Document is a presentation on wounds

1. WOUNDS

2. Introduction
•The skin which is the body’s largest organ
and is the primary defense against infection
commonly suffers from wounds.
•Wounds result from injurious processes
beginning either internally or externally to
the involved organs.

3. General objective
•At the end of the lecture, students should
gain knowledge on wounds.

4. Specific objectives
At the end of the lecture, students should be
able to
Define wounds
•State the causes of wounds
•State the classification of wounds
•Explain the type of wounds

5. Specific objective contin……
•Explain the management of wounds.
•Explain the process of wound healing.
•Explain the types of wound healing.
•Explain factors that affect wound healing.
•State the complications of wounds.

6. Definition
•A wound is a break in the continuity of the
skin (Nurse’s dictionary, 1994).
•
•A break in the structure of an organ or tissue
caused by an external agent (Medical
dictionary, 2006)

7. Causes of wounds
•Surgical- caused by incision or excision
•Traumatic- caused by mechanical, chemical,
electrical, thermal, or nuclear sources.
•Chronic- caused by an underlying pathologic
condition (e.g. pressure ulcers)

8. Types of wounds
•Abrasion - skin scraped off,
bleeding is limited
•Incision – cut with sharp object such
as knife, scissors, razor blade,
•If cut is deep, bleeding can be
heavy, also can have damage to
muscles and nerves.

9. Types contin……
•Puncture –Caused by sharp object (pin,
nail, bullet, spear etc.)
• It can be deep or narrow
•It can be dangerous because it may lead
to damage to internal organs
•External bleeding can be minimal, may
lead to infection.

10. Types contin…..
•Laceration – tearing of tissues from
excessive force from blunt object, it has
jagged edges and bleeding may be
heavy.
•Deep lacerations may become infected

11. Types contin…….
•Contusion- this is a bruised, skin is not
torn but hematoma is produced
(collection of blood under the skin).
•Usually caused by blunt objects
•Amputation – Body part cut off or
separated from the body, bleeding can
be extensive, important to preserve
separated part for reattachment.

12. Classification
•Clean contaminated: a wound involving
normal but colonized tissue
•Contaminated: a wound containing foreign or
infected material
Infected: a wound with pus present.
•Trauma Wounds
caused by either a mechanical or a chemical
injury resulting in tissue damage

13. Classification contin……
•Chronic Wounds
•Fail to heal in an orderly and timely
manner. The chronic wound environment
is different to the acute wound
environment. The clinical signs of chronic
wounds may include:
•Non viable wound tissue (slough and/or
necrosis)

14. •Lack of healthy granulation tissue
(wound tissue may be pale, greyish
and avascular)
•No reduction in wound size over
time
•Recurrent wound breakdown

15. Classification contin……
• Burns
•Injuries to tissues caused by heat, friction,
electricity, radiation, or chemicals.
•Burns may be caused by even a brief
encounter with heat greater than
•120°F (49°C).
•The source of this heat may be the sun , hot
liquids, steam, fire, electricity, friction, and
chemicals .

16. Classification contin…..
•Pressure Injuries
•A localised injury to the skin and/or
underlying tissue usually over a bony
prominence, as a result of pressure
and/or friction, or a combination of
these factors.

17. Classification contin…..
•Infected Wounds
•Invasion of wound tissue by and
multiplication of pathogenic
microorganisms, which may produce
subsequent tissue injury and progress to
overt disease through a variety of
cellular or toxic mechanisms.

18. Wound management
•Principles of wound management
•Assessment.
•Haemostasis.
•Analgesia.
•Skin preparation and wound toilet.

19. •Closure.
•Dressing.
•Infection prevention.
•Follow-up.

20. Wound healing process
•Phase 1 - INFLAMMATORY /REACTIVE
PHASE (0-4 Days) the body's normal
response to injury. This phase activates
vasodilatation leading to increased blood
flow causing HEAT, REDNESS, PAIN,
SWELLING, LOSS OF FUNCTION (e.g. arm
swells and cannot bend). Wound ooze
may be present and this is also a normal
body response.

21. •The severed tissue is quickly glued
together by strands of fibrin and a thin
layer of clotted blood forming a scab.
•This seal helps to prevent fluid loss and
bacteria invasion.

22. Wound healing process cont…..
•Phase 2 - PROLIFERATIVE
PHASE/REGENERATIVE (4-14 Days) the time
when the wound is healing.
•The body makes new blood vessels, which
cover the surface of the wound.

23. •This phase includes reconstruction and
epithelialisation.
•While reepithelization takes place,
collagen synthesis and wound
contraction are occurring. The wound
will become smaller as it heals.

24. Wound healing process contin….
•Phase 3 –REMODELING/ MATURATION
PHASE (14-365 Days) Remodelling begins
approximately 2-4 weeks depending on the
size of the wound.
•This the final phase of healing, when scar
tissue is formed. It may last 1 year or longer.
•The wound at this stage is still at risk and
should be protected where possible.

25. Types of wound healing
•Primary Intention; Healing through primary
intension occurs when wounds are created
aseptically with minimum of tissue
destruction and postoperative tissue
reaction. The edges of the wounds are
approximated with steri strips, glue, sutures
and/or staples. Minimal loss of tissue and
scarring results.

26. Wound healing contin…
•Delayed Primary Intention; is defined as
the surgical closure of a wound 3 -5 days
after the thorough cleansing or
debridement of the wound bed.
• Used for
•1. Traumatic wounds,
• 2. Contaminated surgical wounds.

27. Wound healing contin….
•Secondary intention; occurs slowly by
granulation, contraction and re-
epithelialisation and results in scar
formation. It is common in Pressure Injuries
and Leg ulcers
•Skin Graft can be done.This is the removal of
partial or full thickness segment of epidermis
and dermis from its blood supply and
transplanting it to another site to speed up
healing and reduce the risk of infection.

28. Wound healing contin…
•Delayed primary closure or third intension
•The healing process occurs when
approximation of wound edges is
intentionally delayed by 3 or more days after
injury or surgery.

29. Factors that influence wound healing
•Malnutrition- inadequate supply of
protein, carbohydrates, fatty acids, and
trace elements essential for all phases
of wound healing
•.
•Chemotherapy - suppresses the
immune system and inflammatory
response Radiotherapy - increases
production of free radical which damage

30. •Psychological stress and lack of sleep- increase risk
of infection and delayed healing
•Medication - Non-steroidal anti-inflammatory drugs
and Corticosteroids.
• Reduced Blood supply - Cardiovascular disorders
and Ischemia

31. Factors contin…..
•Obesity - decreases tissue perfusion
•Infection -prolong inflammatory phase, use
vital nutrients, impair epithelialisation and
release toxin
•Underlying Disease - Diabetes Mellitus
•Age. Healing is delayed in old age due to
immune suppression

32. Complications
•Keloids
•Wound rapture
•Malignant changes

33. SUMMARY
•A wound is a break in the continiuty of the
skin.It maybe caused by trauma,surgical
incision,chronic condition etc.some wounds
can be puncture wounds,lacerations.Wounds
can be managed by assessing the patient,see
extent of damage.

34. Summary contin….
•Give analgesics, arrest haemorrhage,change
dressing. complications of wounds maybe
keloid formation,contractures,infection.

35. Assignment
•Identify 5 problems a patient with
wounds can have and mange them
using a nursing care plan

36. References
• Martin. E.A, (2006), Oxford concise Medical
Dictionary, Manzar Khan Oxford University Press, New
Delhi
• Loeb.S et al, (1993), Diseases, Springhouse
Corporation, Springhouse, Pennsylvania
• Shirley E. Otto. (2001). Oncology Nursing, 4th Ed.
Mosby Co. St Louis

37. Reference continu……
• Phillips, W.J. et al. (2005). Medical Surgical Nursing, Mosby
Co. ST Louis
• Polaski A.L and Tatro E.S. (1996), Luckmann’s core
principles and practice of Medical- Surgical Nursing, W.B.
Saunders company, Division of Harcourt Brace and company
, Philadelphia
• Weller B.F. and Wells R.J. (1990), Bailliere’s Nurse’s
Dictionary, 21st Edition, ELBS with Bailliere Tindall, London.