The Skin

Question 1

Describe the mechanism of wound heeling (1)

Answer 1

1) Haemostasis- within minutes, vasoconstriction (reduced blood flow from damaged vessels)

Question 2

Describe the mechanisms of wound heeling (2)

Answer 2

2) Inflammation: fist few hrs, becomes inflamed, blood clot (mainly fibrin) and cell debris fill the gap, phagocytes migrate into blood clot. They begin to remove clot and debris, stimulating fibroblast activity. Fibroblast secrete collagen fibres, which bind wound margins together

Question 3

Describe the mechanisms of wound heeling (3)

Answer 3

3) Proliferation: epithelial cells proliferate across the wound, through the clot. The epidermis meets and grows upwards until full thickness is restored. The clot above the tissue becomes the scab which separates after 3-10 days. Granulation tissue, consisting of new capillary beds, phagocytes and fibroblasts, develops invading the clot restoring blood supply.

Question 4

Describe the mechanisms of wound heeling (4)

Answer 4

4) Maturation: the granulation tissue is gradually replaced by fibrous scar tissue. Rearrangement of collage fibres occurs and strength of increases. Scar fades and becomes less vascular.

Question 5

2) consider the assessment of skin integrity in clinical practice

Answer 5

Observe: colour, mottling, dry, loose, bruises, burns, flakiness, self-hygiene ect
Touch: clammy, sweaty, moist, sensitive, exaggerate sensation, dry, capillary refill > 2 secs
Positioning: ability to re-position, pain on movement
Clothing: loose, restrictive, soiled
Current medications: creams, steroids, allergies
Skin conditions: chronic, acute, infections
Malnutrition: this should be assessed alongside SSKIN bundle
Skin map: document and if necessary photograph wounds and repeat a full skin assessment weekly

Question 6

3) identify the management of pressure areas

Answer 6

Moisture lesions and the use of barrier creams
Pressure relieving devices, including mattresses, cushions, sheepskins, overlays ect
Skin message/drubbing, positioning and repositioning
National interventions (including hydration) as preventive strategies for people with and without nutritional deficiency
Patient and carer education, including self assessment education and training for healthcare professionals
Assessment and grading of pressure ulcers
Management including: debridement and larval therapy
Native pressure wound therapy and hyperbaric oxygen therapy