Wound Helaing & Management

Question 1

What are the phases of wound healing?

Answer 1

Haemostasis

Inflammation

Repair

Maturation

Question 2

What is involved in the haemostasis stage?

Answer 2

Initial bleeding flushes the wound

Vasoconstriction reduced blood flow

Question 3

What forms in the haemostasis stage?

Answer 3

-platelet plug forms which is triggered by damage to the blood vessel wall

-formation of fibrin plug and Escher (scab)

Question 4

What is involved in the inflammation stage?

Answer 4

Vasodilation (increased blood flow) and inflammatory response

Wound exudates (pus) - fluid, dead neutrophils and tissue debris

T-lymphocytes are released

Question 5

What enters the wound in the inflammation stage?

Answer 5

Neutrophils
Monocytes
Macrophages

-phagocytose bacteria and debris

Question 6

What is involved in the repair stage?

Answer 6

Escher sloughs

Epithelialisation occurs, new epidermal cells are formed at wound edges
(May take weeks to months to fully stratify)

Question 7

How long does it take for epithelialisation to occur in different wounds?

Answer 7

Immediately in partial thickness wounds

Several days later in full thickness wounds

Question 8

What develops in the repair stage?

Answer 8

Granulation tissue and connective tissue develops from the fibrin plug

New capillaries develop

Collagen forms

Question 9

What happens during wound contraction during the repair stage?

Answer 9

Are of the wound reduces

Surrounding skin stretches

Question 10

What is involved in the maturation stage?

Answer 10

Wound edges meet and epithelialisation is completed

Redness reduces

Remodelling and reorganisation of connective tissue

Question 11

What % does wound strength reach at the maturation stage?

Answer 11

70-80% of normal tissue

Question 12

What are factors that promote wound healing?

Answer 12

-Moist wound environment
-Nutrition
-Tissue oxygenation
-Limited movement of wound edges
-Clean wound
-Good immune system

Question 13

What are factors that delay wound healing?

Answer 13

-Excessively dry or exudating wound
-Poor circulation
-Lack of essential nutrients
-Lack of oxygen delivery and waste removal from tissues
-Patient interference
-Infection

Question 14

What can cause wounds?

Answer 14

Bites
Branches
Glass
Matting
Urine scalding
Burns
Metal or barbed wires

Question 15

What is a puncture wound?

Answer 15

Open wound

Deep narrow wound caused by a sharp pointed instrument

Question 16

What can cause a puncture wound?

Answer 16

Nails
Stakes
Thorns
Claws
Canine teeth

Question 17

What is an incised wound?

Answer 17

Open wound

Clean, sliced wound

They bleed freely and are often deep

Question 18

What causes an incised wound?

Answer 18

A sharp implement

Question 19

What is an abrasion wound?

Answer 19

Open wound

Dragging or friction injury causing removal of skin surface (graze)

Question 20

What is a lacerated wound?

Answer 20

Tear wound in the tissues with rough edges

Question 21

What causes laceration wounds?

Answer 21

Barbered wire
Dog teeth
Cat claws
Sharp objects

Question 22

What is a degloving wound?

Answer 22

Open wound

The top layers of skin and tissue is torn away from the underlying muscle, connective tissue or bone

Question 23

What causes a degloving wound?

Answer 23

RTA
Fighting
Falls

Question 24

What is a contusion wound?

Answer 24

Closed wound

Blunt blow or impact that has caused the capillaries below the skin to rupture

Associated with fractures

Question 25

What is a haematoma wound?

Answer 25

Closed wound Damage to the veins and arteries under the skin surface causing pooling of blood

Question 26

What causes haematoma wounds?

Answer 26

Allergies Ear infections These can lead to excessive shaking or scratching

Question 27

What are crush injury wounds?

Answer 27

Closed wound Excessive force or pressure is put on a body part causing injury under the skin to organs/skeletal framework

Question 28

What is involved in a wound assessment?

Answer 28

Asses the whole patient initially Stabilise the patient if required The time since the injury Contamination status Any concurrent diseases or medication

Question 29

What are the wound contamination statuses?

Answer 29

Clean Clean-contaminated Contaminated Dirty

Question 30

What is included in wound preparation?

Answer 30

-swabbing for culture and sensitivity -keep covered with sterile dressing -ensure analgesia is adequate -GA is usually required

Question 31

How is the wound cleaned?

Answer 31

Insert water soluble jelly into the wound Clip the area around the wound Debridement

Question 32

How should lavage be carried out?

Answer 32

-wear gloves and use towel to prevent cross contamination -requires pressure -produced by a syringe through needle -should be carried out initially and at every dressing change

Question 33

What are techniques of wound closure?

Answer 33

Sutures Staples Reconstruction Surgical drains

Question 34

When should wounds not be reconstructed?

Answer 34

Not appropriate for contaminated wounds

Question 35

How should open wound management be assessed?

Answer 35

Tissue Infection and inflammation Moisture Epithelialisation

Question 36

Why should open wounds receive lavage?

Answer 36

To rehydrate necrotic tissue and remove debris and bacteria

Question 37

Why are open wounds debrided?

Answer 37

To create a viable tissue edge

Question 38

Why are dressings applied to open wounds?

Answer 38

To create an optimum environment for effective healing

Question 39

What factors are included in choosing an appropriate dressing?

Answer 39

Effective wound assessment Location of the wound Consideration of costs Knowledge of stages of healing

Question 40

When is a hydrogel dressing used?

Answer 40

For burns or infected wounds

Question 41

When is a cloth dressing used?

Answer 41

Minor injuries such as grazes or cuts

Question 42

What are the 2 types of absorbent dressings?

Answer 42

Alleyvin - foam dressing, absorbs exudates from wound surface Melolin - low adhering absorbent dressing used in exudating wounds

Question 43

What is laser therapy?

Answer 43

The use of a low level laser waves to enhance wound healing and reduce or prevent infection

Question 44

What are the benefits of laser therapy?

Answer 44

Increased blood flow Increased oxygenation Decreased inflammation Decreased pain

Question 45

What is a vacuum assisted closure?

Answer 45

The use of negative pressure to encourage epithelialisation and contraction of the wound through the use of a vacuum pump sealed within a plastic dressing

Question 46

What are the 3 most common wound problems?

Answer 46

Devitalised tissue Exudating wounds Infection

Question 47

How does devitalised tissue create wound problems?

Answer 47

Provides an optimum condition for growth of bacteria Reduced the viability of the wound bed Requires debridement

Question 48

How does exudating wounds affect healing?

Answer 48

Normal part of inflammatory process Excess, prolonged, infected or fresh bleeding is abnormal

Question 49

What is maceration damage to wounds?

Answer 49

Prolonged contact with moisture causing it to become soggy

Question 50

What is excoriation damage to wounds?

Answer 50

Contact with toxins from wound causing damage to top layers of skin

Question 51

How does infection develop in wounds?

Answer 51

Contamination Colonisation Critical colonisation Infection

Question 52

What are signs of infection in wounds?

Answer 52

Erythema Pain Oedema Localised heat

Question 53

What does infection cause to delay healing?

Answer 53

It damages and allows for deterioration of the wound to occur

Question 54

How is infection prevented in wounds?

Answer 54

Must check wound is properly debrided and cleaned Antimicrobial dressings