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Wounds & dressings: Nursing (Differences between acute, chronic and…
Wounds & dressings: Nursing
Differences between acute, chronic and malignant wounds
acute
: usually heal within 6 weeks
chronic
: take longer than 3 months WOUNDS can broken down further into surgical/ non-surgical
Phases of wound healing (defensive, proliferative & maturation)
defensive
: begins at time of injury and last 3-6 days - haemostatsis and inflammation occurs
proliferative
: begins from day 2-3 for approx - 2-3 weeks - granulation tiss. prod. and wound closure
maturation
- begins from around day 21 and may last years - collagen remodelling occurs to increase strength
Primary, secondary & tertiary intention healing.
primary
: tissue surfaces are closed and there is minimal tissue loss. wound edges are easily opposed
secondary
:extensive wound and considerable tissue loss. wound heals through process of granulation
tertiary
: wounds left open for 3-5 days. primary intention closure is then attempted.
Local and systemic factors that may adversely affect wound healing
LOCAL
- Pressure - desiccation - maceration - trauma - oedema - infection - foreign bodies - necrosis - dead space
SYSTEMIC
- age - oxygenation and circulation - nutritional status - medication and general health - glucose control - immunosuppresion - smoking - connective tissue disorders - obesity
Types of wound exudate including causes
Exudate due to movement of fluid and cells from vascular space into the wound : occurs during defensive phase
serous
: composed primarily of serum and is watery in appearance and has low protein count and is yellow in colour
purulent
thick, tenacious, and is yellow/green in colour and contains dead pathogens and cells debris.
haemorrhagic
has a large component of RBC and is usually bright red in colour
T.I.M.E
tissue
-necrosis - eschar - slough - granulation
infection & inflammation
- INFECTION: - increased pain - delayed healing - purulent discharge - green appearance - malodorous INFLAMMATON: - pain surrounding wound - erythema - hot on palpation - peri-wound breakdown
moisture
DRY WOUNDS: - scab - delayed healing - wound contraction MOIST WOUNDS: - optimal environment - minimal scarring WET WOUNDS: -altered fluid balance - maceration of skin - damage to tissues
edge of wound
DESICCATION: excessive dryness MACERATION: excessive moisture UNDERMINING: rolling of wound edges
Importance of moist wound healing and dressing products that promote this environment
moist wound healing
- decreased dehydration and cell death - increased angiogenesis - increased re-epithelialisation - enhanced autolytic debridement of wound - decreased pain - improved cosmesis
Difference between ileostomy, colostomy and urostomy
interstitial stomas
GIT: a stoma is an opening onto abdominal wall to allow evacuation of faecal material: (colostomy - ileostomy )-stomas can be permanent / temporary depending on the reason the bowel was diverted RENAL: ureters are resected from the bladder and anastomosed to a resected part of the ileum (-illeal conduit/urostomy)
Colostomy/Ileostoy indications
- bowel obstruction - trauma - ischaemic bowel - perforated bowel - infection - inflammatory bowel disease
illeal conduit
- bladder cancer requiring a cystectomy - traumatic bladder injury - incontinence - neurogenic bladder threatening kidney function
Care of stoma including changing an appliance
Ostomy pouch/appliance is preffered term (-1 or 2 piece applic. - drainable/closed - disposable/reusable - stoma+wound nurses - outreach service)
one piece ostomy appliance
- common for patients with a colostomy - patient needs to cut the wafer to size of stoma - various sizes avail. including discrete options - pt receives a mthly supply. and can order more if requ.
two piece ostomy appliance
- common for patients with ileostomy - wafer needs to be cut to size of stoma - need to be emptied when 1/3 full to prevent slippage of pouch - patient receives a montly supply can order more if requi.
Common stomal complications
leaking and cellulitis : common in early post-operative period 2. food bolus blockage (ileostomy) 3. inactive stoma: manage as a a suspected bowel obstruction 4. mucocutaneous separation 5. necrosis: serious and potentially life caused by venous or arterial insufficiency 6. proplapse: - when stoma is replaced - caused by obesity and inadequate bowel fixation 7. stoma retraction: usual cause tension on intestines or obesity 8. altered body image: changes of styles of cothing - embarrassment -