenesis. The fragile and highly permeable capillaries that form first allow easy passage of fluid, often leading to some swelling. Once this capillary system is created, it completes a matrix that covers the entire wound bed. The result is granulation tissue, bright red tissue that is a sign of wound healing but is also prone to bleeding with any trauma. Fibroblasts work to restore connective tissue to the wound bed. The matrix is referred to the scaffolding on which a scar is formed and skin integrity is restored. Once the matrix is formed, collagen begins to be deposited a rough scar is also formed during this phase

visual assessment of a wound should include...

shape, size, depth, colors, exudate, bleeding, any tissue that impairs healing (necrosis, erythematous or infected tissue, tunneling, edema), and any tissue that helps with healing (granulating tissue, clean wound edges). Temperature changes range from very warm (typical with infection) to very cold (vascular compromise). Textural changes include roughened or raised wounds or deep wounds that interrupt the natural contour of the skin. Odors, a very important component of wound assessment, can help you detect specific infectious organisms or suggest the cause of the wound.

Final Stage Pressure Ulcer

the "unstageable" variety of ulcers whose stage cannot be determined because eschar or slough obscures the wound.

Transparent film dressings

thin layer of plastic that covers the wound area. This dressing type provides no absorption but does create a barrier to the environment. Transparent dressings do allow some oxygen exchange to reduce anaerobic bacteria growth and a wet environment to promote healing. Transparent film dressings are commonly used for wounds with dry eschar or for superficial skin tears but are not recommended for infected wounds.

mechanical cleansing

use of gauze and a cleansing solution to clean contaminated wound areas. Excessive scrubbing of a wound can be painful, however, and can also remove healing tissue. Mechanical cleansing with sterile instruments is called debridement and is generally effective. Biologic debridement, another effective method, involves the use of larvae or maggots to help remove necrotic tissue.

physical assessment of a wound should include...

visually perceived changes, temp and texture changes and odor