Wound Assessment and Care Flashcards
(28 cards)
haemostasis
blood vessels constrict to stop bleeding, forming clots
proliferation
wound is rebuilt with connective tissue to promote granulation and repair wound
remodelling
epithelial tissue forms in a moist healing environment
acute wound
occurs suddenly and progresses through healing stages as expected
chronic wound
wound that fails to progress or progresses slowly through healing stages
surgical wound
wound secondary to surgical intervention
epithelial tissue
appears pink or pearly white
wrinkles when touched
final stages of healing when wound is covered by healthy epithelium
granulating tissue
appears red and moist
occurs when healthy tissue is formed in remodelling phase
well vascularised
bleeds easily
slough tissue
appears yellow, brown or grey
devitalised tissue made of dead cells or debris
necrotic tissue
appears hard, dry and black
dead tissue preventing wound healing
hyper granulating tissue
appears red, uneven or granular
occurs in proliferative phase when tissue is overgrown
viable tissue
granulating
epithelial
non-viable tissue
necrotic
slough
colonisation
microorganisms multiply without provoking a host response
local infections
invasion by an agent that may cause injuries
treatment for local infections
topical antimicrobial
spreading and systemic infections
microorganisms spread from wound to vascular or lymphatic systems impairing healing
treatment for spreading and systemic infections
topical microbials and antibiotics to prevent sepsis
serous
appears yellow/clear
typical in inflammatory phase
thin and watery drainage
haemoserous
appears clear/yellow with pink tinge
typical in inflammatory and proliferative phase
sanguineous
common exudate blood
associated with hyper granulation
purulent
containing pus
milky/thick in consistency
grey, green or yellow
indicates infection
haemopurulent
blood and pus
often due to established infection
advancing edges
edges are pink
healing is taking place
