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Wound Healing:
Homeostasis
- immediately post injury
- vessels contrict
- clotting begins- scab
- permeability: plasma and blood leak out to form exudate
- Exudate fills wound, spreads it open
- Swelling = pain
- platelets attract others to site
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Wound Healing:
Inflammatory
- lasts 4-6 days
- WBC mosve to wound
- Leukocytes: ingest bacteria, collect debri
- Macrophages: ingest debri, release growth factors to heal
- Fibroblasts: fill wound
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Wound Healing:
Proliferation (Regeneration, Connective, Fibroblast)
- Fibroblasts build new tissue
- Granulation tissue fills the wound
- wound covered by meshwork of skin cells that grow over the tissue
- Builds a wound bed (beneath gran. tissue)
- Fibrogen builds a bridge (granulation)
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Maturation
- collagen continues deposition
- scar is formed
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Pressure
disrupts bloodflow to wound area
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Desiccation
- cells dehydrate
- dryp up
- crust over
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Maceration
- overhydration
- impaired skin integrity
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Trauma
- repeated wound
- unable to heal
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Edema
inadequate oxygen and nutrients
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Infection
bacteria increases stress on body
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Necrosis
dead tissue that delays healing
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Pressure Ulcer
- wound of localized area of tissue necrosis
- Risk Factors: immobility, nutrition/hydration status, moisture, mental status, age
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Stage I Pressure Ulcer
- observable alterations
- first indication is blanching
- termperature-consistency sensation
- persistent redness
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Stage II Pressure Ulcer
- Partial Thickness
- Epidermis/Dermis
- superficial abrasion, blister, shallow crater
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Stage III Pressure Ulcer
- Full Thickness
- Damage/Necrosis of SubQ tissue
- may extend down also
- deep crater w/out undermining of adjacent tissue
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Stage IV Presure Ulcer
- Full Thickness
- Extensive Destruction
- damage to muscle, tissue, bone, structures
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Wound Appearance
- location: nearest bony prominence
- size: mm/cm
- approximation of edges
- dehescence/evisceration
- color and around
- foreign objects
- Red: protect
- Yellow: cleanse
- Black: debride
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Wound Drainage
- Exudate: drainage
- Serous: clear, watery
- Sanguineous: looks like blood
- Serosanguineous: mixture of serum and RBC
- Purulent: WBC, liquified dead debri, bacteria
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Wound Sutures/Staples
- Skin Sutures: hold tissue/skin together
- Retension Sutures: obese or risk for dehisence
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Hot/Cold Treament
- increase temp or lengthening time can cause serious damage
- Heat: max vasodilation @ 20-30 min
- Cold: max vasoconstrictor @ 15*C
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Epidermis
top layer of skin
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Dermis
second layer of skin
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Exudate
- plasma and blood leakage into wound site
- swelling and pain
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Eschar
- necrotic thick, leathery scab
- must be removed to determine stage
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Granulation tissue
- new tissue formed by fibroblasts
- foundation for scar tissue
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Scar
avascular collagen tissue
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Dehiscence
partial/total separatoin of wound layers due to excessive stress on wounds not healed
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Evisceration
- most serious complication
- wound completely separates
- protrusion of viscera through the incisional area
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Fistula
abnormal passage from an internal organ to the ouside of the body, or from one internal organ to another
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Shearing Force
one layer of skin slide over another
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Ischemia
- local anemia resulting from poor circulation
- rapidly followd by hyperemia
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Macerated
softening or disintegration of skin in response to moisture
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Dressing
protective covering placed over a wound
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