WEEK 5 - post-procedural wound assessment and management

Question 1

What are standard precautions?

Answer 1

prevents microorganisms on hands, surfaces, equipment

• hand hygiene
• ppe
• gloves
• goggles
• masks
• disposable equipment

Question 2

What are platelets?

Answer 2

small, colourless cell fragments in our blood that form clots and prevent bleeding.

Question 3

What are neutrophils?

Answer 3

a type of white blood cell (leukocytes) that act as your immune system’s first line of defence.

Question 4

What are cytokines?

Answer 4

small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells.

Question 5

What are enzymes?

Answer 5

proteins that help speed up metabolism, or the chemical reactions in our bodies.

Question 6

What are fibroblasts?

Answer 6

a type of cell that contributes to the formation of connective tissue.

Question 7

What is the cell matrix?

Answer 7

dynamic gel in the cytoplasm of the cell.

Question 8

What is collagen?

Answer 8

main structural protein in skin/connective tissues.

Question 9

what is actin?

Answer 9

cellular protein found especially in actin/microfilaments and active in muscular contraction, cellular movement, maintenance of cell shape.

Question 10

What is anaemia?

Answer 10

condition; lack enough healthy red blood cells to carry adequate oxygen to body tissues; tired and weak.

Question 11

What is sepsis?

Answer 11

life threatening organ dysfunction caused by a person’s impaired immune or metabolic response to an infection, anywhere in the body.

Question 12

What is dehiscence?

Answer 12

the partial or complete separation of the wound edges and the layers below the skin.

Question 13

What is granulation?

Answer 13

the wound is progressing from the inflammatory phase of healing to the proliferative phase of healing. Pink in colour, an indication of healing.

Question 14

What is evisceration?

Answer 14

when the person’s viscera protrude through the disrupted wound.

Question 15

What is necrotic tissue?
Eschar
Slough

Answer 15

dead cells in wound (should be removed to allow new tissues to form and cover wound bed)

eschar (dry, thick, leathery tissue that is often tan, brown or black)

slough (yellow, tan, green or brown in colour and may be moist, loose and stringy in appearance).

Question 16

3 types of healing + descriptions:

Answer 16

Primary healing

• Clean wound – no infection
• +- sutured
• Minimal disruption to basement membrane

Secondary healing

• Needs to remain open for an extended period
• Extensive loss of tissue
• Increased infection risk – longer for granulation to fill deficit

Tertiary healing

• Loss of tissue
• Required to remain open for observation
• Possibility of primary closure at a later stage

Question 17

What are the 4 stages of the healing process?

Answer 17

1. Haemostasis (-burns)
2. Inflammatory phase
3. Proliferative phase
4. Remodelling phase

Question 18

THE HEALING PROCESS: HAEMOSTASIS (3pts)

Answer 18

• Initiates smooth muscle contraction of vessels to halt the bleeding.
  Clotting causes platelets to go to the wound.
• Tissues become hypoxic and acidic causing vasodilation.

Question 19

THE HEALING PROCESS: INFLAMMATORY PHASE (4pts)

Answer 19

• Body recognises an injury (not necessarily when an infection is present).
• Neutrophils attracted from the release of cytokines and enzymes.
• Neutrophils remove foreign materials, pathogens and any damaged tissue through phagocytosis.
• Apoptosis, which is programmed cell death, or appear as slough.

Question 20

THE HEALING PROCESS: PROLIFERATIVE PHASE (4pts)

Answer 20

• Fibroblasts ingrate to form a matrix.
• Enable collagen and actin into bundles.
• The intracellular matrix is the foundation of wound repair.
• Angiogenesis occurs where new blood vessels occur across wound.

(Wounds do not have blood supply in its centre, relies on viable tissue at edges of wound – they perfuse the area and little capillaries sprout out into the wound).

Question 21

THE HEALING PROCESS: REMODELLING PHASE (2pts)

Answer 21

• Development of epithelium and scar formation.

- Blood vessels in scar areas die off and collagen returns to normal (not as strong as original collagen matrix).

Question 22

Local vs systemic factors for wound healing:

Answer 22

Local factors
o Position of wound?
o Dehiscence risk or wound infection?

Systemic factors
o Consider increasing age, malnutrition/nutritional deficiencies; smoking, obesity; immune disorders; stress; anaemia; immobility; shock

Question 23

TIMERS

Answer 23

T – tissue is it deficient or non-viable (not capable of living, growing, developing, or functioning successfully)

I – infection or inflammation

M – moisture imbalance

E – edge of wound: is it undermined or non-advancing

R – repair of tissue and regeneration

S – social factors: including patient’s knowledge, language, mental health, living conditions

Question 24

HOPE

Answer 24

o Heat – large amount of exudate/discharge
o Oedema
o Pain
o Erythema

Question 25

HOPE

Answer 25

o Heat – large amount of exudate/discharge o Oedema o Pain o Erythema

Question 26

To heal a wound must have:

Answer 26

o Cellular replication o Supporting matrix o Foreign/damaged material elimination

Question 27

Conditions that may affect wound healing:

Answer 27

o Cardiovascular and reparatory failure – systemic o Peripheral vascular disease – regional o Poor angiogenesis in the wound – locally (formation of blood vessels)

Question 28

LAYERS OF THE SKIN: EPIDERMIS

Answer 28

o Epidermis: outer sheet of dead cells called stratum corneum + basal layer - deeper level of rapidly dividing cells (basal layer cells rise to replace stratum corneum cells following injury/scrapes – initial barrier to invading foreign substances)

Question 29

LAYERS OF THE SKIN: DERMIS

Answer 29

o Dermis: made of dense connective tissue, sensory receptors embedded inside (e.g., thermos, Meissner’s corpuscles are sensitive to touch, free nerve endings that detect pain + tissue damage), sweat glands, hair follicles, blood vessels