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Wound Assessment
Is VITAL elements of care given to the patient Is ESSENTIAL in order to deliver optimum care. No single dressing is going to be suitable for the management of a wound from the time of injury until the time of healing.
Protection Excretion
Synthesis of Vitamin D Thermo-regulatory control
Definition of wound
Wound is defined as an injury to the skin and underlying tissue caused by trauma (accident) or fracture or violence (stabbing)
wound products
Proliferation of wound products
• More then 5000 wound products in the market
Ideal dressing
According to Morrison 1992
• Non‐adherent • Impermeable to bacteria • Capable of maintaining a high humidity at the wound site • Removing excess exudate • Thermally insulating • Non‐toxic and non‐allergenic
Anatomy of the skin
Sensation
Sensitive to touch, pain, pressure, heat & cold Mechanical damage, bacterial invasion, dehydration, UV radiation and chemical substance Excretes water, salts and other organic components UV light + compound = Vit D (D = Dihydroxycalciferol) Perspiration, changes of blood flow (vasoconstrict & vasodilate)
Why moist wound healing?
Wound exudate
- Serves as transport medium enzymes, growth factors and hormones. - Allows the different cells to communicate with each other to ensure that the healing process proceed in a co-ordinated manner - Provides ideal conditions for different cells in the immune system to destroy invading pathogens – bacteria, foreign bodies and necrotic tissues. Thereby diminishing the infection rate. In summary: - Prevents the formation of scab - Allows epithelial cells to spread horizontally outwards through a thin layer of wound exudate to rapidly close the wound
Hydrocolloids
• Components of gelatin, peptinor cellulose • Occlusive, waterproof • Partial thickness wounds with low-moderate exudate • Contraindicated for clinical infected wounds • Conformable • Adhesive, may damage fragile peri-wound skin
Goals of wound therapy
• • • • Cleanse debris from the wound Promotion of wound healing. Absorb excess exudate Promote granulation and epithelialization when appropriate Minimize discomfort Prevent complications or deterioration of an existing wound Prevent additional skin breakdown Minimize harmful effects of the wound on the patient’s overall condition If possible treat wound infections Possible debridement
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Reference:
Wound healing
• Traditional wound care - standard plasters or gauze compresses is to cover and protect the wound, to absorb excess wound exudate and to keep the wound dry. • Essential feature of dry healing is that all repair and regenerative processes take place under a protective scab - this firm crust of coagulated blood is the body`s own wound cover protecting the wound
THEN…
Wound care never an Entity on its Own Nurses had little or no role, recognition or reward and seldom did research, in wound care
NOW…
• Arena for nurses’ expertise through education and specialisation • Nurses have gained autonomy through research and evidence base practices
against external influences.
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Why moist wound healing?
The idea of moist healing was born in 1962 when George D. Winter discovered that epithelisation would proceed twice as fast in a moist environment than under a scab.
Management of Wounds
OBJECTIVES
• Review the structure of the skin. • Define ‘a wound’
• Demonstrate the ability to make a wound assessment.
• Demonstrate the ability to select an appropriate wound dressing product.
Why moist wound healing?
Do not dry out the wound
The best environment for the natural wound healing process to work is a warm, moist and non toxic Drying out the wound will cause all the healing process to stop.
Hydrogels - Hydroactive gel
• Hydrophillic • High water content, viscosity varies by manufacturer • Limited absorptive capacity • Autolytic debridement of necrotic / slough tissues • Partial or full thickness wounds • Conformable • No residue in wounds
Type of dressings - Films
• • • • • • Polyurethane or co-polyester composition Waterproof and gas permeable Superficial wounds with no / minimal exudate Permits wound evaluation Can tear healthy skin if improperly removed Occlusion may reduce pain